Cancer Causes & Control

, Volume 24, Issue 2, pp 313–321

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia

  • Emily S. Tonorezos
  • Kim Robien
  • Debra Eshelman-Kent
  • Chaya S. Moskowitz
  • Timothy S. Church
  • Robert Ross
  • Kevin C. Oeffinger
Original paper

DOI: 10.1007/s10552-012-0116-6

Cite this article as:
Tonorezos, E.S., Robien, K., Eshelman-Kent, D. et al. Cancer Causes Control (2013) 24: 313. doi:10.1007/s10552-012-0116-6



Determine the relationship between diet and metabolic abnormalities among adult survivors of childhood acute lymphoblastic leukemia (ALL).


We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral and subcutaneous adiposity were measured by abdominal CT. Adherence to a Mediterranean diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using multivariate analysis adjusted for age and gender.


Greater adherence to a Mediterranean diet pattern was associated with lower visceral adiposity (p = 0.07), subcutaneous adiposity (p < 0.001), waist circumference (p = 0.005), and body mass index (p = 0.04). For each point higher on the Mediterranean Diet Score, the odds of having the metabolic syndrome fell by 31 % (OR 0.69; 95 % CI 0.50, 0.94; p = 0.019). Higher dairy intake was associated with higher HOMA-IR (p = 0.014), but other individual components of the Mediterranean diet, such as low intake of meat or high intake of fruits and vegetables, were not significant. PAEE was not independently associated with metabolic outcomes, although higher PAEE was associated with lower body mass index.


Adherence to a Mediterranean diet pattern was associated with better metabolic and anthropometric parameters in this cross-sectional study of ALL survivors.


Insulin resistanceLeukemiaMediterranean dietObesitySurvivorship



Acute lymphoblastic leukemia


Body mass index


Cranial radiotherapy


Food frequency questionnaire


Homeostasis model for insulin resistance


Physical activity energy expenditure

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Emily S. Tonorezos
    • 1
    • 2
  • Kim Robien
    • 3
    • 4
  • Debra Eshelman-Kent
    • 5
  • Chaya S. Moskowitz
    • 6
  • Timothy S. Church
    • 7
  • Robert Ross
    • 8
  • Kevin C. Oeffinger
    • 1
    • 9
  1. 1.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Cancer Detection, Treatment and Survivorship Program, Masonic Cancer CenterUniversity of MinnesotaMinneapolisUSA
  5. 5.Division of Hematology OncologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  6. 6.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  7. 7.Pennington Biomedical Research CenterBaton RougeUSA
  8. 8.Queen’s UniversityKingstonCanada
  9. 9.Department of PediatricsMemorial Sloan-Kettering Cancer CenterNew YorkUSA