Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia

Abstract

OBJECTIVE: To test whether excess weight gain in patients treated for childhood acute lymphoblastic leukaemia (ALL) was predictable using patient characteristics at diagnosis. DESIGN AND SUBJECTS: Longitudinal study of changes in body mass index (BMI) in all 98 patients treated in Scotland on treatment protocol MRC UKALL-XI who had reached at least 3 y post-diagnosis in ®rst remission. MEASUREMENTS: The in¯uence of the following variables on changes in BMI, expressed as a standard deviation score (SDS), was tested using variable selection techniques and classi®cation and regression trees: BMI SDS at diagnosis; age at diagnosis; gender; socioeconomic status; treatment. RESULTS: Prevalence of obesity (BMI SDSb2.0) was`2% at diagnosis, but increased to 16% at 3 y. Gain in BMI SDS was signi®cantly inversely in¯uenced by BMI SDS at diagnosis (P`0.01) and age at diagnosis (P`0.01). CONCLUSION: Obesity is common in ALL by the end of therapy, and is more likely in children who are younger and thinner at diagnosis. Excess weight gain was not readily predictable from routinely collected information available at diagnosis and so all children treated for ALL should be considered`at risk' of excess weight gain and the target of obesity prevention.

Obesity in Pediatric ALL Survivors: A Meta-Analysis

“…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. For the remaining 10 studies, the SD was either calculated as a pooled SD based on subgroup values assuming equal variance (n = 5), 29,33,34,37,38 calculated from the 95% CI (n = 2), 16,27 estimated from median and range (n = 1), 39 obtained directly from study authors (n = 1), 30 or estimated based on the SD at diagnosis and SD for the change in BMI z score from diagnosis to study evaluation (n = 1).…”

“…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.…”

“…First, we performed the analysis after excluding 7 studies 29,33,34,[36][37][38][39] for which the mean BMI z score or its SD was not explicitly reported or could not be calculated based on subgroup values (for mean BMI z score) or 95% CIs (for SD of BMI z score). We also repeated the analysis after excluding 7 longitudinal studies that did not report sample size of survivors at the follow-up evaluation, 8,12,29,33,34,36,38,42 for which we substituted it with the sample size reported at cancer diagnosis assuming loss to follow-up was random. In addition, we performed a "leave-one-out meta-analysis" to evaluate the impact of individual studies on the summary estimates.…”

“…For the remaining 10 studies, the SD was either calculated as a pooled SD based on subgroup values assuming equal variance (n = 5), 29,33,34,37,38 calculated from the 95% CI (n = 2), 16,27 estimated from median and range (n = 1), 39 obtained directly from study authors (n = 1), 30 or estimated based on the SD at diagnosis and SD for the change in BMI z score from diagnosis to study evaluation (n = 1). 36 To explore the association between patient and treatment characteristics and obesity, we performed subgroup meta-analyses separately by receipt of CRT, gender, and interval since treatment completion. We also performed sensitivity analyses to assess the robustness of our findings.…”

“…Ten studies reported a higher prevalence of overweight/ obesity or a higher BMI z score in survivors treated with CRT compared with those treated without CRT, [6][7][8]14,48,50,57,58,62,63 and 9 studies did not find a difference. [9][10][11]28,31,36,40,49 Gender On the basis of the 10 studies that reported separate BMI z scores for male and female ALL survivors, the BMI z score of the 450 female survivors was 1.0 (95% CI: 0.7-1.4) and the BMI z score of the 489 male survivors was 0.7 (95% CI: 0.3-1.1; Fig 3).…”