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Relation between percentage trunk fat and GH max. Trunk-region fat ¼ 36.34 2 0.81 £ GH max ; r ¼ 20.5 (S.D. around the regression function is 7.81); P ¼ 0.005.
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Obesity is frequently reported in patients treated for childhood leukaemia. Obesity, particularly abdominal obesity, is one of the main characteristics of the metabolic syndrome and a risk factor for cardiovascular disease and non-insulin-dependent diabetes mellitus (NIDDM).
All patients treated for acute lymphoblastic leukaemia (ALL) before the on...
Context in source publication
Context 1
... CRT þ men had significantly higher total body fat than the CRT 2 men (P ¼ 0.001). There was no differ- ence among the women (Table 2). The CRT þ men had significantly higher percentage of trunk fat than the CRT 2 men (P ¼ 0.001). There was no difference among the women (Table 2). GH max was negatively cor- related to both percentage total body fat (r ¼ 2 0.42; P ¼ 0.017) and percentage trunk fat (r ¼ 2 0.5; P ¼ 0.005). To explore whether GH max influenced all three components (percentage FFM, percentage total body fat and percentage trunk fat) to the same extent, or if one of the variables was affected primarily and the other two secondarily, we performed a multiple linear- regression analysis where GH max was the dependent variable and fat components were the three independent variables. This analysis revealed that only the partial regression coefficient for percentage trunk fat remained significant (r ¼ 2 0.5; P ¼ 0.005; Fig. 2). The cortico- steroid dose did not correlate with percentage total body fat (P ¼ 0.63) or percentage trunk fat (P ¼ 0.61). The estimated percentage total body fat in the patients was calculated with the equation of Gallagher et al. (12), as given in the Subjects and methods section. The estimated body-fat percentages in men were 21.6% (range 15.5 -24.4) and 12.0% (6.8 -17.6) in the CRT þ and CRT 2 groups, respectively. The estimated body-fat percentages in women were 30.4% (23.0 - 39.9) and 30.6% (23.9 -39.3) in the CRT þ and CRT 2 groups, respectively. The differences between the percentage total body fat mass measured using DEXA and the estimated total body fat mass from the Gal- lagher equation were calculated and found to have medians of 8.9% (4.0 -15.5) and 8.4% (2 4.2 -8.6) in the CRT þ and CRT 2 men, respectively. In the data for the patients in this study compared with BMI of 5439 (2762 men, 2677 women) normal Swedish young adults aged 16-34 years (grey shading; Statistics, Sweden). B, Patients with low GH secretion; X, patients with normal GH secretion. Horizontal lines are the means of the population data. (Fig. 3). All eight men with peak GH secretion below 3.3 mg/l had a percentage total body fat greater than 21%, which is the predicted percentage of total body fat in men aged 20-39 years with a BMI of 25 -30 kg/m 2 according to Gallagher et al. (12). On the other hand, although only one woman in our study had a GH max below 3.3 mg/l, the women overall had a high percentage of total body fat. 14 (seven CRT þ and seven CRT 2 ) out of the 18 women had a percentage fat of more than 33%, which is the predicted percentage of fat mass for these women ...
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Citations
... Seven out of 10 childhood cancer survivors suffer from complications of the disease and cancer treatment over time [2]. This includes a significant risk of metabolic syndrome [3], cardiovascular disease [4], secondary cancer [5,6] and neurocognitive impairments [7]. Regular physical activity is associated with a lower risk of morbidity and mortality in several chronic diseases, including cancer survivors [8,9]. ...
Background
Regular physical activity and limited sedentary time are recommended for adult childhood cancer survivors. The Swedish National Board of Health and Welfare designed a questionnaire to assess levels of physical activity (BHW-Q), including two questions: one on vigorous physical activity (BHW-Q VPA) and one on moderate physical activity (BHW-Q MPA). Furthermore, a single-item question was developed to measure sedentary time (SED-GIH-Q). These questions are recommended for clinical practice and have been found valid for the general population but have so far not been tested in adult childhood cancer survivors. The aim of the study was to assess test–retest reliability, agreement and criterion-related validity of the BHW-Q and the SED-GIH-Q in adult childhood cancer survivors.
