High incidence of obesity in young adults after treatment of acute lymphoblastic leukemia in childhood

doi:10.1016/S0022-3476(95)70258-X

The Journal of Pediatrics

Volume 127, Issue 1, July 1995, Pages 63-67

https://doi.org/10.1016/S0022-3476(95)70258-X Get rights and content

Abstract

To determine whether obesity complicated the treatment of childhood acute lymphoblastic leukemia, we studied the body mass index (BMI) of 63 female when and 51 male patients from the time of diagnosis of acute lymphoblastic leukemia to the time when final height was attained. The BMI z score was calculated for each patient at diagnosis, at end of treatment, and at attainment of final height. Obesity at attainment of final height was defined as a BMI greater than the 85th percentile of the normal reference population. At final height 23 of 51 male (45%) and 30 of 63 female patients (47%) were obese. Girls became obese between diagnosis and the end of chemotherapy (p = 0.02), after which they had no further increase, indicating that chemotherapy may have played a role in their obesity. Boys had a progressive and gradual increase in BMI z score through to attainment of final height. Obesity did not appear to be associated with growth hormone insufficiency, disproportionate growth, or abnormal timing of puberty. We conclude that approximately half the survivors of leukemia in childhood become obese young adults. Many of those treated with the more recent regimens studied are still only in their mid or preteen years and should be advised regarding a more active lifestyle and a healthy diet in an attempt to reduce the incidence of obesity. (J PEDIATR 1995;127:63-7)

Section snippets

Patients

All patients treated successfully for ALL at three tertiary referral centers for the treatment of children with malignant disease, who were in their first prolonged continuous remission and had reached final height, were studied from the time of diagnosis to the time when final height was achieved. Patients who had received testicular, mediastinal, or craniospinal irradiation, or those who had a documented diagnosis of growth hormone insufficiency (n = 18), were excluded. The diagnosis of

RESULTS

One hundred fourteen patients (63 girls) were studied from the time of diagnosis at a median age of 6.7 years (range, 2 to 15.9 years) to attainment of final height at a median age of 16.2 years (range, 13.3 to 20.6 years). Thirty-seven girls and 27 boys received treatment with the regimens in group 1; 26 girls and 24 boys received treatment with regimens in group 2. The median intervals for boys and girls from diagnosis to the end of treatment were 2.7 years (range, 1.8 to 3.0 years) and 2.6

DISCUSSION

In later childhood, BMI increases because of physiologic changes during puberty rather than because of the development of obesity. The increase is partly related to the acquisition of lean body mass during normal puberty.¹⁵ The BMI in adolescence correlates well with BMI in adulthood.¹⁶ The most widely used definition of obesity in adulthood is a BMI greater than the 85th percentile¹⁷ for the normal reference population. It has not been defined in childhood and adolescence; various workers have

Acknowledgements

We thank Prof. J. S. Lilleyman, Dr. P. Morris-Jones, Dr. P. Barber, and Dr. D. A. Walker for permitting us to study their patients and Dr. J. Buckler for providing us with a large, up-to-date cohort of children with BMI at final height. We also thank Mr. M. Dougal for help with the statistical analysis.

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^☆: From the Department of Endocrinology, Christie Hospital, NHS Trust, Manchester; the Department of Child Health, Queen's Medical Centre, Nottingham; and the University Department of Paediatrics, Children's Hospital, Sheffield, United Kingdom

^☆☆: Supported by the Leukaemia Research Fund, United Kingdom.

^★: Reprint requests: S. M. Shalet, Department of Endocrinology, Christie Hospital, National Health Service Trust, Wilmslow Road, Manchester M20 9BX, United Kingdom.

^★★: 0022-3476/95/$3.00 + 0 9/20/64278

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High incidence of obesity in young adults after treatment of acute lymphoblastic leukemia in childhood☆,☆☆,★,★★

Abstract

Section snippets

Patients

RESULTS

DISCUSSION

Acknowledgements

Am J Clin Nutr

Disproportionate short stature following cranial irradiation and combination chemotherapy for acute lymphoblastic leukaemia

Arch Dis Child

Precocious and premature puberty associated with treatment of acute lymphoblastic leukaemia

Arch Dis Child

Weight gain and height velocity during prolonged first remission from acute lymphoblastic leukaemia

Arch Dis Child

Prevalence of obesity in children after therapy for acute lymphoblastic leukaemia

Am J Pediatr Hematol Oncol

A method of predicting adult height and obesity in long term survivors of childhood acute lymphoblastic leukaemia

J Clin Oncol

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

Arch Dis Child

Improvements in treatment for children with acute lymphoblastic leukaemia

Lancet

Present problems in management of childhood lymphoblastic leukaemia: experience from the Hospital for Sick Children, London

Body mass index variations: centiles from birth to 87 years

Eur J Clin Nutr

The LMS method for constructing normalised standards

Eur J Clin Nutr

Standards for birth to maturity for height, weight, height velocity, weight velocity: British children, 1965-part 1

Arch Dis Child