Cancer Causes & Control

, Volume 24, Issue 2, pp 313–321 | Cite as

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



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 resistance Leukemia Mediterranean diet Obesity Survivorship 



Acute lymphoblastic leukemia


Body mass index


Cranial radiotherapy


Food frequency questionnaire


Homeostasis model for insulin resistance


Physical activity energy expenditure



This work was supported by research grants from the National Institutes of Health (R01-CA 100474 and K05-CA165702), the Howard J. and Dorothy Adleta Foundation, and the Donald W. Reynolds Cardiovascular Research Center at Dallas, the General Clinical Research Center (Grant M01-RR-00633 and CTSA UL1-RR-024982), and an American Cancer Society Cancer Control Career Development Award.

Conflict of interest

None of the authors has a possible conflict of interest to declare.


  1. 1.
    Smith MA, Seibel NL, Altekruse SF et al (2010) Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol 28:2625–2634PubMedCrossRefGoogle Scholar
  2. 2.
    Geenen MM, Cardous-Ubbink MC, Kremer LC et al (2007) Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA 297:2705–2715PubMedCrossRefGoogle Scholar
  3. 3.
    Armstrong GT, Liu Q, Yasui Y et al (2009) Late mortality among 5-year survivors of childhood cancer: a summary from the childhood cancer survivor study. J Clin Oncol 27:2328–2338PubMedCrossRefGoogle Scholar
  4. 4.
    Yeh JM, Nekhlyudov L, Goldie SJ, Mertens AC, Diller L (2010) A model-based estimate of cumulative excess mortality in survivors of childhood cancer. Ann Intern Med 152(409–17):W131–W138Google Scholar
  5. 5.
    Skinner R, Wallace WH, Levitt GA (2006) Long-term follow-up of people who have survived cancer during childhood. Lancet Oncol 7:489–498PubMedCrossRefGoogle Scholar
  6. 6.
    Reulen RC, Winter DL, Frobisher C et al (2010) Long-term cause-specific mortality among survivors of childhood cancer. JAMA 304:172–179PubMedCrossRefGoogle Scholar
  7. 7.
    Oeffinger KC, Mertens AC, Sklar CA et al (2006) Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 355:1572–1582PubMedCrossRefGoogle Scholar
  8. 8.
    Garmey EG, Liu Q, Sklar CA et al (2008) Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. J Clin Oncol 26:4639–4645PubMedCrossRefGoogle Scholar
  9. 9.
    Gurney JG, Ness KK, Sibley SD et al (2006) Metabolic syndrome and growth hormone deficiency in adult survivors of childhood acute lymphoblastic leukemia. Cancer 107:1303–1312PubMedCrossRefGoogle Scholar
  10. 10.
    Oeffinger KC, Mertens AC, Sklar CA et al (2003) Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. J Clin Oncol 21:1359–1365PubMedCrossRefGoogle Scholar
  11. 11.
    Oeffinger KC, Adams-Huet B, Victor RG et al (2009) Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 27:3698–3704PubMedCrossRefGoogle Scholar
  12. 12.
    Meacham LR, Gurney JG, Mertens AC et al (2005) Body mass index in long-term adult survivors of childhood cancer: a report of the childhood cancer survivor study. Cancer 103:1730–1739PubMedCrossRefGoogle Scholar
  13. 13.
    Meacham LR, Sklar CA, Li S et al (2009) Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study. Arch Intern Med 169:1381–1388PubMedCrossRefGoogle Scholar
  14. 14.
    Tonorezos ES, Vega GL, Sklar CA et al (2012) Adipokines, body fatness, and insulin resistance among survivors of childhood leukemia. Pediatr Blood Cancer 58:31–36PubMedCrossRefGoogle Scholar
  15. 15.
    Keys A, Menotti A, Karvonen MJ et al (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124:903–915PubMedGoogle Scholar
  16. 16.
    de Lorgeril M, Renaud S, Mamelle N et al (1994) Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 343:1454–1459PubMedCrossRefGoogle Scholar
  17. 17.
    Singh RB, Dubnov G, Niaz MA et al (2002) Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 360:1455–1461PubMedCrossRefGoogle Scholar
  18. 18.
    Romaguera D, Norat T, Vergnaud AC et al (2010) Mediterranean dietary patterns and prospective weight change in participants of the EPIC-PANACEA project. Am J Clin Nutr 92:912–921PubMedCrossRefGoogle Scholar
  19. 19.
    Panagiotakos DB, Chrysohoou C, Pitsavos C, Stefanadis C (2006) Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study. Nutrition 22:449–456PubMedCrossRefGoogle Scholar
  20. 20.
    Tyrovolas S, Bountziouka V, Papairakleous N, et al (2009) Adherence to the Mediterranean diet is associated with lower prevalence of obesity among elderly people living in Mediterranean islands: the MEDIS study. Int J Food Sci Nutr 60:1–14Google Scholar
  21. 21.
    Alvarez Leon EE, Henriquez P, Serra-Majem L (2006) Mediterranean diet and metabolic syndrome: a cross-sectional study in the Canary Islands. Public Health Nutr 9:1089–1098PubMedGoogle Scholar
  22. 22.
    Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba JM, Martinez-Gonzalez MA (2007) Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 30:2957–2959PubMedCrossRefGoogle Scholar
  23. 23.
    Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57:1299–1313PubMedCrossRefGoogle Scholar
  24. 24.
    Esposito K, Ciotola M, Giugliano D (2007) Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res 51:1268–1274PubMedGoogle Scholar
