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Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy
Author(s) -
Esbenshade Adam J.,
Simmons Jill H.,
Koyama Tatsuki,
Lindell Robert B.,
Friedman Debra L.
Publication year - 2013
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.24489
Subject(s) - medicine , adiponectin , insulin resistance , leptin , homeostatic model assessment , body mass index , blood pressure , insulin , metabolic syndrome , endocrinology , obesity , cohort , gastroenterology
Background Pediatric acute lymphoblastic leukemia (ALL) survivors are at increased risk for the metabolic syndrome (MS). To establish the trajectory of development during active treatment, we followed patients longitudinally over the first year of maintenance therapy. Procedure In a prospective cohort of 34 pediatric ALL patients, followed over the first 12 months of ALL maintenance, we evaluated changes in body mass index (BMI), blood pressure, fasting insulin and glucose, lipids, Homeostatic Metabolic Assessment (HOMA), leptin, and adiponectin. Results Over the study time period, the median BMI z‐score increased from 0.29 to 0.66 ( P = 0.001), median fasting insulin levels increased from 2.9 to 3.1 µU/ml ( P = 0.023), and the proportion of patients with insulin resistance by HOMA (>3.15) increased from 3% to 24% ( P = 0.016). Median leptin increased from 2.5 to 3.5 ng/ml ( P = 0.001), with levels correlated with BMI z‐score. Median adiponectin level decreased from 18.0 to 14.0 µg/ml ( P = 0.009), with levels inversely correlated to BMI z‐score. No change in median total cholesterol and LDL levels was observed. Median triglycerides decreased ( P < 0.001) and there was a trend to increase in HDL ( P = 0.058). Blood pressure did not significantly change, although overall prevalence of systolic and diastolic hypertension was high (23.5% and 26.4%, respectively). Conclusions Following patients over the first year of ALL maintenance therapy demonstrated that components of the MS significantly worsen over time. Preventive interventions limiting increases in BMI and insulin resistance during maintenance therapy should be targeted during this time period to avoid long‐term morbidity associated with the MS in long‐term survivors. Pediatr Blood Cancer 2013;601287‐1291. © 2013 Wiley Periodicals, Inc.