1
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Al Zein M, Akomolafe AF, Mahmood FR, Khrayzat A, Sahebkar A, Pintus G, Kobeissy F, Eid AH. Leptin is a potential biomarker of childhood obesity and an indicator of the effectiveness of weight-loss interventions. Obes Rev 2024:e13807. [PMID: 39044542 DOI: 10.1111/obr.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/12/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
Childhood obesity represents a significant public health concern, imposing a substantial burden on the healthcare system. Furthermore, weight-loss programs often exhibit reduced effectiveness in adults who have a history of childhood obesity. Therefore, early intervention against childhood obesity is imperative. Presently, the primary method for diagnosing childhood obesity relies on body mass index (BMI), yet this approach has inherent limitations. Leptin, a satiety hormone produced by adipocytes, holds promise as a superior tool for predicting both childhood and subsequent adulthood obesity. In this review, we elucidate the tools employed for assessing obesity in children, delve into the biological functions of leptin, and examine the factors governing its expression. Additionally, we discuss maternal and infantile leptin levels as predictors of childhood obesity. By exploring the relationship between leptin levels and weight loss, we present leptin as a potential indicator of the effectiveness of obesity interventions.
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Affiliation(s)
- Mohammad Al Zein
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Fathima R Mahmood
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ali Khrayzat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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2
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Hammoud RA, Mulrooney DA, Rhea IB, Yu C, Johnson JN, Chow EJ, Ehrhardt MJ, Hudson MM, Ness KK, Armstrong GT, Dixon SB. Modifiable Cardiometabolic Risk Factors in Survivors of Childhood Cancer: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:16-32. [PMID: 38510292 PMCID: PMC10950443 DOI: 10.1016/j.jaccao.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 03/22/2024] Open
Abstract
The growing community of childhood cancer survivors faces a heavy burden of late onset morbidities and mortality, with cardiovascular diseases being the leading noncancer cause. In addition to demographics and cancer treatment exposures, which cannot be altered, cardiometabolic risk factors (obesity, hypertension, diabetes, and dyslipidemia) and frailty potentiate the risk of morbidity and mortality associated with chronic health conditions. Important opportunities exist to target these risk factors and improve late health outcomes for survivors. Unfortunately, limited evidence exists on the optimal methods to prevent, screen, and treat cardiometabolic risk factors among survivors, resulting in significant underdiagnosis and undertreatment. In this review, we discuss the prevalence of, risk factors for, current survivor-specific recommendations, and gaps in knowledge to mitigate potentially modifiable cardiometabolic risk factors and frailty among survivors of childhood cancer.
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Affiliation(s)
- Rawan A. Hammoud
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Isaac B. Rhea
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christine Yu
- Department of Pediatric Medicine, Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason N. Johnson
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie B. Dixon
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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3
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Pluimakers VG, van Atteveld JE, de Winter DTC, Bolier M, Fiocco M, Nievelstein RJAJ, Janssens GOR, Bresters D, van der Heiden-van der Loo M, de Vries ACH, Louwerens M, van der Pal HJ, Pluijm SMF, Ronckers CM, Versluijs AB, Kremer LCM, Loonen JJ, van Dulmen-den Broeder E, Tissing WJE, van Santen HM, van den Heuvel-Eibrink MM, Neggers SJCMM. Prevalence, risk factors, and optimal way to determine overweight, obesity, and morbid obesity in the first Dutch cohort of 2338 long-term survivors of childhood cancer: a DCCSS-LATER study. Eur J Endocrinol 2023; 189:495-507. [PMID: 37837608 DOI: 10.1093/ejendo/lvad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Overweight and obesity are common challenges among childhood cancer survivors. Overweight may be disguised, as survivors can have normal weight but high fat percentage (fat%) on dual-energy X-ray absorptiometry (DXA). We aimed