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A meta-analysis of body mass index of adolescent and adult survivors of pediatric acute lymphoblastic leukemia

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Abstract

Purpose

We conducted a meta-analysis of existing studies to examine body mass index (BMI) of adolescent and adult survivors of pediatric acute lymphoblastic leukemia (ALL) compared to individuals without cancer.

Methods

Studies were identified and reviewed using specific inclusion criteria. The effect size was odds ratio (OR) of the prevalence of overweight/obese BMI (≥25 kg/m2) in ALL survivors versus comparison groups. Study data were coded and validated. Fixed-effects (FE) and random-effects (RE) estimates of the effect size were estimated.

Results

A total of 9 studies met our inclusion criteria. Survivors were more likely to be overweight/obese compared to comparison groups (FE OR = 1.12, 95 % CI 1.06–1.18 and RE OR = 1.28, 95 % CI 1.07–1.53). When limited to studies from North American samples, female survivors were overweight/obese more often than the comparison groups (FE OR = 1.30, 95 % CI 1.19–1.43).

Conclusions

Adolescent and adult survivors of pediatric ALL, especially female survivors, may be at a higher risk of being overweight/obese compared to individuals without cancer. However, few studies provided detailed information on patient and treatment factors (e.g., cranial radiation) that can impact BMI. Standardized reporting of study content is vital for providing robust information on the risk of developing late effects among cancer survivors.

Implications for cancer survivors

Adolescent and adult survivors of pediatric ALL require additional weight management resources such as targeted counseling for physical activity and dietician support both early in treatment and after the end of their therapy. Female survivors may need additional guidance to develop healthy eating practices and to participate in exercise programs.

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References

  1. Ma H, Sun H, Sun X. Survival improvement by decade of patients aged 0–14 years with acute lymphoblastic leukemia: a SEER analysis. Sci Rep. 2014;4:4227. doi:10.1038/srep04227.

    PubMed Central  PubMed  Google Scholar 

  2. Leukemia & Lymphoma Society. Facts Spring 2014. http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/generalcancer/pdf/facts.pdf. Accessed 3 July 2014.

  3. Oeffinger KC, Eshelman DA, Tomlinson GE, Buchanan GR, Foster BM. Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting. Cancer. 2000;88(7):1687–95.

    Article  CAS  PubMed  Google Scholar 

  4. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82. doi:10.1056/NEJMsa060185.

    Article  CAS  PubMed  Google Scholar 

  5. Asner S, Ammann RA, Ozsahin H, Beck-Popovic M, von der Weid NX. Obesity in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2008;51(1):118–22. doi:10.1002/pbc.21496.

    Article  CAS  PubMed  Google Scholar 

  6. Oeffinger KC, Mertens AC, Sklar CA, Yasui Y, Fears T, Stovall M, et al. Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21(7):1359–65.

    Article  Google Scholar 

  7. Shaw MP, Bath LE, Duff J, Kelnar CJ, Wallace WH. Obesity in leukemia survivors: the familial contribution. Pediatr Hematol Oncol. 2000;17(3):231–7. doi:10.1080/088800100276406.

    Article  CAS  PubMed  Google Scholar 

  8. Warner EL, Fluchel M, Wright J, Sweeney C, Boucher KM, Fraser A, et al. A population-based study of childhood cancer survivors’ body mass index. J Cancer Epidemiol. 2014;2014:531958. doi:10.1155/2014/531958.

    PubMed Central  PubMed  Google Scholar 

  9. National Obesity Observatory. A simple guide to classifying body mass index in children. 2011. http://www.noo.org.uk/uploads/doc/vid_11601_A_simple_guide_to_classifying. Accessed 3 July 2014.

  10. Zhang FF, Kelly MJ, Saltzman E, Must A, Roberts SB, Parsons SK. Obesity in pediatric ALL survivors: a meta-analysis. Pediatrics. 2014;133(3):e704–15. doi:10.1542/peds. 2013-3332.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Chow EJ, Pihoker C, Hunt K, Wilkinson K, Friedman DL. Obesity and hypertension among children after treatment for acute lymphoblastic leukemia. Cancer. 2007;110(10):2313–20. doi:10.1002/cncr.23050.

    Article  PubMed  Google Scholar 

  12. Garmey EG, Liu Q, Sklar CA, Meacham LR, Mertens AC, Stovall MA, et al. 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 Off J Am Soc Clin Oncol. 2008;26(28):4639–45. doi:10.1200/jco.2008.16.3527.

    Article  Google Scholar 

  13. Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC, et al. Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49(7):975–81. doi:10.1002/pbc.21091.

