Early Lifestyle Intervention for Obesity Prevention in Pediatric Survivors of Acute Lymphoblastic Leukemia

Abstract

Patients with pediatric acute lymphoblastic leukemia (ALL) experience rapid weight gain during treatment and increases in weight are maintained throughout treatment and beyond. Without prompt interventions, altered dietary and physical activity behaviors may become difficult to reverse, contributing to obesity risk long-term. Fifteen children, aged 3–9 years, diagnosed with pediatric ALL who were on maintenance therapy or within two years of treatment completion (mean BMI percentile: 70.4th) and one parent from each family, were enrolled into a 12-week lifestyle intervention delivered remotely through web-based sessions and phone calls with a lifestyle coach. Outcomes were assessed at baseline and end of the intervention. Thirteen of the 15 enrolled families (86.7%) completed the intervention. Parents reduced the “pressure to eat” feeding practice (change in mean score: −0.60, 95% CI: −1.12 to −0.07; p-value = 0.03) post intervention. Children increased the consumption of milk (0.54 serving/d, 0.02 to 1.07; p-value = 0.04) and percent of calories from protein (2.54%, 0.22 to 4.87%; p-value = 0.04) and reduced the consumption of potatoes (−0.16 serving/d, -0.30 to −0.03; p-value = 0.02). No significant changes were observed for children’s levels of physical activity, BMI, or waist circumference. Results from this pilot support the feasibility and preliminary efficacy of early lifestyle intervention among pediatric ALL survivors.

Behavioural interventions targeting physical activity and diet behaviours in pediatric oncology: A Scoping Review

“…The age of the participants ranged from three to 34 years old. Four studies targeted adolescents and/or young adults (11-34 years old) [21][22][23][24], seven included children and adolescents (4-20 years old) [25][26][27][28][29][30][31] and three were designed for the caregivers of younger children (3-13 years old) [32][33][34]. No studies included families of children younger than 3 years of age.…”

“…Most studies included cancer patients with mixed diagnoses groups, except for four studies that included specifically patients with acute lymphoblastic leukemia [27,29,32,34] and one that included only children with leukemia and brain tumours [31]. Moreover, the majority of studies had few inclusion criteria, with the exception of two studies that were designed specifically for CCS with obesity, defined as a body mass index (BMI) [?]…”

“…Eight studies targeted the cancer patients or survivors [21-24, 26, 28, 30, 31], five were family-oriented [25,27,29,32,34] and one was designed for parents [33].…”

“…Participants in nine studies were survivors [21-24, 26, 28, 29, 31, 33], whereas the remaining five studies recruited children undergoing treatment [25,27,30,32,34].…”

“…More than half of the studies focused on one specific health behaviour, whereas the others addressed multiple health behaviours. Furthermore, studies evaluated a combination of modalities including educational interventions (n=11) [21-24, 26, 28-30, 32-34], individualized or group PA interventions (n=6) [21,25,27,[30][31][32], counselling (n=5), psychosocial support or training (n=6) [22,23,25,27,33,34], reward system (i.e. healthy goods and services) (n=2) [24,31] and adventure-based activities (n=1) [26].…”