Obesity and metabolic syndrome in adolescent survivors of standard risk childhood acute lymphoblastic leukemia in Saudi Arabia

Aldhafiri, Fahad K.; Al-Nasser, Abdullah; Al-Sugair, Abdulaziz; Almutairi, Hanan; Young, David; Reilly, John J.

doi:10.1002/pbc.24012

Cited by 33 publications

(29 citation statements)

References 31 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of overweight/obesity ranged between 29% to 69% in 14 studies that Age at study and year since Dx are the mean or median as reported or estimated based on the reported age at diagnosis and duration of follow-up (the mean duration of treatment was estimated to be 2.5 y if not indicated by the study). evaluated pediatric ALL survivors off treatment 5 to 9 years (mean/median age = 13.2-19.4 years) [8][9][10]24,33,[51][52][53][54][55][56][57][58] except for 1 early study published in 1986 59 that reported a prevalence of obesity of 8% ( Table 2). The prevalence of overweight/obesity was fairly consistent in 5 studies that evaluated pediatric ALL survivors off treatment $10 years (mean/median age = 20.5-24.1 years), ranging from 34% to 46% 7,14,40,60,61 (Table 3).…”

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

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Obesity in Pediatric ALL Survivors: A Meta-Analysis

et al. 2014

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Obesity in Pediatric ALL Survivors: A Meta-Analysis abstract BACKGROUND AND OBJECTIVE: Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis. METHODS:A MEDLINE search was performed from its inception through 2013. Studies met the inclusion criteria if they (1) included at least 10 survivors of pediatric ALL; (2) assessed the prevalence or indicators of obesity; and (3) compared obesity among ALL survivors to a reference population or external control group. Extracted data included patient and treatment characteristics, study design, population used for comparison, and prevalence of obesity. RESULTS:Forty-seven studies met the inclusion criteria. Despite significant heterogeneity among the studies (I 2 = 96%), the mean BMI z score in 1742 pediatric ALL survivors was 0.83 (95% confidence interval: 0.60-1.06), which corresponds to the 80th BMI percentile, indicating a significantly higher BMI in pediatric ALL survivors than the reference population. Subgroup analyses found a high prevalence of obesity in ALL survivors regardless of survivors' receipt of cranial irradiation, gender, or age at diagnosis. CONCLUSIONS:Obesity is prevalent in pediatric ALL survivors and is independent of patient-and treatment-related characteristics. Clinicians need to screen for obesity and its associated health conditions early in survivorship. Pediatrics 2014;133:e704-e715

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Section: Discussionmentioning

confidence: 99%

Section: Prevalence Of Obesity In Pediatric All Survivorsmentioning

confidence: 99%

Obesity in Pediatric ALL Survivors: A Meta-Analysis

et al. 2014

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“…In healthy individuals, blood glucose concentrations are maintained within narrow physiological range by a state of balance between insulin production by specialized pancreatic b-cells and insulin-mediated glucose uptake in target tissues, which is further determined by the translocation of glucose transporters, of which GLUT-4 is the most abundant, to the cell surface (Kern et al 1990). Evidence that insulin resistance in classic insulin-target organs, together with the associated hyperglycemia and hyperinsulinemia (followed by hypoinsulinemia) are the pathological hallmark of metabolic disorders such as obesity and type 2 diabetes is compelling (Ricketts 1947, Berry & Helwig 1948, Ahmed et al 2012, Aldhafiri et al 2012). Several population-based studies revealed a decrease in cancer risk in diabetic patients assuming antidiabetic agents of the biguanide family such as metformin (Pezzino et al 1982, Suissa 2008, Kiri & Mackenzie 2009).…”

