Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(02): 97-102
DOI: 10.4103/ijmpo.ijmpo_69_16
Original Article

Evaluation of Metabolic Syndrome and Related Factors in Children Affected by Acute Lymphoblastic Leukemia

Soheila Zareifar
Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Sezaneh Haghpanah
Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Eslam Shorafa
Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
,
Nader Shakibazad
Department of Pediatrics, Division of Pediatric Hematology/Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
,
Zohreh Karamizadeh
Department of Pediatrics, Division of Pediatric Endocrinology, Shiraz University of Medical Sciences, Shiraz, Iran
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Introduction: Obesity is among the medical problems in survivors of childhood acute lymphoblastic leukemia (ALL). These patients are at risk of metabolic syndrome (MS). The present study aimed to follow the patients with ALL regarding the incidence of MS. Patients and Methods: This study was conducted on all patients who referred to the oncology clinic from July 2012 to July 2013. The exclusion criteria of the study were ALL relapse, secondary malignancy, hypothyroidism, Down syndrome, and below 2 years of age. ALL had to be diagnosed at least 12 months before enrollment into this study. MS was assessed by serum triglyceride, cholesterol, fasting blood sugar, leptin, and insulin levels. Besides, body mass index (BMI) and blood pressure (BP) were measured at diagnosis and at the last visit. Results: This study was conducted on 53 patients (male = 35, female = 18). At the end of the study, 13 patients (24.53%) were overweight compared to 3 patients at diagnosis (P = 0.04). The mean blood leptin level was higher in overweight patients compared to the others (P = 0.001). MS was detected in 21 patients (39.6%), including 12 males and 9 females. In addition, the BMI Z- score significantly increased over the study period (P = 0.001). Conclusions: Being overweight is a complication of ALL treatment, which is associated with elevated blood leptin level and BMI Z- score. Therefore, MS criteria, such as BP, weight, and serum triglyceride level, should be taken into account in each visit.

Keywords

Acute lymphoblastic leukemia - body mass index - leptin - metabolic syndrome - overweight


