Anthropometric parameters and their relationship to serum growth hormone-binding protein and leptin levels in children with acute lymphoblastic leukemia: a prospective study

Abstract

Objective: The aim of this study was to follow auxological parameters and their relationship to serum growth hormone-binding protein (GHBP) and leptin levels in children with acute lymphoblastic leukemia (ALL). Design and methods: In total, 26 prepubertal children with ALL were studied. We report these data at the time of the clinical diagnosis (n 26) and at 6 (n 21), 12 (n 21), 18 (n 21), 24 (n 20), 30 (n 16) and 36 months (n 16) after beginning treatment. Results: Serum GHBP levels decreased during the ®rst 18 months and returned to normal when therapy was withdrawn. Height SDS increased at 24 months after diagnosis. Weight and the upper arm circumference had increased 6 months after chemotherapy withdrawal, whereas tricipital and subscapular skinfolds had increased both at 6 months after diagnosis and 6 months after therapy had stopped. Therefore, the tendency to become overweight is both an early and a late side-effect of anti-leukemia therapy. A signi®cant positive correlation was found between serum leptin levels and every nutritional anthropometric parameter, with body mass index having the best relationship. However, serum GHBP levels were only correlated with BMI at the end of the study. No correlation was found between leptin and GHBP. Conclusions: In children with ALL, linear growth is compromised during the acute phase of their illness and therapy; this is probably secondary to a state of partial and transient GH insensitivity. These patients tend to become obese after therapy withdrawal, with leptin being an excellent nutritional marker.

Incidence of Obesity Does Not Appear to Be Increased after Treatment of Acute Lymphoblastic Leukemia in Brazilian Children: Role of Leptin, Insulin, and IGF-1

“…This observation is consistent with previous reports of high serum leptin levels in patients treated for ALL during childhood [1, 10, 12, 16, 30, 31]. …”

“…Obesity is considered a frequent complication in long-term acute lymphoblastic leukemia (ALL) survivors who show a tendency to gain body weight starting shortly after the end of the therapy [1,2,3]. This phenomenon might be associated with a significant earlier appearance of the so-called adiposity rebound [2].…”

“…On the contrary, chemotherapy alone produced obesity in only 10.5% of the treated patients. Nevertheless, no other author found any relationship between radiotherapy and obesity in ALL survivors [1, 8, 20]. Similarly, chemotherapy alone has been associated with obesity by some authors [1, 3, 6, 7, 21], but not by others [8, 11].…”

“…Nevertheless, no other author found any relationship between radiotherapy and obesity in ALL survivors [1, 8, 20]. Similarly, chemotherapy alone has been associated with obesity by some authors [1, 3, 6, 7, 21], but not by others [8, 11]. In studies in which a positive correlation was found, chemotherapy, mainly by glucocorticoids, was shown to decrease fat oxidation during fasting [21] and to produce a significant increase in weight gain immediately after the beginning of the therapy [15] and after the end of it [20, 22, 23].…”

“…However, obese patients have high plasma leptin levels suggesting that they have leptin resistance [27,28,29]. Similarly, leptin resistance is probably present in patients treated for ALL, since leptin levels are elevated and associated with obesity [1, 10, 12, 16, 30, 31]. Hyperinsulinemia and reduced insulin sensitivity have also been described to be associated with weight gain in ALL survivors [12, 26].…”