    Article  PubMed  Google Scholar 

  14. Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. doi:10.1097/01.SLA.0000071560.76194.11.

  15. Poirier P, Eckel RH. Obesity and cardiovascular disease. Curr Atheroscler Rep. 2002;4(6):448–53.

    Article  PubMed  Google Scholar 

  16. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91. doi:10.1038/nrc1408.

    Article  CAS  PubMed  Google Scholar 

  17. Nathan PC, Daugherty CK, Wroblewski KE, Kigin ML, Stewart TV, Hlubocky FJ, et al. Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. J Cancer Survivorship: Res Pract. 2013;7(3):275–82. doi:10.1007/s11764-013-0271-0.

    Article  Google Scholar 

  18. Henderson TO, Hlubocky FJ, Wroblewski KE, Diller L, Daugherty CK. Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: a mailed survey of pediatric oncologists. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(5):878–83. doi:10.1200/jco.2009.25.6107.

    Article  Google Scholar 

  19. Centers for Disease Control and Prevention. Child development—teenagers (15–17 years of age). 2014. http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.html. Accessed 3 July 2014.

  20. Geenen MM, Bakker PJ, Kremer LC, Kastelein JJ, van Leeuwen FE. Increased prevalence of risk factors for cardiovascular disease in long-term survivors of acute lymphoblastic leukemia and Wilms tumor treated with radiotherapy. Pediatr Blood Cancer. 2010;55(4):690–7. doi:10.1002/pbc.22518.

    Article  CAS  PubMed  Google Scholar 

  21. Birkebaek NH, Clausen N. Height and weight pattern up to 20 years after treatment for acute lymphoblastic leukaemia. Arch Dis Child. 1998;79(2):161–4.

    Article  CAS  PubMed  Google Scholar 

  22. Veringa SJ, van Dulmen-den BE, Kaspers GJ, Veening MA. Blood pressure and body composition in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2012;58(2):278–82. doi:10.1002/pbc.23251.

    Article  PubMed  Google Scholar 

  23. Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, Hudson MM, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev: Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2007;16(7):1356–63. doi:10.1158/1055-9965.epi-07-0048.

    Article  Google Scholar 

  24. Meacham LR, Gurney JG, Mertens AC, Ness KK, Sklar CA, Robison LL, et al. Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study. Cancer. 2005;103(8):1730–9. doi:10.1002/cncr.20960.

    Article  PubMed  Google Scholar 

  25. Jarfelt M, Lannering B, Bosaeus I, Johannsson G, Bjarnason R. Body composition in young adult survivors of childhood acute lymphoblastic leukaemia. Eur J Endocrinol Eur Fed Endocr Soc. 2005;153(1):81–9. doi:10.1530/eje.1.01931.

    Article  CAS  Google Scholar 

  26. Tylavsky FA, Smith K, Surprise H, Garland S, Yan X, McCammon E, et al. Nutritional intake of long-term survivors of childhood acute lymphoblastic leukemia: evidence for bone health interventional opportunities. Pediatr Blood Cancer. 2010;55(7):1362–9. doi:10.1002/pbc.22737.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Jarvela LS, Niinikoski H, Lahteenmaki PM, Heinonen OJ, Kapanen J, Arola M, et al. Physical activity and fitness in adolescent and young adult long-term survivors of childhood acute lymphoblastic leukaemia. J Cancer Survivorship: Res Pract. 2010;4(4):339–45. doi:10.1007/s11764-010-0131-0.

    Article  Google Scholar 

  28. National Institute of Health National Heart, Lung and Blood Institute. Aim for a healthy weight—assessing your weight and health risk. 2014. http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm. Accessed 3 July, 2014.

  29. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Independent subgroups within a study. Introduction to meta-analysis. Wiley, Ltd; 2009. p. 217–23.

  30. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Fixed-effect versus random-effects models. Introduction to meta-analysis. Wiley, Ltd; 2009. p. 77–86.

  31. Biggerstaff BJ, Tweedie RL. Incorporating variability in estimates of heterogeneity in the random effects model in meta-analysis. Stat Med. 1997;16(7):753–68.

    Article  CAS  PubMed  Google Scholar 

  32. Mannocci A. The Mantel-Haenszel procedure. 50 years of the statistical method for confounders control. Italian J Public Health. 2009;6(4):338–40. doi:10.2427/5765.

    Google Scholar 

  33. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. doi:10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  34. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67. doi:10.1016/s0140-6736(10)62037-5.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA: J Am Med Assoc. 2006;295(13):1549–55. doi:10.1001/jama.295.13.1549.

