Obesity and Metabolic Syndrome Among Adult Survivors of Childhood Leukemia

Abstract

Opinion statement Treatment-related obesity and the metabolic syndrome in adult survivors of childhood acute lymphoblastic leukemia (ALL) are risk factors for cardiovascular disease. Both conditions often begin during therapy. Preventive measures, including dietary counseling and tailored exercise should be initiated early in the course of survivorship, with referral to specialists to optimize success. However, among adults who develop obesity or the metabolic syndrome and who do not respond to lifestyle therapy, medical intervention may be indicated to manage underlying pathology, such as growth hormone deficiency, or to mitigate risk factors of cardiovascular disease. Because no specific clinical trials have been done in this population to treat metabolic syndrome or its components, clinicians who follow adult survivors of childhood ALL should use the existing American Heart Association/National Heart Lung and Blood Institute Scientific Statement to guide their approach.

DNA methylation and obesity in survivors of pediatric acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study

“…18,19,24 This is consistent with one report indicating the association between genetic variation in the leptin receptor (LEPR) gene and obesity was specific to those who received CRT. 24 Another potential underlying pathology in those exposed to CRT is growth hormone deficiency, 29 Notably, among the survivors who received chemotherapy only, the direction of associations for the 39 replicated BMI-DNA methylation loci were consistent with previous assessments. [20][21][22][23] The strongest association was observed for the ELOVL3 locus.…”

Late outcomes of adult survivors of childhood non‐Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort Study

“…26 Among survivors of other hematologic malignancies, the prevalence ranges from 6% to 34%, strongly associated with cranial and abdominal radiation. [27][28][29] Meacham and colleagues previously observed no difference in the prevalence of obesity between survivors and siblings (20.6% vs. 20.8%…”

Preventive Cardio-Oncology: The Time Has Come

“…For example, chemotherapy can affect the vasculature and lead to initial diagnosis of, or aggravation of pre-existing, hypertension (12,39). Radiation to the abdomen, brain, or whole body can affect the endocrine system resulting in abnormalities with hypothalamus-pituitary, thyroid, or pancreatic function (36,40,41), as well as hypertension, hyperlipidemia, and elevated waist circumference and levels of free fatty acids (40). Surgery to the brain can potentially also affect endocrine function, but appears to have very limited effect on cardiovascular risk, if any at all (42).…”