Childhood Leukemia Survivors At Risk for Harmful Obesity

Abstract

Endocrinology| January 01 2008 Childhood Leukemia Survivors At Risk for Harmful Obesity AAP Grand Rounds (2008) 19 (1): 5. https://doi.org/10.1542/gr.19-1-5 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Childhood Leukemia Survivors At Risk for Harmful Obesity. AAP Grand Rounds January 2008; 19 (1): 5. https://doi.org/10.1542/gr.19-1-5 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: childhood leukemia, obesity, survivors, leptin, insulin-like growth factor i, leukemia, lymphocytic, acute, childhood Source: Janiszewski PM, Oeffinger KC, Church TS, et al. Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia. J Clin Endocrinol Metab. 2007;92(10):3816–3821; doi:10.1210/jc.2006–2178 Acute lymphoblastic leukemia (ALL), the most common malignancy of childhood, has an overall cure rate of approximately 80%.1 Long-term survivors of childhood ALL are at increased risk for obesity, cardiovascular disease, and related mortality in the years following treatment.2 Investigators from multiple US institutions studied young adult survivors of ALL to assess the association of cranial radiotherapy (CRT) with levels of total, regional, and ectopic fat storage, metabolic risk, IGF-1, and leptin. A total of 237 young adult survivors of childhood ALL, treated from 1970–2000 in the Dallas-Fort Worth area, were identified. Of the 189 individuals who met eligibility criteria, 114 were enrolled and completed the study. Study participants’ mean age was 23.8 years, their mean age at diagnosis was 6.2 years, the mean interval from diagnosis to study enrollment was 17.5 years, and 23.7% were of an ethnic or racial minority group. Anthropometric measures, blood pressure, metabolic status, and levels of IGF-1 and leptin were assessed in 52 male (15 CRT-treated) and 62 female (24 CRT-treated) participants. Visceral, liver, and subcutaneous fat were determined using abdominal CT scan. Data from patients treated with CRT and non-CRT survivors were compared after controlling for potentially confounding variables. Exposure to CRT had no effect on BMI, waist circumference, or liver fat. Controlling for age and race, ALL survivors treated with CRT had significantly higher body fat percentage and more abdominal and visceral fat than non-CRT patients. IGF-1 levels were significantly lower and leptin levels significantly higher in the group that received CRT. There was more evidence of insulin resistance and dyslipidemias in CRT patients compared with the non-CRT survivors. The authors conclude that among ALL survivors CRT is associated with excess accumulation of abdominal fat, particularly visceral fat, and elevated metabolic risk. Dr. Varma has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Fortunately, we are seeing more and more long-term survivors of ALL. ALL survivors are at high risk for obesity,3 cardiovascular disease,4 and related mortality.2 CRT during ALL treatment has been shown to be the potential cause for excess weight gain among survivors.5 The authors of the current study suggest that treatment with CRT among ALL survivors is associated with increased plasma leptin levels, even when it is expressed per unit of fat mass. This observation indicates that obesity subsequent to treatment with CRT may be secondary to induced hypothalamic resistance to leptin. The abdominal and visceral obesity are warning signs for the metabolic syndrome. Since oncologists may not follow ALL survivors late into adolescence, primary care providers need to be aware of the sequelae of treatment, and monitor patients with a history of CRT for signs of obesity and other cardiovascular risks. (For discussions... You do not currently have access to this content.