  25. 25.
    Salas-Salvado J, Fernandez-Ballart J, Ros E et al (2008) Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med 168:2449–2458PubMedCrossRefGoogle Scholar
  26. 26.
    Janiszewski PM, Oeffinger KC, Church TS et al (2007) Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia. J Clin Endocrinol Metab 92:3816–3821PubMedCrossRefGoogle Scholar
  27. 27.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRefGoogle Scholar
  28. 28.
    Chen J, Wildman RP, Hamm LL et al (2004) Association between inflammation and insulin resistance in U.S. nondiabetic adults: results from the Third National Health and Nutrition Examination Survey. Diabetes Care 27:2960–2965PubMedCrossRefGoogle Scholar
  29. 29.
    Kulkarni KR (2006) Cholesterol profile measurement by vertical auto profile method. Clin Lab Med 26:787–802PubMedCrossRefGoogle Scholar
  30. 30.
    Kulkarni KR, Garber DW, Jones MK, Segrest JP (1995) Identification and cholesterol quantification of low density lipoprotein subclasses in young adults by VAP-II methodology. J Lipid Res 36:2291–2302PubMedGoogle Scholar
  31. 31.
    Aubourg A, Benboubker L, Picon L, Goupille P, Maillot F (2011) Successful autologous stem cell transplantation in Gaucher disease patient with multiple myeloma. Am J Hematol 86:529–530PubMedCrossRefGoogle Scholar
  32. 32.
    Hu FB, Rimm E, Smith-Warner SA et al (1999) Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 69:243–249PubMedGoogle Scholar
  33. 33.
    Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC (1992) Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 135:1114–1126 discussion 27–36PubMedGoogle Scholar
  34. 34.
    Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB (2012) Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr 95:1182–1189PubMedCrossRefGoogle Scholar
  35. 35.
    Adult Treatment Panel III (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA 285:2486–2497CrossRefGoogle Scholar
  36. 36.
    Andre D, Pelletier R, Farringdon J et al (2006) The development of the SenseWear armband, a revolutionary energy assessment device to assess physical activity and lifestyle. BodyMedia Inc., PittsburghGoogle Scholar
  37. 37.
    Liden CB, Wolowicz M, Stivoric J et al (2006) Characterization and implications of the sensors incorporated into the SenseWear armband for energy expenditure and activity detection. BodyMedia Inc., PittsburghGoogle Scholar
  38. 38.
    Jakicic JM, Marcus M, Gallagher KI et al (2004) Evaluation of the SenseWear Pro Armband (TM) to assess energy expenditure during exercise. Med Sci Sports Exerc 36:897–904PubMedGoogle Scholar
  39. 39.
    King GA, Torres N, Potter C, Brooks TJ, Coleman KJ (2004) Comparison of activity monitors to estimate energy cost of treadmill exercise. Med Sci Sports Exerc 36:1244–1251PubMedCrossRefGoogle Scholar
  40. 40.
    Welk GJ, McClain JJ, Eisenmann JC, Wickel EE (2007) Field validation of the MTI Actigraph and BodyMedia armband monitor using the IDEEA monitor. Obesity 15:918–928PubMedCrossRefGoogle Scholar
  41. 41.
    St-Onge M, Mignault D, Allison DB, Rabasa-Lhoret R (2007) Evaluation of a portable device to measure daily energy expenditure in free-living adults. Am J Clin Nutr 85:742–749PubMedGoogle Scholar
  42. 42.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608PubMedCrossRefGoogle Scholar
  43. 43.
    Esposito K, Marfella R, Ciotola M et al (2004) Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 292:1440–1446PubMedCrossRefGoogle Scholar
  44. 44.
    Knoops KT, de Groot LC, Kromhout D et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292:1433–1439PubMedCrossRefGoogle Scholar
  45. 45.
    Trichopoulou A, Orfanos P, Norat T et al (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330:991PubMedCrossRefGoogle Scholar
  46. 46.
    Maillot M, Issa C, Vieux F, Lairon D, Darmon N (2011) The shortest way to reach nutritional goals is to adopt Mediterranean food choices: evidence from computer-generated personalized diets. Am J Clin Nutr 94:1127–1137PubMedCrossRefGoogle Scholar
  47. 47.
    Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC (2011) Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr 93:601–607PubMedCrossRefGoogle Scholar
  48. 48.
    Robien K, Ness KK, Klesges LM, Baker KS, Gurney JG (2008) Poor adherence to dietary guidelines among adult survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 30:815–822PubMedCrossRefGoogle Scholar
  49. 49.
    Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D (2011) Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Met Syn Rel Dis 9:1–12CrossRefGoogle Scholar
  50. 50.
    Green DM, Cox CL, Zhu L et al (2012) Risk factors for obesity in adult survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 30:246–255PubMedCrossRefGoogle Scholar
  51. 51.
    Braitman LE, Adlin EV, Stanton JL Jr (1985) Obesity and caloric intake: the National Health and Nutrition Examination Survey of 1971–1975 (HANES I). J Chron Dis 38:727–732PubMedCrossRefGoogle Scholar
  52. 52.
    Lichtman SW, Pisarska K, Berman ER et al (1992) Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med 327:1893–1898PubMedCrossRefGoogle Scholar

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

Personalised recommendations