Method
A non-experimental methodological study. In total 60 participants (50% women), median age 28 (min-max 18–54) years were included at the Long-Term Follow-Up Clinic at Sahlgrenska University Hospital. Participants were instructed to wear an accelerometer for seven days, and to answer the BHW-Q and the SED-GIH-Q before and after the seven days. Test-retest reliability and criterion-related validity comparing the BHW-Q and SED GIH-Q with accelerometer data were calculated with weighted Kappa (k) (agreement) and by using Spearman´s rho (r) (correlation).
Results
Test-retest reliability regarding the SED-GIH-Q showed a high agreement (k = 0.88) and very strong correlation (r = 0.93), while the BHW-Q showed a moderate agreement and moderately strong correlation, BHW-Q VPA (k = 0.50, r = 0.64), BHW-Q MPA (k = 0.47, r = 0.58). Both the agreement and the correlation of the criterion-related validity were interpreted as fair for the BHW-Q VPA (k = 0.29, r = 0.45), while the agreement for BHW-Q MPA was interpreted as low (k = 0.07), but the correlation as fair (r = 0.37). The agreement of the SED-GIH-Q (k = 0.13) was interpreted as low and the correlation as poor (r = 0.26).
Conclusion
These simple questions assessing physical activity and sedentary time can be used as screening tools in clinical practice to identify adult childhood cancer survivors in need of support to increase physical activity level. Further development is needed on the design of a sufficiently valid question measuring sedentary time.
Trial registration
This research project was registered in the Swedish National Database of Research and Development; identifier 275251, November 25, 2020. https://www.researchweb.org/is/vgr/project/275251.
... The most important risk factors associated with weight gain and hypertension among all patients with ALL are cranial radiotherapy and long-term treatment with corticosteroids. [20][21][22][23] It has also been reported that the incidence of cardiovascular disease in children with ALL leads to an increased risk of obesity and hypertension in adulthood. [24,25] Studies of pediatric cancer survivors have shown that high blood pressure (BP) rates range from 1.7% to 70.6%. ...
Background: The exact prevalence of hypertension in children surviving acute lymphoblastic
leukemia (ALL) has not been fully estimated. The aim of this study was to investigate the prevalence
of arterial hypertension (AH) and to determine the risk factors for the development of AH in children
surviving ALL with current treatments. Materials and Methods: A total of 150 patients (84 males,
66 females, with an age range of 1–16 years) were included in the study. Demographic and clinical
information of patients were initially recorded. Hypertension is defined as average systolic blood
pressure (BP) and/or diastolic BP that is greater than the 95th percentile for gender, age, and height.
Results: The mean age at the assessment of BP was 11.3 and 9.8 years in the ALL and control
group, respectively. A total of 20.6% of survivors of ALL and 10% of controls had high BP. Most
patients in both groups had normal BP (65.3% patients in ALL group and 75.4% subjects in the
control group). The number of patients with hypertension was significantly higher in ALL patients
as compared with the control group (P = 0.026). Conclusion: The prevalence of AH in children
surviving ALL is higher than in children in the general population, which emphasizes the need
for regular monitoring of BP in children surviving ALL and intervention in the lifestyle of this
population. Careful follow‑up of BP status is warranted for long‑term survivors of childhood cancer.
... The most important risk factors associated with weight gain and hypertension among all patients with ALL are cranial radiotherapy and long-term treatment with corticosteroids. [20][21][22][23] It has also been reported that the incidence of cardiovascular disease in children with ALL leads to an increased risk of obesity and hypertension in adulthood. [24,25] Studies of pediatric cancer survivors have shown that high blood pressure (BP) rates range from 1.7% to 70.6%. ...
Background:
The exact prevalence of hypertension in children surviving acute lymphoblastic leukemia (ALL) has not been fully estimated. The aim of this study was to investigate the prevalence of arterial hypertension (AH) and to determine the risk factors for the development of AH in children surviving ALL with current treatments.
Materials and methods:
A total of 150 patients (84 males, 66 females, with an age range of 1-16 years) were included in the study. Demographic and clinical information of patients were initially recorded. Hypertension is defined as average systolic blood pressure (BP) and/or diastolic BP that is greater than the 95th percentile for gender, age, and height.
