A cross‐sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL)

Love, Erin; Schneiderman, Jane E.; Stephens, Derek; Lee, Sylvia; Barron, Mary; Tsangaris, Elena; Urbach, Stacey; Staneland, Patricia; Greenberg, Mark; Nathan, Paul C.

doi:10.1002/pbc.23010

Cited by 41 publications

(45 citation statements)

References 47 publications

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“…10,11,14,34,47,51,60 However, the other 15 studies did not find evidence of a gender difference. [6][7][8]12,15,28,31,33,36,38,47,[52][53][54]62 FIGURE 2…”

Section: Obesity In Pediatric All Survivors By Patient and Treatment mentioning

confidence: 64%

“…Four studies reported that being overweight/obese or having a high BMI z score at diagnosis was associated with a high prevalence of obesity. 10,30,51,52 However, 1 study found a low BMI z score at diagnosis predicted obesity after treatment completion. 36 …”

Section: Age At Diagnosismentioning

confidence: 88%

“…The prevalence of overweight/obesity ranged between 29% to 69% in 14 studies that Age at study and year since Dx are the mean or median as reported or estimated based on the reported age at diagnosis and duration of follow-up (the mean duration of treatment was estimated to be 2.5 y if not indicated by the study). evaluated pediatric ALL survivors off treatment 5 to 9 years (mean/median age = 13.2-19.4 years) [8][9][10]24,33,[51][52][53][54][55][56][57][58] except for 1 early study published in 1986 59 that reported a prevalence of obesity of 8% ( Table 2). The prevalence of overweight/obesity was fairly consistent in 5 studies that evaluated pediatric ALL survivors off treatment $10 years (mean/median age = 20.5-24.1 years), ranging from 34% to 46% 7,14,40,60,61 (Table 3).…”

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

“…6 Although different definitions were used to assess obesity, there was a consistently high prevalence of overweight/obesity in both recent and long-term survivors. The prevalence of overweight/obese survivors exceeded 40% in 11 studies that included pediatric ALL survivors off treatment ,5 years (mean/median age = 7.3-15.2 years) 27,28,32,34,[49][50][51] (Table 1). The prevalence of overweight/obesity ranged between 29% to 69% in 14 studies that Age at study and year since Dx are the mean or median as reported or estimated based on the reported age at diagnosis and duration of follow-up (the mean duration of treatment was estimated to be 2.5 y if not indicated by the study).…”

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

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Obesity in Pediatric ALL Survivors: A Meta-Analysis

et al. 2014

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Obesity in Pediatric ALL Survivors: A Meta-Analysis abstract BACKGROUND AND OBJECTIVE: Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis. METHODS:A MEDLINE search was performed from its inception through 2013. Studies met the inclusion criteria if they (1) included at least 10 survivors of pediatric ALL; (2) assessed the prevalence or indicators of obesity; and (3) compared obesity among ALL survivors to a reference population or external control group. Extracted data included patient and treatment characteristics, study design, population used for comparison, and prevalence of obesity. RESULTS:Forty-seven studies met the inclusion criteria. Despite significant heterogeneity among the studies (I 2 = 96%), the mean BMI z score in 1742 pediatric ALL survivors was 0.83 (95% confidence interval: 0.60-1.06), which corresponds to the 80th BMI percentile, indicating a significantly higher BMI in pediatric ALL survivors than the reference population. Subgroup analyses found a high prevalence of obesity in ALL survivors regardless of survivors' receipt of cranial irradiation, gender, or age at diagnosis. CONCLUSIONS:Obesity is prevalent in pediatric ALL survivors and is independent of patient-and treatment-related characteristics. Clinicians need to screen for obesity and its associated health conditions early in survivorship. Pediatrics 2014;133:e704-e715

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“…10,11,14,34,47,51,60 However, the other 15 studies did not find evidence of a gender difference. [6][7][8]12,15,28,31,33,36,38,47,[52][53][54]62 FIGURE 2…”

Section: Obesity In Pediatric All Survivors By Patient and Treatment mentioning

confidence: 64%

Section: Age At Diagnosismentioning

confidence: 88%

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

See 2 more Smart Citations

Obesity in Pediatric ALL Survivors: A Meta-Analysis

et al. 2014

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“…Research on overweight prevalence has involved mostly ALL survivors (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), whereas study of risk factors has led to inconsistent conclusions (4). Studies conducted in the United States reflect the lifestyles and eating habits of CSSs in that country (10-13, 16, 17, 19-22), whereas the duration of follow-up in other studies has been only short to medium term (4,5), and many have had small (<250 participants) sample sizes (4,11,(13)(14)(15)(17)(18)(19). With this background of research in mind, we analyzed data from the Swiss Childhood Cancer Survivor Study (SCCSS) to 1) assess overweight prevalence in CCSs overall and for specific, different diagnoses; 2) compare overweight prevalence in CCSs with that in their siblings and the Swiss general population; and 3) identify sociodemographic and clinical risk factors for excessive weight.…”