to assess prevalence, identify determinants and biomarkers, and assess which method captures overweight best, in a nationwide cohort. METHODS The prevalence of overweight and obesity, primarily defined by body mass index (BMI), was assessed in the DCCSS-LATER cohort of adult survivors treated from 1963-2002, with the LifeLines cohort as reference. The associations between risk factors and overweight metrics were investigated using logistic regression. Additional overweight metrics included DXA fat%, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and high-molecular-weight (HMW) adiponectin. RESULTS A total of 2338 (mean age 35.5 years, follow-up 28.3 years) survivors participated. The overweight prevalence was 46.3% in men and 44.3% in women (obesity 11.2% and 15.9%, morbid obesity 2.4% and 5.4%), with highest rates among brain tumor survivors. Compared to controls, there was no overall increased overweight rate, but this was higher in women > 50 years, morbid obesity in men > 50 years. Overweight at cancer diagnosis (adjusted odds ratio [aOR] = 3.83, 95% CI 2.19-6.69), cranial radiotherapy (aOR = 3.21, 95% CI 1.99-5.18), and growth hormone deficiency (separate model, aOR = 1.61, 95% CI 1.00-2.59) were associated with overweight. Using BMI, WC, WHR, and WHtR, overweight prevalence was similar. Low HMW adiponectin, present in only 4.5% of survivors, was an insensitive overweight marker. Dual-energy X-ray absorptiometry-based classification identified overweight in an additional 30%, particularly after abdominal radiotherapy, total body irradiation, anthracyclines, and platinum. CONCLUSIONS Overweight occurs in almost half of long-term survivors. There was no overall increased incidence of overweight compared to controls. We identified factors associated with overweight, as well as subgroups of survivors in whom DXA can more reliably assess overweight.
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Affiliation(s)
| | | | - Demi T C de Winter
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Melissa Bolier
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden 2333 ZA, The Netherlands
- Mathematical Institute Leiden University, Leiden 2333 ZA, The Netherlands
| | - Rutger Jan A J Nievelstein
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Radiology & Nuclear Medicine, UMC Utrecht, Utrecht 3584 CX, The Netherlands
| | - Geert O R Janssens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Radiation Oncology, UMC Utrecht, Utrecht 3584 CX, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus MC, Rotterdam 3015 CN, The Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden UMC, Leiden 2333 ZA, The Netherlands
| | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg 26129, Germany
| | - Andrica B Versluijs
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/UMC Utrecht, Utrecht 3584 EA, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC, Amsterdam 1105 AZ, The Netherlands
| | | | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, University of Groningen, UMC Groningen, Groningen 9713 GZ, The Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/UMC Utrecht, Utrecht 3584 EA, The Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Medicine, Section Endocrinology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
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4
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Marunowski K, Świętoń D, Bzyl W, Grzywińska M, Bandosz P, Khrichenko D, Piskunowicz M. Reference values for MRI-derived psoas and paraspinal muscles and macroscopic fat infiltrations in paraspinal muscles in children. J Cachexia Sarcopenia Muscle 2022; 13:2515-2524. [PMID: 35851581 PMCID: PMC9530503 DOI: 10.1002/jcsm.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sarcopenia, defined as loss of skeletal muscle mass, is a novel term associated with adverse outcomes in children. Magnetic Resonance Imaging (MRI) is a safe and precise technique for measuring tissue compartments and is commonly used in most routine paediatric imaging protocols. Currently, there is a lack of MRI-derived normative data which can help in determining the level of sarcopenia. This study aimed to introduce reference values of total psoas muscle area (tPMA), total paraspinal muscle area (tPSMA), and total macroscopic fat infiltrations of the PSMA (tMFI). METHODS In this retrospective study, the local database was searched for abdominal and pelvic region MRI studies of children aged from 1 to 18 years (mean age (standard deviation (SD)) of 9.8 (5.5) years) performed in the years 2010-2021. Children with chronic diseases and a history of surgical interventions were excluded from