Results:
The mean age at the assessment of BP was 11.3 and 9.8 years in the ALL and control group, respectively. A total of 20.6% of survivors of ALL and 10% of controls had high BP. Most patients in both groups had normal BP (65.3% patients in ALL group and 75.4% subjects in the control group). The number of patients with hypertension was significantly higher in ALL patients as compared with the control group (P = 0.026).
Conclusion:
The prevalence of AH in children surviving ALL is higher than in children in the general population, which emphasizes the need for regular monitoring of BP in children surviving ALL and intervention in the lifestyle of this population. Careful follow-up of BP status is warranted for long-term survivors of childhood cancer.
... Adiposity rebound usually occurs between the ages of 5 and 7 years. Because ALL is frequently noted between the ages of 3 and 5 years, chemotherapy and RT may cause early adiposity rebound in these cases and may be the cause of obesity [40][41][42][43]. In the study by Razzouk et al., it was determined that age of < 6 years at the time of diagnosis is a risk factor for being overweight/obese in adulthood [44]. ...
Objectives
In this study, it was aimed to determine the prevalence and clinical features of obesity and metabolic syndrome, which are long-term effects of survivors after treatment in children with leukemia and lymphoma.
Patients and Methods
Patients with leukemia and lymphoma, who were diagnosed between 2000 and 2012 (at least 2 two years after remission) were included. Data obtained through reviewing the family history, demographic characteristics, anthropometric measurements, and laboratory parameters (blood glucose, lipid, and insulin levels) were analyzed and compared at the time of diagnosis, after the treatment and at time of the study.
Results
Eighty nine patients (45 boys, 44 girls) were included (mean age: 14.7 ± 4.3 years): 77.5% had acute lymphoblastic leukemia, 11.2% had acute myeloid leukemia, and 11.2% had lymphoma. Overall, 46% patients had received radiotherapy, 7% had undergone surgery, and 2.2% had received stem cell transplantation in addition to chemotherapy. The mean duration of treatment was 2.4 years, and the time elapsed after treatment was 4.9 years. While only one had obesity at the diagnosis, a significant increase in obesity (20%), hypertension (15.7%), hyperglycemia (15%), insulin resistance (35%) were observed at the time of study, and family history of hypertension, dyslipidemia, and cardiovascular diseases were significantly higher in this subgroup.
Conclusion
The prevalence of metabolic syndorme is higher in children with leukemia and lymphoma after treatment, and begins to increase with the initiation of treatment and continues to increase over time. These children should be followed-up for late-effects including metabolic syndrome through life-long period.
... Several studies have reported an increased prevalence of overweight or obese cancer survivors. [22][23][24] Previous researchers have suggested that an abnormal lipid profile, especially triglycerides, contributes to endothelial dysfunction, which was further hypothesized for adult survivors of childhood ALL. 8 ...
Background
An increased risk of cardiovascular complications is reported in survivors of childhood acute lymphoblastic leukemia (ALL). Early identification of impaired vascular health may allow for early interventions to improve outcomes.
Aim
The study was conducted to assess the endothelial dysfunction in ALL survivors using a new marker, serum endocan, and measurement of the mean common carotid arteries intima media thickness (cIMT).
Methods
A case-control study was conducted on 100 childhood ALL survivors (aged 6–18 years), with 80 healthy age and sex-matched children as a control group. Lipid profile, hepatitis markers, and serum ferritin where measured, in addition to the measurement of serum endocan. and cIMT by B-mode high-resolution ultrasonography for all study participants.
Results
Triglycerides, total cholesterol, post prandial glucose, and serum ferritin were significantly higher in ALL survivors than controls ( p < 0.05). Dyslipidemia was detected in 6% of ALL survivors. ALL survivors showed statistically higher serum endocan levels (470.41 ± 556.1 ng/l, versus, 225.94 ± 185.2 ng/l, respectively) and increased cIMT levels compared with the control group (0.650 ± 0.129 mm versus 0.320 ± 0.095 mm, respectively) p < 0.05. Serum endocan was positively correlated with cIMT and blood cholesterol.
