Risk Factors for Obesity and Time Frame of Weight Gain in Non-Irradiated Survivors of Pediatric Acute Lymphoblastic Leukemia

Maheen Hassan, Carol H. Lin, Lilibeth Torno

Department of Pediatrics, Children’s Hospital & Research Center Oakland, Oakland, USA.
The Hyundai Cancer Institute, Children’s Hospital of Orange County, Orange, USA.

DOI: 10.4236/jct.2013.41017                

Abstract

Background: Obesity has been described among survivors of pediatric Acute Lymphoblastic Leukemia (ALL), especially those who have received cranial radiation. This study aims to evaluate the prevalence of overweight or obesity in pediatric ALL survivors who were not exposed to radiation, identify the time frame in which the rate of obesity rise is the greatest, and identify contributing clinical and treatment variables. Methods: In this retrospective, single institution study, the charts of 132 ALL survivors were reviewed. Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated for being overweight or obese at their 2 year follow-up for the following clinical variables: ethnicity, age at diagnosis, and weight at diagnosis. Changes in BMI percentiles between 4 different time points were assessed using t-test comparison and p values. Results: Survivors of ALL were more likely to be overweight or obese than the general population at the 2 and 5 year follow-up. White and Hispanic ethnicity and being overweight or obese at diagnosis were also risk factors for being overweight or obese 2 years after the end of treatment. When looking at the time frame of weight gain, survivors had a significant increase in BMI percentile between diagnosis and end of therapy, and between diagnosis and 2 year follow-up, but did not have a significant increase between end of therapy and 2 year follow-up. Conclusion: Patients with ALL have an increased risk of being obese at follow-up. They show early weight gain, between diagnosis and end of treatment, and remain overweight/obese long term. Ethnicity and BMI weight category at diagnosis were significant influences. A strategic plan to prevent this weight gain should be implemented early during therapy.