the analysis. Finally, a total of 465 healthy children (n = 233 girls, n = 232 boys) were enrolled in the study. The values of the tPMA, tPMSA, and tMFI were measured in square centimetres (cm2 ) at the level of the L4/L5 intervertebral disc as the sum of the left and right regions. Age-specific and sex-specific muscle, fat, and body mass index percentile charts were constructed using the LMS method. Inter-observer agreement and intra-observer reproducibility were assessed using the Bland-Altman plots. RESULTS Both tPMA and tPSMA showed continuous increases in size (in cm2 ) throughout all age groups. At the age of 18, the median tPMA areas reached 26.37 cm2 in girls and 40.43 cm2 in boys. Corresponding tPSMA values were higher, reaching the level of 40.76 cm2 in girls and 56.66 cm2 in boys. The mean value of tMFI within the paraspinal muscles was 5.0% (SD 3.65%) of their total area in girls and 3.5% (SD 2.25%) in boys with the actual difference between sexes up to 0.96 cm2 . Excellent intra-observer reproducibility and inter-observer agreement were noted. Actual mean differences for tPMA were at the level of 0.43 and 0.39 cm2 , respectively. Mean bias for tPSMA was 0.1 cm2 for inter-observer and 0.05 cm2 for intra-observer measurements. CONCLUSIONS Our findings demonstrate novel and highly reproducible sex-specific MRI-derived reference values of tPMS, tPSMA, and tMFI at the level of the L4/L5 intervertebral disc for children from 1 to 18 years old, which may guide a clinician in the assessment of sarcopenia, a prognostic outcome marker in children.
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Affiliation(s)
- Kacper Marunowski
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Włodzimierz Bzyl
- Faculty of Mathematics, Physics, and Informatics, University of Gdansk, Gdansk, Poland
| | | | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland
| | - Dmitry Khrichenko
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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5
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Scarano E, Solari D, Riccio E, Arianna R, Somma T, Cavallo LM, Romano F, Colao A, Di Somma C. Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience. Front Neurol 2022; 13:783737. [PMID: 35356458 PMCID: PMC8959765 DOI: 10.3389/fneur.2022.783737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with craniopharyngioma often have comorbidities, such as obesity and hypopituitarism. These two conditions affect each other and worsen the quality of life of patients, which lead to a higher risk of morbidity and mortality. In addition, abdominal obesity, measured as waist circumference (WC), is together with other parameters [arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol], one of the components of metabolic syndrome (MS). Each one of these morbidities occurs in patients with craniopharyngioma more frequently than in the remaining population. On these bases, we evaluated metabolic parameters in patients with craniopharyngioma at the time of diagnosis and after a 5-year follow-up, which compares these data with those of age-, gender-, WC-, and body mass index (BMI)-matched controls. In addition, we evaluated the prevalence of MS according to IDF criteria (MS-IDF) and the prevalence of MS according to ATP III (MS-ATPIII) criteria in patients and controls at baseline and after 5 years. We recruited 20 patients with craniopharyngioma (age 38.5 ± 15 years, 10 M) and 20 age-, gender-, WC- and BMI-matched controls (age 34.16 ± 13.19 years, 10 M). In all patients and controls, we evaluated the following: anthropometric features [height, weight, BMI, WC, hip circumference (HC) and waist-to-hip ratio (WHR)], systolic blood pressure (SBP) and diastolic blood pressure (DBP), lipid profile [total cholesterol (TC), HDL, low-density lipoprotein (LDL) cholesterol, triglycerides (TG)], and blood glucose at baseline and after 5 years. The prevalence of MS, according to IDF and ATPIII criteria, was calculated in the two groups at baseline and after 5 years. According to our results, at baseline, patients with craniopharyngioma had a worse metabolic profile than controls and a higher prevalence of MS. Besides, at a 5-year follow-up, patients still had impaired metabolic characteristics and more frequent MS (according to IDF and ATPIII criteria) when compared to controls. These data confirm that MS in patients with craniopharyngioma is unresponsive to life-changing interventions and to a common pharmacological approach. Other factors may be involved in the evolution of these conditions; so, further studies are needed to establish the correct management of these patients.
