Obesity in Pediatric ALL Survivors: A Meta-Analysis

Abstract

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

Associating Physical Activity Levels with Motor Performance and Physical Function in Childhood Survivors of Acute Lymphoblastic Leukemia

“…41 The current study also identified that higher BMI was associated with reduced physical function; this finding was consistent with those of previous studies in children with 5,19 and without a cancer diagnosis. BMI has been identified as a key predictor of 6MWD in children without 42 a cancer diagnosis, potentially because of higher energetic cost with greater mass, attitude toward PA, altered movement patterns, and pain.…”

“…However, consistent with previous literature, poorer 6MWT performance was associated with higher BMI weight status. These findings have important clinical implications because pediatric 41 and adult 50 childhood ALL survivors are reported to be at higher risk of developing obesity and the health conditions associated with obesity, such as cardiovascular disease. 51 The study results emphasize the importance of the role of health care providers in weight management among childhood ALL survivors and the potential need for physiotherapy interventions focusing on physical function as children complete treatment.…”

“…BMI has been identified as a key predictor of 6MWD in children without 42 a cancer diagnosis, potentially because of higher energetic cost with greater mass, attitude toward PA, altered movement patterns, and pain. 43 Although it is difficult to conclude that there is a causal relationship because children who complete treatment for ALL have an increased risk for weight gain and obesity, 41 this pattern of elevated BMI accompanying reduced physical function indicates the need for regular follow-up for physical function assessment and weight management in pediatric oncology. 19,44 Our study has several limitations.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

“…The prevalence of obesity in patients with craniopharyngioma was reported at 55% despite the adequate replacement of all pituitary hormone deficiencies (183). Obesity also affects a substantial proportion of ALL survivors with a prevalence of 34-46% at 10 years of follow-up (184). Although cranial irradiation represents a significant risk factor of obesity and diabetes mellitus in ALL survivors (185), those treated with chemotherapy alone continue to experience high rates of persistent obesity and overweight after many years of follow-up, likely because of their prolonged exposure to high-dose glucocorticoids (186).…”

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

“…Two meta-analyses suggested that obesity was more common in childhood acute lymphoblastic leukemia (ALL) survivors within 5 y of treatment (BMI z score: 0.89), but obesity diminished 5-9 y post-treatment (BMI z score: 0.64) compared with their healthy peers (4,5). Results are inconclusive for those ≥10 y post-treatment, although overweight prevalence (34-46%) in these long-term ALL survivors seemed to be similar to that in noncancer comparison groups (4). Risk factors for overweight in the general population are sedentary lifestyle, low (≤2.5 kg) and high (>4 kg) birth weights (6,7), and overweight during early childhood (8).…”