Section: Introductionmentioning

confidence: 99%

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

Belle

Weiß

Schindler

et al. 2018

The American Journal of Clinical Nutrition

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Background: An increased risk of becoming overweight has been reported for childhood cancer survivors (CCSs), in particular leukemia survivors, although the evidence is inconclusive. Objective: We assessed the prevalence of overweight in CCSs, with a focus on leukemia survivors, compared it with their peers, and determined potential risk factors. Design: As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire between 2007 and 2013 to all Swiss resident CCSs aged <21 y at diagnosis who had survived ≥5 y. We calculated body mass index (BMI) from medical records at diagnosis and self-reported heights and weights at survey. We calculated BMI z scores by using Swiss references for children and compared overweight prevalence in CCSs, their siblings, and the general population with the use of the Swiss Health Survey (SHS) and assessed risk factors for being overweight by using multivariable logistic regression. Results: The study included 2365 CCSs, 819 siblings, and 9591 SHS participants. At survey, at an average of 15 y after diagnosis, the prevalence of overweight in CCSs overall (26%) and in leukemia survivors (26%) was similar to that in siblings (22%) and the general population (25%). Risk factors for being overweight in CCSs were male sex (OR: 1.8; 95% CI: 1.5, 2.1), both young (OR for ages 5-14 y: 1.6; 95% CI: 1.2, 2.3) and older (range-OR for ages 25-29 y: 1.7; 95% CI: 1.2, 2.4; OR for ages 40-45 y: 4.0; 95% CI: 2.5, 6.5) age at study, lower education (OR: 1.4; 95% CI: 1.1, 1.8), migration background (OR: 1.3; 95% CI: 1.1, 1.7), and no sports participation (OR: 1.4; 95% CI: 1.1, 1.7). Risk factors for overweight were similar in peers. CCSs treated with cranial radiotherapy (≥20 Gy) were more likely to be overweight than their peers (OR: 1.6; 95% CI: 1.2, 2.2). Conclusions:The prevalence of and risk factors for being overweight are similar in long-term CCSs and their peers. This suggests that prevention methods can be the same as in the general population. An important exception is CCSs treated with cranial radiotherapy ≥20 Gy who may need extra attention during follow-up care. This study was registered at clinicaltrials.gov as NCT03297034. Am J Clin Nutr 2018;107:3-11.

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Validity of anthropometric measurements for characterizing obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study

Karlage

Wilson

Zhang

et al. 2015

Cancer

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Background Childhood cancer survivors (CCS) are at risk for obesity. The purpose of this project was to determine which clinical measures of body composition are most accurate among CCS when compared to dual energy x-ray absorptiometry (DXA). Methods We evaluated agreement between body mass index (BMI), skinfolds percent body fat, and waist to height ratio (WHtR), with DXA among 1361 CCS (mean age 32.4±7.7), ≥10 years from diagnosis. We calculated sensitivity and specificity of BMI, skinfolds, and WHtR obesity classifications compared to DXA. Log-binomial regression, stratified by sex, was used to evaluate treatment-related factors for misclassification as non-obese by BMI, skinfolds, and WHtR. Results Mean body fat values for skinfolds were 23.3±7.7% (males) and 32.3±8.1% (females), and for DXA, 26.9±7.4% (males) and 38.4±7.7% (females). Pearson correlations between skinfolds and DXA were high: R=0.83 males, R=0.84 female. Skinfolds incorrectly classified 34.5% of obese males and 27.3% of obese females. BMI measures were the least sensitive with false negative rates of 46.4% (males) and 53.1% (females). Males exposed to abdominal/pelvic radiation were at increased risk for misclassification as non-obese by BMI (RR 1.57; 95% CI 1.25–1.95). The percentages classified as obese were highest when using DXA (63.1%, males; 84.8%, females) and lowest when using BMI (35.7%, males; 39.7%, females). Although skinfolds and WHtR underestimated the percentage classified as obese compared to DXA, the differences were not as large. Conclusion Findings suggest that skinfolds and WHtR are better than BMI for obesity classification in CCS. Clinicians should be aware of the high risk of misclassifying obese CCS as non-obese.

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A cross‐sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL)

Cited by 41 publications

References 47 publications

Obesity in Pediatric ALL Survivors: A Meta-Analysis

Obesity in Pediatric ALL Survivors: A Meta-Analysis

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

Validity of anthropometric measurements for characterizing obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study

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