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Affiliation(s)
- Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Enrico Riccio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rossana Arianna
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Fiammetta Romano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University of Naples Federico II, Naples, Italy
| | - Carolina Di Somma
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University of Naples Federico II, Naples, Italy
- *Correspondence: Carolina Di Somma
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6
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The triponderal mass index as a measure of adiposity in pediatric survivors of acute lymphoblastic leukemia: a cross-sectional study. Sci Rep 2022; 12:1404. [PMID: 35082328 PMCID: PMC8792003 DOI: 10.1038/s41598-022-05236-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. Treatments of ALL predispose survivors to obesity, which increases the risk of cardiovascular disease and diabetes. The hallmark of obesity is excess fat mass, and adiposity is a superior predictor of cardiometabolic risk when compared to Body Mass Index (BMI), yet clinical measures of adiposity in children are lacking. The Tri-Ponderal Mass Index (TMI) (kg/m3) is a more accurate adiposity measure compared to BMI z-score in the general pediatric population. This cross-sectional study aimed to validate TMI as an adiposity measure against DEXA scan-derived adiposity, and to compare it to BMI z-score, in pediatric ALL survivors. This study was a retrospective chart review of pediatric ALL survivors diagnosed between 2004 and 2015 at McMaster Children’s Hospital, a tertiary pediatric center in Ontario, Canada. One hundred and thirteen patients (Female n = 55, 48.70%) were included, and adiposity was measured using DEXA scans. Exploratory partial correlations and linear regression analyses were adjusted for age, sex, ethnicity, and ALL risk status. Both TMI and BMI z-score correlated with the DEXA-measured fat mass percentage (FM%) (partial correlation TMI versus FM% r = 0.56; p value < 0.0001; BMI z-score versus FM% r = 0.55; p value < 0.0001). In regression analyses, the association of TMI was not inferior to BMI z-score in assessing adiposity (TMI versus FM% estimated unstandardized B 0.80, 95% CI 0.56, 1.02; p value < 0.0001; BMI z-score versus FM% (unstandardized B 0.37, 95% CI 0.26, 0.49; p value < 0.0001). The TMI is a useful clinical adiposity-specific measure in survivors of pediatric ALL.
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7
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Pluimakers VG, van Santen SS, Fiocco M, Bakker MCE, van der Lelij AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review. Obes Rev 2021; 22:e13312. [PMID: 34258851 PMCID: PMC8596408 DOI: 10.1111/obr.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.
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Affiliation(s)
| | - Selveta S van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Marie-Christine E Bakker
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, University Medical Center Utrecht, Netherlands
| | - Aart J van der Lelij
- Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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8
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Marunowski K, Świętoń D, Bzyl W, Grzywińska M, Kaszubowski M, Bandosz P, Khrichenko D, Piskunowicz M. MRI-Derived Subcutaneous and Visceral Adipose Tissue Reference Values for Children Aged 6 to Under 18 Years. Front Nutr 2021; 8:757274. [PMID: 34660672 PMCID: PMC8517194 DOI: 10.3389/fnut.2021.757274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
The assessment of body composition in pediatric population is essential for proper nutritional support during hospitalization. However, currently available methods have limitations. This study aims to propose a novel approach for nutrition status assessment and introduce magnetic resonance imaging (MRI)-derived subcutaneous and visceral fat normative reference values. A total of 262 healthy subjects aged from 6 to 18 years underwent MRI examinations and anthropometric measurements. MRI images at the second lumbar vertebrae were used by two radiologists to perform the semi-automatic tissue segmentation. Based on obtained adipose tissue surface areas and body mass index (BMI) scores sex-specific standard percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th) and z-scores were constructed using LMS method. Additionally, 85th and 95th centiles of subcutaneous and visceral adipose tissue were proposed as equivalents of overweight and obesity. Bland-Altman plots revealed an excellent intra-observer reproducibility and inter-observer agreement. In conclusion, our findings demonstrate highly reproducible method and suggest that MRI-derived reference values can be implemented in clinical practice.
