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Body mass index predicts insulin resistance in survivors of pediatric acute lymphoblastic leukemia
Author(s) -
Lowas Stefanie,
Malempati Suman,
Marks Daniel
Publication year - 2009
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21993
Subject(s) - medicine , insulin resistance , body mass index , prediabetes , insulin , endocrinology , diabetes mellitus , type 2 diabetes
Abstract Background Pediatric acute lymphoblastic leukemia (ALL) therapies have been associated with many late effects, including obesity, hyperglycemia, and insulin resistance. Few data are available linking these abnormalities to specific risk factors present during ALL treatment. Methods Retrospective cohort study with prospective follow‐up. Subjects had been diagnosed with ALL at ages 1–18 years and had been off chemotherapy for >9 months. Oral glucose tolerance testing (OGTT) was performed and these results compared to demographic, treatment, and anthropomorphic data from medical records. Results Twenty‐seven subjects (11 female) were evaluated. Mean (±SD) diagnosis age 5.7 ± 3.5 years, mean study age 11.3 ± 3.7 years, mean time off therapy 2.8 ± 1.5 years. Six subjects had transient hyperglycemia during ALL treatment. At study time, one subject had prediabetes; eight (29.6%) had insulin resistance. Insulin resistance was not predicted by glucose levels during treatment, cumulative steroid or asparaginase dose, or type of steroid received. Body mass index (BMI) for age correlated significantly with several measures of insulin resistance, including fasting insulin, HOMA index, Matsuda index and insulin AUC ( P = 0.001–0.009). Waist/hip ratio and BMI at ALL diagnosis also correlated with insulin resistance, but these factors' effects could not be separated from BMI at study time. Conclusions Variations in ALL therapy and presence of transient hyperglycemia do not appear to increase risk of glucose intolerance or insulin resistance in the first few years after completion of therapy. Elevated BMI strongly predicted insulin resistance in this study, as it does in the general population. Pediatr Blood Cancer 2009;53:58–63. © 2009 Wiley‐Liss, Inc.