    Article  CAS  Google Scholar 

  36. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Multiple outcomes or time-points within a study. Introduction to meta-analysis. Wiley, Ltd; 2009. p. 225–38.

  37. Yao X, Gomes MM, Tsao MS, Allen CJ, Geddie W, Sekhon H. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: a systematic review. Curr Oncol (Toronto, Ont). 2012;19(1):e16–27. doi:10.3747/co.19.871.

    CAS  Google Scholar 

  38. Russell HV, Panchal J, Vonville H, Franzini L, Swint JM. Economic evaluation of pediatric cancer treatment: a systematic literature review. Pediatrics. 2013;131(1):e273–87. doi:10.1542/peds. 2012-0912.

    Article  PubMed  Google Scholar 

  39. Iughetti L, Bruzzi P, Predieri B, Paolucci P. Obesity in patients with acute lymphoblastic leukemia in childhood. Ital J Pediatr. 2012;38:4. doi:10.1186/1824-7288-38-4.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Zhang FF, Rodday AM, Kelly MJ, Must A, MacPherson C, Roberts SB, et al. Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer. 2014;61(7):1263–9. doi:10.1002/pbc.24960.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Mattano Jr LA, Sather HN, Trigg ME, Nachman JB. Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: a report from the Children’s Cancer Group. J Clin Oncol: Off J Am Soc Clin Oncol. 2000;18(18):3262–72.

    Google Scholar 

  42. Irwin ML. Physical activity interventions for cancer survivors. Br J Sports Med. 2009;43(1):32–8. doi:10.1136/bjsm.2008.053843.

    Article  CAS  PubMed  Google Scholar 

  43. Deurenberg P, Weststrate JA, Seidell JC. Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 1991;65(2):105–14.

    Article  CAS  PubMed  Google Scholar 

  44. White J, Flohr JA, Winter SS, Vener J, Feinauer LR, Ransdell LB. Potential benefits of physical activity for children with acute lymphoblastic leukaemia. Pediatr Rehabil. 2005;8(1):53–8.

    PubMed  Google Scholar 

  45. Barnes MJ, Demark-Wahnefried W. Importance of balanced diet and physical activity during and after cancer treatment in adolescent patients. Clin Oncol Adolesc Young Adults. 2014;4:13–20. doi:10.2147/COAYA.S62567.

    Article  Google Scholar 

  46. Demark-Wahnefried W, Platz EA, Ligibel JA, Blair CK, Courneya KS, Meyerhardt JA, et al. The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomarkers Prev: Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2012;21(8):1244–59. doi:10.1158/1055-9965.EPI-12-0485.

    Article  Google Scholar 

  47. Huang TT, Ness KK. Exercise interventions in children with cancer: a review. Int J Pediatr. 2011;2011:461512. doi:10.1155/2011/461512.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Ladas EJ, Sacks N, Brophy P, Rogers PC. Standards of nutritional care in pediatric oncology: results from a nationwide survey on the standards of practice in pediatric oncology. A Children’s Oncology Group study. Pediatr Blood Cancer. 2006;46(3):339–44. doi:10.1002/pbc.20435.

    Article  PubMed  Google Scholar 

  49. American Cancer Society. Nutrition for children with cancer. 2014. http://www.cancer.org/acs/groups/cid/documents/webcontent/002902-pdf.pdf. Accessed 5 November, 2014.

  50. Tota-Maharaj R, Defilippis AP, Blumenthal RS, Blaha MJ. A practical approach to the metabolic syndrome: review of current concepts and management. Curr Opin Cardiol. 2010;25(5):502–12. doi:10.1097/HCO.0b013e32833cd474.

    Article  PubMed  Google Scholar 

  51. Brunner EJ, Rees K, Ward K, Burke M, Thorogood M. Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev. 2007;4:CD002128. doi:10.1002/14651858.CD002128.pub3.

    PubMed  Google Scholar 

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Funding and other disclosures

This study was funded by the Primary Children’s Hospital (PCH) Pediatric Cancer Program that is supported by the Intermountain Healthcare Foundation and the Primary Children’s Hospital Foundation. Additional support was provided by the Center for Children’s Cancer Research at the Huntsman Cancer Institute at the University of Utah. The authors have no financial or other interests to report.

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The authors declare that they have no conflict of interest.

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Correspondence to Anne C. Kirchhoff.

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Nam, G.E., Kaul, S., Wu, Y. et al. A meta-analysis of body mass index of adolescent and adult survivors of pediatric acute lymphoblastic leukemia. J Cancer Surviv 9, 412–421 (2015). https://doi.org/10.1007/s11764-014-0415-x

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  • DOI: https://doi.org/10.1007/s11764-014-0415-x

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