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Affiliation(s)
- Kacper Marunowski
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Włodzimierz Bzyl
- Faculty of Mathematics, Physics and Informatics, University of Gdańsk, Gdańsk, Poland
| | | | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Institute of Statistics, Gdansk University of Technology, Gdańsk, Poland
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Prevention and Medical Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Dmitry Khrichenko
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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9
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Pluimakers V, Fiocco M, van Atteveld J, Hobbelink M, Bresters D, Van Dulmen-den Broeder E, Van der Heiden-van der Loo M, Janssens GO, Kremer L, Loonen J, Louwerens M, Van der Pal H, Ronckers C, Van Santen H, Versluys B, De Vries A, Van den Heuvel-Eibrink M, Neggers S. Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS). JMIR Res Protoc 2021; 10:e21256. [PMID: 32750002 PMCID: PMC7875697 DOI: 10.2196/21256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. OBJECTIVE The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. METHODS This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. RESULTS Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. CONCLUSIONS The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21256.
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Affiliation(s)
| | - Marta Fiocco
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | | | - Monique Hobbelink
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Eline Van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Geert O Janssens
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leontien Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cécile Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Hanneke Van Santen
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Birgitta Versluys
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrica De Vries
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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10
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Malhotra P, Kapoor G, Jain S, Jain S, Sharma A. Obesity and Sarcopenia in Survivors of Childhood Acute Lymphoblastic Leukemia. Indian Pediatr 2021. [PMID: 33408276 PMCID: PMC8139219 DOI: 10.1007/s13312-021-2213-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To describe the prevalence of obesity and sarcopenia among survivors of childhood acute lymphoblastic leukemia (ALL) using DEXA scan, and study associated risk factors. Methods This case control study was conducted between July, 2013 and June, 2014 at a tertiary care cancer centre in India. Study participants included 65 survivors of childhood ALL who were <18 years of age at diagnosis, treated between years 1996 and 2008, and were at least two years since completion of therapy. The controls included 50 matched siblings. Dual energy X-ray absorptiometry (DEXA) was used to study the body composition (body fat percentage, BF% and lean body mass, LBM) of the participants and controls. McCarthys body fat reference data were applied and logistic regression analysis was used to study various risk factors. Results At a median (range) follow-up of 5 (7.217.2) years, BF% (DEXA) identified a significantly higher prevalence of obesity of 21.5% (14/65) and sarcopenic obesity (14%) among survivors as compared to the controls (0/50, P<0.001), while the prevalence of sarcopenia as detected by LBM was similar at 60% (39/65) and 56% (28/50), respectively. On multivariate analysis, age at evaluation, high-risk disease and cranial irradiation were independently associated with high likelihood of obesity, while none of the factors predicted sarcopenia. Conclusion High prevalence of obesity and sarcopenic obesity were observed among survivors of childhood ALL.
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Affiliation(s)
- Payal Malhotra
- Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Gauri Kapoor
- Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India. Correspondence to: Dr Gauri Kapoor, Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector 5, Delhi, India.
| | - Sandeep Jain
- Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Silky Jain
- Department of Pediatric Hematology Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Anurag Sharma
- Department of Biostatistics, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
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11
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Guolla L, Morrison KM, Barr RD. Adiposity in Survivors of Cancer in Childhood: How is it Measured and Why Does it Matter? J Pediatr Hematol Oncol 2021; 43:1-11. [PMID: 33122586 DOI: 10.1097/mph.0000000000001988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Survival of cancer in childhood is increasingly common with modern therapeutic protocols but leads frequently to adverse long-term impacts on health, including metabolic and cardiovascular disease. Changes in body composition, especially an increase in fat mass and a decrease in muscle mass, are found early in patients with pediatric cancer, persist long after treatment has been completed and seem to contribute to the development of chronic disease. This review details the effects of such changes in body composition and reviews the underlying pathophysiology of the development of sarcopenic obesity and its adverse metabolic impact. The authors discuss the particular challenges in identifying obesity accurately in survivors of pediatric cancer using available measurement techniques, given that common measures, such as body mass index, do not distinguish between muscle and adipose tissue or assess their distribution. The authors highlight the importance of a harmonized approach to the assessment of body composition in pediatric cancer survivors and early identification of risk using "gold-standard" measurements. This will improve our understanding of the significance of adiposity and sarcopenia in this population, help identify thresholds predictive of metabolic risk, and ultimately prevent or ameliorate the long-term metabolic and cardiovascular impacts on health experienced by survivors of cancer in childhood.