Keywords

Acute Lymphoblastic Leukemia; Obesity; Body Mass Index

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. Ogden and M. Carroll, “Prevalence of Obesity among Children and Adolescents: United States, Trends 1963-1965 through 2007-2008,” 2010. http://www.cdc.gov/nchs/data/hestat/obesity_child_ 07_08/obesity_child_07_08.htm.
[2]	V. K. Dalton, M. Rue, L.B. Silverman, R. D. Gelber, B. L. Asselin, R. D. Barr, L. A. Clavell, C. A. Hurwitz, A. Moghrabi, Y. Samson, M. Schorin, N. J. Tarbell, S. E. Sallan and L. E. Cohen, “Height and Weight in Children Treated for Acute Lymphoblastic Leukemia: Relationship to CNS Treatment,” Journal of Clinical Oncology, Vol. 21, No. 15, 2003, pp. 2953-2960. doi:10.1200/JCO.2003.03.068
[3]	B. I. Razzouk, S. R. Rose, S. Hongeng, D. Wallace, M. P. Smeltzer, M. Zacher, C. H. Pui and M. M. Hudson, “Obesity in Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma,”Journal of Clinical Oncology, Vol. 25, No. 10, 2007, pp. 1183-1189. doi:10.1200/JCO.2006.07.8709
[4]	N. Howlader, A. M. Noone, M. Krapcho, N. Neyman, R. Aminou, W. Waldron, S. F. Altekruse, C. L. Kosary, J. Ruhl, Z. Tatalovich, H. Cho, A. Mariotto, M. P. Eisner, D. R. Lewis, H. S. Chen, E, J. Feuer and K. A. Cronin, “SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations),” 2012. http://seer.cancer.gov/csr/1975_2009_pops09/.
[5]	S. J. Veringa, E. van Dulmen-den Broeder, G. J Kasparas and M. A. Veening, “Blood Pressure and Body Composition in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia,” Pediatric Blood Cancer, Vol. 25, No. 2, 2012, pp. 278-282. doi:10.1002/pbc.23251
[6]	L. Iughetti, P. Bruzzi, B. Predieri and P. Paolucci, “Obesity in Patients with Acute Lymphoblastic Leukemia in Childhood,” Italian Journal of Pediatrics, Vol. 38, No. 4, 2012.
[7]	H. L. Mueller, “Consequences of Craniopharyngioma Surgery in Children,” The Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 7, 2011, pp. 1981-1991. doi:10.1210/jc.2011-0174
[8]	K. C. Oeffinger, A. C Mertens, C. A. Sklar, Y. Yasui, T. Fears, M. Stovall, T. A. Vik, P. D. Inskip and L. L. Robison, “Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study,” Journal of Clinical Oncology, Vol. 21, No. 7, 2003, pp. 1359-1365. doi:10.1200/JCO.2003.06.131
[9]	L. R. Meacham, J. G. Gurney, A. C. Mertens, K. K. Ness, C. A. Sklar, L. L. Robison and K. C. Oeffinger, “Body Mass Index in Long-Term Adult Survivors of Childhood Cancer: A Report of the Childhood Cancer Survivor Study,” Cancer, Vol. 103, No. 8, 2005, pp. 1730-1739. doi:10.1002/cncr.20960
[10]	C. A. Sklar, A. C. Mertens, A. Walter, D. Mitchell, M. E. Nesbit, M. O’Leary, R. Hutchinson, A. T. Meadows and L. L. Robison, “Changes in Body Mass Index and Prevalence of Overweight in Survivors of Childhood Acute Lymphoblastic Leukemia: Role of Cranial Irradiation,” Medical and Pediatric Oncology, Vol. 35, No. 2, 2000, pp. 91-95. doi:10.1002/1096-911X(200008)35:2<91::AID-MPO1>3.0.CO;2-G
[11]	C. A. Brouwer, J. A. Gietema, J. M. Vonk, W. J. Tissing, H. M. Boezen, N. Zwart and A. Postma, “Body Mass Index and Annual Increase of Childhood Cancer Survivors; Relationship to Treatment,” Support Care Cancer, Vol. 20, No. 2, 2012, pp. 311-318. doi:10.1007/s00520-010-1080-x
[12]	F. Craig, A. D. Leiper, R. Stanhope, C. Brain, S. T. Meller and S. S. Nussey, “Sexually Dimorphic and Radiation Dose Dependent Effect of Cranial Irradiation on Body Mass Index,” Archives of Disease in Childhood, Vol. 81, No. 6, 1999, pp. 500-504. doi:10.1136/adc.81.6.500
[13]	I. Odame, J. J. Reilly, B. E. S. Gibson, M. D. C. Donaldson, “Patterns of Obesity in Boys and Girls After Treatment of Acute Lymphoblastic Leukemia,” Archives of Disease in Childhood, Vol. 71, No. 2, 1994, pp. 147-149. doi:10.1136/adc.71.2.147
[14]	R. J. Kuczmarski, C. L. Ogden, S. S. Guo, L. M. Grummer-Strawn, K. M. Flegal, Z. Mei, R. Wei, L. R. Curtin, A. F. Roche and C. L. Johnson, “CDC growth charts for the United States: Methods and development,” National Center for Health Statistics Vital Health Stat, Vol. 11, No. 246, 2002, pp. 31-32.
[15]	K. M. Flegal, C. J. Tabak and C. L. Ogden, “Overweight in Children: Definitions and Interpretation,” Health Education Research, Vol. 21, No. 6, 2006, pp. 755-760. doi:10.1093/her/cyl128