Conclusions
The survivors of childhood ALL demonstrated an elevated level of serum endocan and increased cIMT. These can be used as predictors of endothelial dysfunction, and, as a consequence, the risk of developing premature atherosclerosis.
... Body mass index (BMI) is an indicator of body fat mass; however, the amount and the distribution of fat are more important risk factors for prediction of cardiovascular disease and type 2 diabetes [5]. The body composition of childhood cancer survivors (CCS) should be considered even if they are not overweight or obese [6]. ...
... [18][19][20] However, in studies evaluating fat distribution using alternate measures, increased percent body fat and abdominal adiposity were identified in survivors, findings that were not detected by BMI. 18,21,22 In subsequent years, the Childhood Cancer Survivor Study published several reports confirming the single-center studies, namely survivors had minimally different rates of obesity based on BMI compared with their siblings, but did have significantly greater cardiovascular risk factors (odds ratio, 1.6-1.9) 5 and increased morbidity and mortality because of chronic health conditions. 4-6 These outcomes have been reviewed extensively. ...
... [31][32][33][34] An increase in fat mass and obesity have been well established also in survivors. 18,21,22,29 The combination of these findings has led to the identification of 'sarcopenic obesity' in survivors of pediatric cancer. 32,33 These changes in survivors of pediatric ALL have been attributed previously to the use of corticosteroids because of their known impact on fat distribution 35,36 and cranial radiation; indeed, survivors of pediatric brain tumors have similar changes in body composition. ...
... Multiple studies have now demonstrated that BMI alone is unable to identify the increased fat mass that accumulates after treatment for pediatric cancer (likely because of the presence of sarcopenic obesity) and that metabolic risk remains elevated when the BMI is in the normal range. 18,21,22,32,33,38,44,45 This highlights the importance of considering alternate techniques for assessment of body composition in this population. ...
Survival of cancer in childhood is increasingly common with modern therapeutic protocols but leads frequently to adverse long-term impacts on health, including metabolic and cardiovascular disease. Changes in body composition, especially an increase in fat mass and a decrease in muscle mass, are found early in patients with pediatric cancer, persist long after treatment has been completed and seem to contribute to the development of chronic disease. This review details the effects of such changes in body composition and reviews the underlying pathophysiology of the development of sarcopenic obesity and its adverse metabolic impact. The authors discuss the particular challenges in identifying obesity accurately in survivors of pediatric cancer using available measurement techniques, given that common measures, such as body mass index, do not distinguish between muscle and adipose tissue or assess their distribution. The authors highlight the importance of a harmonized approach to the assessment of body composition in pediatric cancer survivors and early identification of risk using "gold-standard" measurements. This will improve our understanding of the significance of adiposity and sarcopenia in this population, help identify thresholds predictive of metabolic risk, and ultimately prevent or ameliorate the long-term metabolic and cardiovascular impacts on health experienced by survivors of cancer in childhood.
... Based on previous reports, body composition changes, such as a tendency to gain body fat, especially in the trunk, and reduced LBM, may result in overweight or obesity-related complications after the cessation of cancer therapy and in later life [10,[20][21][22][23]. According to a report from the Children's Oncology Group, the beginning of maintenance therapy was suggested to be the best time to intervene with nutritional and behavioral interventions to reduce the risk for obesity in pediatric cancer patients [22]. ...
Backgrounds/objectives:
Cancer treatment may lead to significant body composition changes and affect growth and disease outcomes in pediatric cancer patients. This prospective study aimed to evaluate short- and long-term body compositions changes focused on body fat during the first year of cancer treatment in children.
Subjects/methods:
A prospective study was conducted in 30 pediatric cancer patients (19 hematologic malignancies and 11 solid tumors) and 30 age- and sex-matched healthy controls. Anthropometric measurements and body composition analysis using whole body dual energy X-ray absorptiometry were performed at baseline and 1, 6, and 12 month(s) of cancer treatment. Kruskal-Wallis tests, Wilcoxon paired t tests, and generalized estimation equation (GEE) were applied for statistical analysis.
