Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia.

Abstract

9552 Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity, insulin resistance and increased visceral adiposity. A history of cranial radiation therapy (CRT) worsens this risk. In non-cancer populations, adherence to a Mediterranean Diet has been shown to improve metabolic parameters and risk of diabetes mellitus. Whether diet may contribute to insulin resistance and increased adiposity in ALL survivors is not known. Methods: We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Fasting blood was obtained on all subjects and insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral adiposity was measured by abdominal CT. Adherence to a Mediterranean Diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using univariate analysis. Results: Subjects were majority female (56%); 25% were minority or Hispanic white. A history of CRT was present in 15 (29%) men and 25 (38%) women. Among all subjects, greater adherence to a Mediterranean diet pattern was associated with improved HOMA-IR (p=0.14), visceral adiposity (p=0.03), subcutaneous adiposity (p=0.005), waist circumference (p=0.02), and body mass index (p=0.03) (all unadjusted analyses). The effect of adherence to a Mediterranean diet on insulin resistance was especially notable in men who did not receive CRT (p=0.06). Higher dairy intake was found to worsen HOMA-IR (p=0.014), but other individual components of the Mediterranean diet, such as low intake of meat and high intake of fruits and vegetables, were not significant. Inclusion of PAEE did not alter our findings, although higher PAEE was associated with lower body mass index. Conclusions: Adherence to a Mediterranean diet pattern, especially low consumption of dairy products, may improve insulin resistance in survivors of childhood ALL. Further study is warranted.

Comparison of childhood cancer survivors' nutritional intake with US dietary guidelines

“…We found a mean HEI‐2010 of 52.7 in 22 CCS, similar to the mean HEI‐2005 score of 55.5 in a previous study of 91 CCS (mean age = 19 years), which assessed adherence to the 2005 DGA . Prior studies, although used different indices and assessment methods to capture nutritional intake, have consistently reported poor diet quality in CCS . The mean diet quality score was either less than half or only slightly above half of the maximum score , ranging from 33% to 56%.…”

“…Prior studies, although used different indices and assessment methods to capture nutritional intake, have consistently reported poor diet quality in CCS . The mean diet quality score was either less than half or only slightly above half of the maximum score , ranging from 33% to 56%.…”

“…Nevertheless, the nutritional intake in CCS has not been adequately examined, in particular among young CCS (i.e., children, adolescents, and young adults) who experience a similar risk for chronic health conditions as their middle‐age siblings . Existing studies provide some evidence suggesting a poor adherence of survivors' diet to the current dietary guidelines . Few studies, however, have assessed dietary intake of a broad category of micronutrients and minerals.…”

Factors influencing risk‐based care of the childhood cancer survivor in the 21st century

“…As observed in the general population, engaging in risky or suboptimal health behaviors has implications for the overall health of survivors. For instance, survivors with better diet quality have lower adiposity, waist circumference, and body mass index; whereas those with poor diet have an excess risk of conditions associated with the metabolic syndrome . Similarly, compared with inactive survivors, those with higher rates of physical activity are more likely to have lower fat mass, abdominal visceral fat, and waist circumferences .…”

Integrative Medicine in Childhood Cancer

“…The authors observed that females, adolescence and young adults, and survivors of tumors of the central nervous system or lymphoma may be at higher risk of following poor dietary patterns than other groups of survivors. Tonorezos et al reported that with greater adherence to the Mediterranean diet, the odds of developing metabolic syndrome fell by 31% (odds ratio 0.69; 95% CI 0.50-0.94; p = 0.019), 27 lending preliminary support for the role of dietary behaviors for the prevention of late effects of childhood cancer. Other cross-sectional surveys have reported positive associations between adherence to dietary recommendations and a higher frequency of physical activity, suggesting that healthy dietary behaviors may also promote the adoption of other healthy lifestyle behaviors.…”