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Affiliation(s)
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
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12
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Johnson AH, Rodgers Phillips S, Rice M. Abnormal weight gain with fatigue and stress in early survivorship after childhood brain tumor diagnosis. J SPEC PEDIATR NURS 2020; 25:e12288. [PMID: 32065725 DOI: 10.1111/jspn.12288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Diagnosis and treatment for individuals with brain tumors during childhood involves sequelae, including abnormal weight gain. This symptom is commonly clustered with fatigue and increased risk for cardiovascular disease. Children's Oncology Group recommendations include annual surveillance of body mass index (BMI) and cardiometabolic comorbidities; however, there has been little emphasis on individualized screening early in survivorship. PURPOSE The primary purpose of this paper is to describe the findings of abnormal weight gain and its correlates in a sample of young childhood brain tumor survivors during early survivorship. DESIGN AND METHODS This cross-sectional multi-site study included brain tumor survivors of ages 8-12 years who were less than 6 years posttreatment. Convenience sampling from two pediatric cancer centers in the southern United States was utilized. Data collected included BMI, parent report of sleep, and child report of fatigue and stress. RESULTS The sample (N = 21) consisted of children who had received chemotherapy, radiation treatment, and surgery for childhood brain tumor. BMI in overweight and obese categories exceeded normative samples with 38% at or above the 85th percentile. There were clinically significant relationships with fatigue, stress about weight, tumor location, cranial radiation, chemotherapy, and recurrence PRACTICE IMPLICATIONS: Screening for abnormal weight gain and related factors, such as fatigue should begin early in survivorship after childhood brain tumor treatment completion with the aim of health promotion and disease prevention. Adiposity measurement techniques should be utilized in future clinical and research settings to improve assessment of cardiometabolic risk.
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Affiliation(s)
- Ann H Johnson
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas
| | | | - Marti Rice
- University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
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13
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Pluimakers VG, van Waas M, Looman CWN, de Maat MP, de Jonge R, Delhanty P, Huisman M, Mattace-Raso FUS, van den Heuvel-Eibrink MM, Neggers SJCMM. Metabolic syndrome detection with biomarkers in childhood cancer survivors. Endocr Connect 2020; 9:676-686. [PMID: 32567553 PMCID: PMC7424353 DOI: 10.1530/ec-20-0144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Augmented survival of childhood nephroblastoma and neuroblastoma has increased long-term side effects such as metabolic syndrome (MetS). Risk stratification is difficult after abdominal radiation because waist circumference underestimates adiposity. We aimed to develop a strategy for determining MetS in irradiated survivors using an integrated biomarker profile and vascular ultrasonography. METHODS The NCEP-ATPIII MetS-components, 14 additional serum biomarkers and 9 vascular measurements were assessed in a single-centre cohort of childhood nephroblastoma (n = 67) and neuroblastoma (n = 36) survivors and controls (n = 61). Multivariable regression models were used to study treatment effects. Principal component analysis (PCA) was used to study all biomarkers in a combined analysis, to identify patterns and correlations. RESULTS After 27.5 years of follow-up, MetS occurred more often in survivors (14%) than controls (3%). Abdominal radiotherapy and nephrectomy, to a lesser extent, were associated with MetS and separate components and with several biomarker abnormalities. PCA of biomarkers revealed a pattern on PC1 from favourable lipid markers (HDL-cholesterol, adiponectin) towards unfavourable markers (triglycerides, LDL-cholesterol, apoB, uric acid). Abdominal radiotherapy was associated with the unfavourable biomarker profile (β = 1.45, P = 0.001). Vascular measurements were not of added diagnostic value. CONCLUSIONS Long-term childhood nephro- and neuroblastoma survivors frequently develop MetS. Additional assessment of biomarkers identified in PCA - adiponectin, LDL, apoB, and uric acid - may be used especially in abdominally irradiated survivors, to classify MetS as alternative for waist circumference. Vascular ultrasonography was not of added value.