Results:
At baseline, no differences in weight, height, body mass index, abdominal circumferences, body fat, and fat-free mass were observed between 30 controls and 30 pediatric cancer patients. Total fat mass (P < 0.001) and body fat percentage (P = 0.002) increased significantly during the first month, but no changes were observed from 1 to 12 months; however, no changes in the total mass were observed during the first year of cancer treatment. Meanwhile, the total fat-free mass decreased during the first month (P = 0.008) and recovered between 6 and 12 months of follow-up (P < 0.001). According to GEE analysis, there was a significant upward trend in body fat percentage during the first year, especially the first month, of cancer treatment in children with hematologic malignancies, but not in those with solid tumors.
Conclusions:
Our results indicate that cancer treatment is related to significant body composition changes and rapid body fat gain, particularly during the first month after initiating cancer treatment, in children with hematologic malignancies. Therefore, individualized dietary strategies to prevent excessive fat gain are needed in pediatric cancer patients for better outcomes.
... I mprovements in pediatric cancer therapies such as combinations of chemotherapy, stem cell transplantation, improved surgeries, and supportive care have led to an increasing number of survivors of childhood cancer living into adulthood. [1][2][3] Thus, the long-term health and quality of life of survivors of childhood cancer have become a focus of research. 4,5 The biopsychosocial model systematically characterizes the complex interactions between biological, psychological, and social factors and their impact on health. ...
Background: Survivors of childhood cancer are prone to an increased risk of chronic
issues such as cardiovascular disease, fatigue, weight-related problems, and emotional
disturbances. Objective: This study utilized the biopsychosocial model to examine
the hypothesis that greater depression and lower mobility would be significantly
associated with greater fatigue and higher body mass index in survivors of childhood
cancer.Methods: Data were analyzed for 144 children treated and followed up for an
oncology condition at a southeastern academic medical center. Voluntarily, children
completed the Patient-Reported Outcomes Measurement Information System 1.0, and
parents completed the Family Symptom Inventory as part of a brief annual psychosocial
screening battery. Height and weight were collected by a clinic nurse prior to
questionnaire completion. Results: Hierarchical linear regression showed that shorter
time since diagnosis (β = −.154, P < .05), greater child-reported depression (β = .396,
P < .01), and lower mobility (β = .427, P < .01) significantly predicted greater fatigue
(adjusted R2 = 0.54).Older age (β = .262, P < .01) and not receiving chemotherapy
(β = −.209, P < .05) significantly predicted higher body mass index (adjusted
R2 = 0.051). Conclusions: Findings showed that fatigue tends to improve over time
after treatment but may be predicted by greater depression symptoms and lower mobility
in recent survivors of childhood cancer. Implications for Practice: For survivors of
childhood cancer with higher levels of fatigue, treating symptoms of depression and
maximizing physical and mobility may be of clinical value. With the impact of
psychological and social factors not yet understood in pediatric cancer survivors, weight
status in recent survivors of childhood cancer is likely a complex interaction between
biological and treatment factors.
... 4,5 Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in children and young adult cancer survivors. 6,7 The International Diabetes Foundation has established the following diagnostic criteria for MS patients: body mass index (BMI) more than the 90th percentile of waist circumference (WC) and 2 factors from the defining criteria. The prevalence of MS in a healthy child population ranges from 3.6% to 4.8%, increasing radically up to 30% among overweight and obese children. ...
Cancer treatments are associated with short and long-effects. Epidemiological reports have revealed clinical features of metabolic syndrome (MS), obesity or overweight in young cancer survivors. The aim of the study was to examine the prevalence of unhealthy weight status and risk factors associated with MS related to chemotherapy. We study 52 pediatric cancer patients and analyze cholesterol, triglycerides, glycosylated hemoglobin, body mass index, waist circumference (WC), FINDRISC test. All the parameters were analyzed according to the percentile corresponding to sex and age of each child. The data show an important modification in weight, body mass index, and WC as in triglycerides, and cholesterol that could be associated with the development of MS. The variance analysis showed that the WC, triglycerides, and cholesterol are statistically correlated in our population. A follow-up for MS in children cancer survivor should be considered necessary.
