Patterns of obesity in boys and girls after treatment for acute lymphoblastic leukaemia.

Abstract

The frequency and pattern of obesity in survivors of acute lymphoblastic leukaemia (ALL) was examined in a retrospective analysis ofheight and weight at zero, two, and four years from diagnosis in 40 children (19 boys and 21 girls). The children had been treated according to the Medical Research Council protocols UKALL VIII and X, both ofwhich included cranial radiotherapy at a dose of 1800 cGy. Body mass index (BMI), determined as weight/height2, was used as a measure of fatness. The BMI Z scores were calculated for each patient from standard tables. The ALL group was compared with a control group of 18 age matched children who had received chemotherapy but no radiotherapy. Changes in BMI between diagnosis and two and four years later were analysed by paired t tests.Mean BMI Z scores at diagnosis were similar between ALL boys, ALL girls, and the control group. Two years after diagnosis the ALL group, particularly the girls, showed a significant increase in BMI. By four years BMI had decreased slightly in the ALL boys, but had increased still further in the ALL girls with 57% having BMI Z scores greater than 2. In the control group BMI increased, but not significantly, at two and four years.It is concluded that the obesity seen in patients treated for ALL is more pronounced in girls than boys, and that cranial irradiation is an important factor.

Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

“…The previous study is limited by lack of BMI data at diagnosis of the malignancy and by analysing BMI values of children without adjusting for sex and age. 38 Several studies have suggested that persons previously treated for ALL without BMT have increased BMI, [19][20][21][22][23][24] but recently we reported that they have BMI like local controls. 25 The use of old reference values in the previous studies, random variation, and, maybe, variation in the use and dose of cranial irradiation, probably explain why our BMI findings in untransplanted ALL survivors did not agree fully with those of others.…”

“…Consequently, BMI is a less valid measure of adiposity in survivors of childhood cancer than in the background population. The BMI [19][20][21][22][23][24][25] and the degree of fatness 25-27 after childhood ALL treated without BMT have been frequently reported, but only one group has reported the BMI after childhood BMT. 28 Whereas excess fatness and, sometimes, being overweight are problems in ALL survivors treated without BMT, childhood BMT survivors seem to suffer mainly from malnutrition and being underweight, at least during the first years following transplantation.…”

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.…”

“…Thirteen studies explicitly reported the mean BMI z score for the overall cohort. For the remaining 7 studies, the mean z score was calculated in the following ways: as a weighted average based on subgroup values (n = 5), 29,33,34,37,38 estimated based on median and range (n = 1), 39 or calculated based on the BMI z score at diagnosis and the change in BMI z score from diagnosis to study followup (n = 1). 36 Ten studies explicitly reported the SD/SE of the BMI z score.…”

Chronic Health Conditions in Childhood Cancer Survivors: Is it All Treatment-Related—or Do Genetics Play a Role?

“…Depending on the definition and methods used for measurement, the reported prevalence of obesity in survivors ranges from 11-40%. [39][40][41][42][43] Survivors of childhood ALL and central nervous system (CNS) tumors are at the highest risk, largely as a consequence of cranial radiation therapy (CRT). 39,[44][45][46] A report from a large cohort of childhood cancer survivors found that compared to siblings, adult survivors of childhood ALL who received CRT at a dose 20 Gy or greater had an up to three-fold increased risk of obesity.…”