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Affiliation(s)
- V G Pluimakers
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Correspondence should be addressed to V G Pluimakers:
| | - M van Waas
- Department of Paediatric Oncology/Haematology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - C W N Looman
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M P de Maat
- Department of Haematology, Erasmus MC, Rotterdam, The Netherlands
| | - R de Jonge
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - P Delhanty
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Huisman
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - F U S Mattace-Raso
- Section Geriatric Medicine, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - S J C M M Neggers
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
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14
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[Body composition evaluation by anthropometry and bioelectrical impedance analysis in childhood acute leukemia survivors]. NUTR HOSP 2020; 37:56-64. [PMID: 31755281 DOI: 10.20960/nh.02465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: survivors of childhood acute leukemia are at risk for obesity. The purpose was to evaluate the different clinical measurements of body composition and to compare with body mass index (BMI). Methods: cross-sectional study of 39 survivors with more than ten years of survivorship since diagnosis. Anthropometry and body composition accuracy measurements were determined and also obesity risk factors. Results: obesity prevalence by body fat percentage were: 38.5% for BMI; 46.1% for waist circumference; 51.3% for skinfolds and 56.4% for bioelectrical impedance analysis (BIA). There was a good correlation among the measurements, but BMI underestimated the percent body fat among childhood leukemia survivors in comparison with: waist circumference (-1.03 ± 2.01), skinfolds (-2.95 ± 5.78) and BIA (-3.78 ± 7.4), and this bias appears to be more variable with increasing percent of body fat > 30%. Three patients showed sarcopenia and only one sarcopenic obesity. Waist circumference fat mass was the better predictor of cardiovascular risk factors (LDL-cholesterol: r = 0.703; HDL-cholesterol: r = -0.612; p < 0.05 and hypertension: OR 4.17; IC 95%: 1.012-19.3). Obesity risk factors were: female sex, high-risk tumor, radiotherapy and stem cell transplantation. Conclusions: BMI underestimates obese childhood leukemia survivors in comparison with waist circumference, skinfolds and bioelectrial impedance analysis. BMI use could misclassify obese survivors as non-obese. Female sex, high tumoral risk and coadyuvant treatments (radiotherapy and stem cell transplant) are risk factors for adiposity.
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15
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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16
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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17
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Body composition, dietary intake and physical activity of young survivors of childhood cancer. Clin Nutr 2019; 38:842-847. [DOI: 10.1016/j.clnu.2018.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 02/09/2018] [Accepted: 02/19/2018] [Indexed: 01/05/2023]
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18
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Pluimakers VG, van Waas M, Neggers SJCMM, van den Heuvel-Eibrink MM. Metabolic syndrome as cardiovascular risk factor in childhood cancer survivors. Crit Rev Oncol Hematol 2018; 133:129-141. [PMID: 30661649 DOI: 10.1016/j.critrevonc.2018.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/06/2018] [Accepted: 10/28/2018] [Indexed: 12/14/2022] Open
Abstract
Over the past decades, survival rates of childhood cancer have increased considerably from 5 to 30% in the early seventies to current rates exceeding 80%. This is due to the development of effective chemotherapy, surgery, radiotherapy and stem cell transplantation, combined with an optimized stratification of therapy and better supportive care regimens. As a consequence, active surveillance strategies of late sequelae have been developed to improve the quality of survival. Several epidemiological studies have reported an increased incidence of (components of) metabolic syndrome (MetS) and cardiovascular disease in childhood cancer survivors (CCS). Growth hormone deficiency (GHD) after cranial radiotherapy (CRT) has been previously described as an important cause of MetS. New insights suggest a role for abdominal radiotherapy as a determinant for MetS as well. The role of other risk factors, such as specific chemotherapeutic agents, steroids, gonadal impairment, thyroid morbidity and genetics, warrants further investigation. This knowledge is important to define subgroups of CCS that are at risk to develop (subclinical) MetS features. These survivors might benefit from standard surveillance and early interventions, for example lifestyle and diet advice and medical treatment, thereby preventing the development of cardiovascular disease.
