Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia

Abstract

Background Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000-2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. Results At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z-score at diagnosis was associated with increased z-score during maintenance (p<0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z-score increased over the first 22 months of maintenance (p<0.001). Patients with high risk disease had lower BMI z-scores regardless of cranial radiotherapy exposure (p<0.001). Pre-hypertension was prevalent over the course of therapy (31.1% with systolic pre-hypertension and 18.6% with diastolic pre-hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. Conclusions During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family-based diet and exercise intervention during maintenance therapy.

Obesity in Pediatric ALL Survivors: A Meta-Analysis

“…These survivors had completed treatment within 10 years at the time of study evaluation. 8,12,13,16,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Only 2 studies 14,40 examined BMI z score assessed $10 years after the completion of treatment (ie, off treatment $10 years). Because neither study reported SD/SE of the BMI z score, the meta-analysis did not include survivors who were off treatment beyond 10 years.…”

“…36 Ten studies explicitly reported the SD/SE of the BMI z score. For the remaining 10 studies, the SD was either calculated as a pooled SD based on subgroup values assuming equal variance (n = 5), 29,33,34,37,38 calculated from the 95% CI (n = 2), 16,27 estimated from median and range (n = 1), 39 obtained directly from study authors (n = 1), 30 or estimated based on the SD at diagnosis and SD for the change in BMI z score from diagnosis to study evaluation (n = 1). 36 To explore the association between patient and treatment characteristics and obesity, we performed subgroup meta-analyses separately by receipt of CRT, gender, and interval since treatment completion.…”

“…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 …”

Estado nutricional de crianças e adolescentes sobreviventes de leucemia linfoide aguda tratados em um Centro de Referência da Região Nordeste do Brasil

“…Resultados diferentes foram obtidos por outros autores 23,27 . 27 , em estudo de coorte retrospectivo realizado com 183 pacientes pediátricos com LLA, encontraram que a média de IMC aumentou durante a fase de indução da remissão da doença, com retorno para os valores normais logo após o término dessa fase.…”

“…27 , em estudo de coorte retrospectivo realizado com 183 pacientes pediátricos com LLA, encontraram que a média de IMC aumentou durante a fase de indução da remissão da doença, com retorno para os valores normais logo após o término dessa fase. Entretanto, houve novamente aumento do IMC nos primeiros 22 meses na fase de manutenção da terapia.…”