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

Abstract

Background/Aims: It has been reported that children treated for acute lymphoblastic leukemia (ALL) in developed countries show an increased risk of overweight and obesity in adolescence and adulthood. However, the majority of patients who came to our observation in Brazil have low or normal body weight and only one of them was obese. Therefore, we have decided to assess some biochemical parameters possibly related to the intermediate metabolism and body composition in these patients. Methods: Two groups of subjects were studied: 27 survivors of childhood ALL (14.0 ± 4.2 years old; post-treatment interval 8.6 ± 3.9 years) (ALL group) and 17 healthy subjects (12.8 ± 4 years old) (control group) selected on the basis of their kinship with the patients. Results: 14/27 patients of the ALL group and 4/17 of the control group had leptin levels higher than the normal range for age and sex (p < 0.05). The leptin level was significantly higher in the ALL group (15.5 ± 1.8 ng/ml) than in the control group (10.7 ± 2 ng/ml) (p < 0.05). When adjusted by sex, BMI z-score, and age, the level of leptin in patients of the ALL group was 8.5 higher than in subjects of the control group (p = 0.006). Leptin/insulin correlation in the ALL group was 0.08 and in the control group it was +0.585 (p < 0.05). Conclusion: The data indicate the presence of alterations in the homeostatic regulatory mechanisms controlling body weight in Brazilian patients treated for ALL in childhood, still, it did not lead to obesity in the absence of favorable environmental conditions.

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.…”

“…Four studies 8,29,33,38 reported separate BMI z scores for survivors treated with and without CRT, 3 studies 34,35,39 included exclusively survivors treated with CRT, and 7 studies 12,13,24,26,27,32,37 included exclusively survivors treated without CRT. On the basis of these 14 studies, the BMI z score for the 478 survivors treated with CRT was 0.9 (95% CI: 0.5-1.3), and the BMI z score for the 830 survivors treated without CRT was 0.7 (95% CI: 0.4-0.9; Fig 3).…”

Relationship between insulin and hypogonadism in men with metabolic syndrome

“…Insulin is also involved in the pathophysiology of obesity following lesions to the hypothalamus-pituitary region (41). It has been suggested that obese patients with insulin resistance have a diminished sensitivity to insulin action in the hypothalamus-pituitary-gonadal axis due to the production of cytokines and hormones by the adipose tissue (29).…”

“…Similarly, other authors have found no correlation between insulin sensitivity and basal, GnRH-or clomiphene-stimulated LH secretion (29,30). Nevertheless, the concentrations and pulse amplitude of LH may be abnormal in morbid obesity patients (41)(42)(43).…”

Post-Therapy Profile of BMI-for-Age of Indian Survivors of Pediatric Acute Lymphoblastic Leukemia and Non-Hodgkin’s Lymphoma

“…CRT received at a young age may blunt hypothalamic leptin sensitivity and thereby alter the body's response to leptin and the regulation of body weight, metabolism, and reproductive function [3]. Two recent studies have reported about significantly higher leptin levels in survivors of ALL treated by CRT [4,5]. Hence, there may be a possibility of radiation-induced hypothalamic resistance to leptin.…”