[16]	L. D. Hammer, H. C. Kraemer, D. M. Wilson, P. L. Ritter and S. M. Dornbusch, “Standardized Percentile Curves of Body-Mass Index for Children and Adolescents,” American Journal of Diseases of Children, Vol. 145, No. 3, 1991, pp. 259-263.
[17]	C. L. Ogden, M. D. Carroll MD, L. R. Curtin, M. M. Lamb and K. M. Flegal, “Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008,” The Journal of the American Medical Association, Vol. 303, No. 3, 2010, pp. 242-249. doi:10.1001/jama.2009.2012
[18]	J. A. Ross, K. C. Oeffinger KC, S. M. Davies, A. C. Mertens, E. K. Langer, W. R. Kiffmeyer, C. A. Sklar, M. Stovall, Y. Yasui and L. L. Robison, “Genetic Variation in the Leptin Receptor Gene and Obesity in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study,” Journal of Clinical Oncology, Vol. 22, No. 17, 2004, pp. 3558-3562. doi:10.1200/JCO.2004.11.152
[19]	V. K. Dalto, M. Rue, L. B. Silverman, R. D. Gelber, B. L. Asselin, R. D. Barr, L. A. Clavell, C. A. Hurwitz, A. Maghrabi, Y. Samson, M. Schorin, N. J. Tarbell, S. E. Sallan and L. E. Cohen, “Height and Weight in Children Treated for Acute Lymphoblastic Leukemia: Relationship to CNS Treatment,” Journal of Clinical Oncology, Vol. 21, No. 15, 2003, pp. 2953-2960. doi:10.1200/JCO.2003.03.068
[20]	J. G. Gurney, K. K. Ness, M. Stoval, S. Wolden, J. A. Punyko, J. P. Neglia, A. C. Mertens, R. J. Packer, L. L. Robison and C. A. Sklar, “Final Height and Body Mass Index Among Adult Survivors of Childhood Brain Cancer: Childhood Cancer Survivor Study,” The Journal of Clinical Endocrinology and Metabolism, Vol. 88, No. 10, 2003, pp. 4731-4739. doi:10.1210/jc.2003-030784
[21]	J. J. Reilly, A. Kelly, P. Ness, A. R. Dorosty, W. H. Wallace, B. E. Gibson and P. M. Emmett PM; ALSPAC Study Team, “Premature Adiposity Rebound in Children Treated for Acute Lymphoblastic Leukemia,” The Journal of Clinical Endocrinology and Metabolism, Vol. 86, No. 6, 2001, pp. 2775-2778. doi:10.1210/jc.86.6.2775
[22]	R. A. Breene, R. M. Williams, J. Hartle, M. Gattens, C. L. Acerini and M. J. Murray, “Auxological Changes in UK Survivors of Childhood Acute Lymphoblastic Leukaemia Treated Without Cranial Irradiation,” British Journal of Cancer, Vol. 104, No. 5, 2011, pp. 746-749. doi:10.1038/bjc.2011.16
[23]	P. C. Nathan, V. Jovcevska, K. K. Ness, N. MammoneD’Agostino, P. Staneland, S. L. Urbach, M. Barron, M. Barrera and M. L. Greenberg, “ The Prevalence of Overweight and Obesity in Pediatric Survivors of Cancer,” The Journal of Pediatrics, Vol. 149, No. 4, 2006, pp. 518-525. doi:10.1016/j.jpeds.2006.06.039
[24]	M. Jarfelt, B. Lannering, I. Bosaeus, G. Johannsson and R. Bjarnason, “Body Composition in Young Adult Survivors of Childhood Acute Lymphoblastic Leukaemia,” European Journal of Endocrinology, Vol. 153, No. 1, 2005, pp. 81-89. doi:10.1530/eje.1.01931
[25]	J. G. Gurney, K. K. Ness, S. D. Sibley, M. O’eary, D. R. Dengel, J. M. Lee, N. M. Youngren, S. P. Glasser and K. S. Baker, “Metabolic Syndrome and Growth Hormone Deficiency in Adult Survivors of Childhood Acute Lymphoblastic Leukemia,” Cancer, Vol. 107, No. 6, 2006, pp. 1303-1312. doi:10.1002/cncr.22120
[26]	J. E. W. M. Van Dongen-Melman, A. C. S. Hokken-Koelega, K. Hahlen, A. De Groot and C. G. Tronmp, “Obesity after Successful Treatment of Acute Lymphoastic Leukemia in Childhood,” Pediatric Research, Vol. 38, No. 1, 1995, pp. 86-90. doi:10.1203/00006450-199507000-00015
[27]	C. S. Tam and E. Ravussin, “Energy Balance: An Overview with Emphasis on Children,” Pediatric Blood & Cancer, Vol. 58, No. 1, 2012, pp. 154-158. doi:10.1002/pbc.23375
[28]	T. L. Miller, S. R. Lipsitz, G. Lopez-Mitnik, A. S. Hinkle, L. S. Constine, M. J. Adams, C. French, C. Proukou, A. Rovitelli and S. E. Lipshultz, “Characteristics and Determinants of Adiposity in Pediatric Cancer Survivors,” Cancer Epidemiology, Biomarkers, and Prevention, Vol. 19, No. 8, 2010, pp. 2012-2022. doi:10.1158/1055-9965.EPI-10-0163
[29]	J. Cohen, C. E. Wakefield, C. A Fleming, R. Gawthorne. L. C. Tapsell and R. J. Cohn, “Dietary Intake after Treatment in Child Cancer Survivors,” Pediatric Blood and Cancer, Vol. 58, No. 5, 2012, pp. 752-757. doi:10.1002/pbc.23280