Publication History

Article published online:
06 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ness KK, Armenian SH, Kadan-Lottick N, Gurney JG. Adverse effects of treatment in childhood acute lymphoblastic leukemia: General overview and implications for long-term cardiac health. Expert Rev Hematol 2011;4:185-97.
  • 2 Iughetti L, Bruzzi P, Predieri B, Paolucci P. Obesity in patients with acute lymphoblastic leukemia in childhood. Ital J Pediatr 2012;38:4.
  • 3 Robison LL. Late effects of acute lymphoblastic leukemia therapy in patients diagnosed at 0-20 years of age. Hematology Am Soc Hematol Educ Program 2011;2011:238-42.
  • 4 Haddy TB, Mosher RB, Reaman GH. Late effects in long-term survivors after treatment for childhood acute leukemia. Clin Pediatr (Phila) 2009;48:601-8.
  • 5 Withycombe JS, Post-White JE, Meza JL, Hawks RG, Smith LM, Sacks N, et al. Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961. Pediatr Blood Cancer 2009;53:1249-54.
  • 6 Pakakasama S, Veerakul G, Sosothikul D, Chainansamit SO, Laosombat V, Thanarattanakorn P, et al. Late effects in survivors of childhood acute lymphoblastic leukemia: A study from Thai Pediatric Oncology Group. Int J Hematol 2010;91:850-4.
  • 7 Wallace AM, Tucker P, Williams DM, Hughes IA, Ahmed SF. Short-term effects of prednisolone and dexamethasone on circulating concentrations of leptin and sex hormone-binding globulin in children being treated for acute lymphoblastic leukaemia. Clin Endocrinol (Oxf) 2003;58:770-6.
  • 8 Skoczen S, Tomasik PJ, Bik-Multanowski M, Surmiak M, Balwierz W, Pietrzyk JJ, et al. Plasma levels of leptin and soluble leptin receptor and polymorphisms of leptin gene -18G>A and leptin receptor genes K109R and Q223R, in survivors of childhood acute lymphoblastic leukemia. J Exp Clin Cancer Res 2011;30:64.
  • 9 Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC Growth Charts for the United States: Methods and development. Vital Health Stat 11 2002;246:1-190.
  • 10 Available from: http://www.cdc.gov/growthcharts/clinical_charts.htm. [Last accessed 2016 Mar 28].
  • 11 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. 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 (Adult Treatment Panel III). JAMA 2001;285:2486-97.
  • 12 Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-74.
  • 13 Lamerz A, Kuepper-Nybelen J, Wehle C, Bruning N, Trost-Brinkhues G, Brenner H, et al. Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany. Int J Obes (Lond) 2005;29:373-80.
  • 14 Zhang LD, Li YH, Ke ZY, Huang LB, Luo XQ. Obesity as the initial manifestation of central nervous system relapse of acute lymphoblastic leukemia: Case report and literature review. J Cancer Res Ther 2012;8:151-3.
  • 15 Aldhafiri F, Al-Nasser A, Al-Sugair A, Al-Mutairi H, Young D, Reilly JJ. Obesity and metabolic syndrome in adolescent survivors of standard risk childhood acute lymphoblastic leukemia in Saudi Arabia. Pediatr Blood Cancer 2012;59:133-7.
  • 16 Jansen H, Postma A, Stolk RP, Kamps WA. Acute lymphoblastic leukemia and obesity: Increased energy intake or decreased physical activity? Support Care Cancer 2009;17:103-6.
  • 17 Szymon S, Bik-Multanowski M, Balwierz W, Pietrzyk JJ, Surmiak M, Strojny W, et al. Homozygosity for the rs9939609T allele of the FTO gene may have protective effect on becoming overweight in survivors of childhood acute lymphoblastic leukaemia. J Genet 2011;90:365-8.
  • 18 Collins L, Zarzabal LA, Nayiager T, Pollock BH, Barr RD. Growth in children with acute lymphoblastic leukemia during treatment. J Pediatr Hematol Oncol 2010;32:e304-7.
  • 19 Gofman I, Ducore J. Risk factors for the development of obesity in children surviving ALL and NHL. J Pediatr Hematol Oncol 2009;31:101-7.
  • 20 Butturini AM, Dorey FJ, Lange BJ, Henry DW, Gaynon PS, Fu C, et al. Obesity and outcome in pediatric acute lymphoblastic leukemia. J Clin Oncol 2007;25:2063-9.
  • 21 Wex H, Ponelis E, Wex T, Dressendörfer R, Mittler U, Vorwerk P. Plasma leptin and leptin receptor expression in childhood acute lymphoblastic leukemia. Int J Hematol 2002;76:446-52.
  • 22 Ethier MC, Alexander S, Abla O, Green G, Lam R, Sung L. Association between obesity at diagnosis and weight change during induction and survival in pediatric acute lymphoblastic leukemia. Leuk Lymphoma 2012;53:1677-81.
  • 23 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;51:118-22.
  • 24 Razzouk BI, Rose SR, Hongeng S, Wallace D, Smeltzer MP, Zacher M, et al. Obesity in survivors of childhood acute lymphoblastic leukemia and lymphoma. J Clin Oncol 2007;25:1183-9.
  • 25 Tonorezos ES, Vega GL, Sklar CA, Chou JF, Moskowitz CS, Mo Q, et al. Adipokines, body fatness, and insulin resistance among survivors of childhood leukemia. Pediatr Blood Cancer 2012;58:31-6.
  • 26 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 2008;26:4639-45.
  • 27 Esbenshade AJ, Simmons JH, Koyama T, Lindell RB, Friedman DL. Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy. Pediatr Blood Cancer 2013;60:1287-91.
  • 28 Reisi N, Azhir A, Hashemipour M, Raeissi P, Amini A, Moafi A. The metabolic syndrome in survivors of childhood acute lymphoblastic leukemia in Isfahan, Iran. J Res Med Sci 2009;14:111-6.
  • 29 Huffman FG, Kanikireddy S, Patel M. Parenthood – A contributing factor to childhood obesity. Int J Environ Res Public Health 2010;7:2800-10.