Section: Introductionmentioning

confidence: 99%

Insulin resistance and cancer: the role of insulin and IGFs

Djiogue¹,

Kamdje²,

Vecchio³

et al. 2012

Endocrine-Related Cancer

229

188

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Insulin, IGF1, and IGF2 are the most studied insulin-like peptides (ILPs). These are evolutionary conserved factors well known as key regulators of energy metabolism and growth, with crucial roles in insulin resistance-related metabolic disorders such as obesity, diseases like type 2 diabetes mellitus, as well as associated immune deregulations. A growing body of evidence suggests that insulin and IGF1 receptors mediate their effects on regulating cell proliferation, differentiation, apoptosis, glucose transport, and energy metabolism by signaling downstream through insulin receptor substrate molecules and thus play a pivotal role in cell fate determination. Despite the emerging evidence from epidemiological studies on the possible relationship between insulin resistance and cancer, our understanding on the cellular and molecular mechanisms that might account for this relationship remains incompletely understood. The involvement of IGFs in carcinogenesis is attributed to their role in linking high energy intake, increased cell proliferation, and suppression of apoptosis to cancer risks, which has been proposed as the key mechanism bridging insulin resistance and cancer. The present review summarizes and discusses evidence highlighting recent advances in our understanding on the role of ILPs as the link between insulin resistance and cancer and between immune deregulation and cancer in obesity, as well as those areas where there remains a paucity of data. It is anticipated that issues discussed in this paper will also recover new therapeutic targets that can assist in diagnostic screening and novel approaches to controlling tumor development.

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“…In this population, the prevalence of MetS is particularly high. [9][10][11] Previous studies have investigated MetS prevalence among childhood AL patients treated without HSCT, [12][13][14][15][16][17][18] although most of these studies had distinct limitations: (I) child or very young adult populations, (II) self-administered questionnaires, (III) single-center studies, (IV) small cohort size, or (V) retrospective design. Thus, the reported MetS prevalence among patients treated without HSCT is quite variable, with values ranging from 8.3% to 31.7%.…”

Section: Metabolic Syndrome In Long-term Survivors Of Childhood Acutementioning

confidence: 99%

Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: an L.E.A. study

et al. 2016

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C ardiovascular conditions are serious long-term complications of childhood acute leukemia. However, few studies have investigated the risk of metabolic syndrome, a known predictor of cardiovascular disease, in patients treated without hematopoietic stem cell transplantation. We describe the overall and age-specific prevalence, and the risk factors for metabolic syndrome and its components in the L.E.A. (Leucémie de l'Enfant et de l'Adolescent) French cohort of childhood acute leukemia survivors treated without hematopoietic stem cell transplantation. The study included 650 adult patients (mean age at evaluation: 24.2 years; mean follow-up after leukemia diagnosis: 16.0 years). The prevalence of metabolic syndrome was 6.9% (95% CI 5.1-9.2). The age-specific cumulative prevalence at 20, 25, 30 and 35 years of age was 1.3%, 6.1%, 10.8% and 22.4%, respectively. The prevalence of decreased high-density lipoprotein cholesterol, increased triglycerides, increased fasting glucose, increased blood pressure and increased abdominal circumference was 26.8%, 11.7%, 5.8%, 36.7% and 16.7%, respectively. Risk factors significantly associated with metabolic syndrome in the multivariate analysis were male sex (OR 2.64; 95% CI 1.32-5.29), age at last evaluation (OR 1.10; 95% CI 1.04-1.17) and body mass index at diagnosis (OR 1.15; 95% CI 1.01-1.32). The cumulative steroid dose was not a significant risk factor. Irradiated and non-irradiated patients exhibited different patterns of metabolic abnormalities, with more frequent abdominal obesity in irradiated patients and more frequent hypertension in non-irradiated patients. Survivors of childhood acute leukemia are at risk of metabolic syndrome, even when treated without hematopoietic stem cell transplantation or central nervous system irradiation. A preventive approach with regular screening for cardiovascular risk factors is recommended.

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Obesity and metabolic syndrome in adolescent survivors of standard risk childhood acute lymphoblastic leukemia in Saudi Arabia

Cited by 33 publications

References 31 publications

Obesity in Pediatric ALL Survivors: A Meta-Analysis

Obesity in Pediatric ALL Survivors: A Meta-Analysis

Insulin resistance and cancer: the role of insulin and IGFs

Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: an L.E.A. study

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