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Affiliation(s)
- V G Pluimakers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands.
| | - M van Waas
- Department of Pediatric Oncology/Hematology, Erasmus MC - Sophia Children's Hospital Rotterdam, the Netherlands
| | - S J C M M Neggers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands; Department of Medicine, section Endocrinology, Erasmus University Medical Centre Rotterdam, the Netherlands
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Bielorai B, Pinhas-Hamiel O. Type 2 Diabetes Mellitus, the Metabolic Syndrome, and Its Components in Adult Survivors of Acute Lymphoblastic Leukemia and Hematopoietic Stem Cell Transplantations. Curr Diab Rep 2018; 18:32. [PMID: 29671081 DOI: 10.1007/s11892-018-0998-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW A growing number of pediatric acute lymphoblastic leukemia (ALL) and hematopoietic stem cell transplantation (HSCT) survivors reach adulthood and face long-term health-related problems. We review risk factors and the prevalence of the metabolic syndrome (MetS), a cluster of obesity-related comorbidities, including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, impaired glucose metabolism, and type 2 diabetes in ALL and HSCT survivors. RECENT FINDINGS Components of the MetS are already detected during the first year of ALL maintenance therapy and significantly worsen over time. The prevalence of MetS increases at a faster rate in this setting than in the general population. Factors found to be of the greatest potential risk to the development of the MetS are central obesity, increased BMI, irradiation therapy, older age, poor diet, and low level of physical activity. The early onset of MetS and its components among ALL and HSCT survivors calls for early and continuous screening to identify those at risk and to implement preventive measures.
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Affiliation(s)
- Bella Bielorai
- Department of Pediatric Hematology-Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
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Xu Y, Sun Y, Zhou K, Li T, Xie C, Zhang Y, Rodriguez J, Wu Y, Hu M, Shao LR, Wang X, Zhu C. Cranial Irradiation Induces Hypothalamic Injury and Late-Onset Metabolic Disturbances in Juvenile Female Rats. Dev Neurosci 2018; 40:120-133. [PMID: 29635235 DOI: 10.1159/000487923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Cranial radiotherapy is one of the most effective tools for treating children with brain tumors. However, radiotherapy-induced late-onset side effects have a significant impact on patients' quality of life. The purpose of this study was to investigate the effects of irradiation on metabolism and the possible molecular and cellular mechanisms behind such effects. Female Wistar rats were subjected to a single dose of 6-Gy whole-brain irradiation on postnatal day 11. The animals were sacrificed 6 h or 20 weeks after irradiation. Cell death and proliferation, microglial activation, and inflammation were analyzed and RNA sequencing was performed. We found that irradiation led to a significantly increased body weight from 15 weeks (p < 0.05) along with white adipose tissue accumulation and adipocyte hypertrophy at 20 weeks, and these changes were accompanied by glucose and lipid metabolic disturbances as indicated by reduced glucose tolerance, increased insulin resistance, increased serum triglycerides, and an increased leptin/adiponectin ratio. Furthermore, irradiation induced cell death, microglial activation, inflammation, and persistent astrocyte reactivity in the hypothalamus. Hypothalamic transcriptome analysis showed that 865 genes were downregulated and 290 genes were upregulated in the irradiated group 20 weeks after irradiation, and further pathway analysis showed that the insulin resistance-related PI3K-Akt signaling pathway and the energy expenditure-related adipocytokine signaling pathway were downregulated. Gene Ontology enrichment analysis showed that the expression of fatty acid metabolism-related proteins and effector proteins was significantly different in the irradiation group. This study demonstrates that ionizing radiation to the juvenile female brain induces hypothalamic damage that is likely to be associated with delayed metabolic abnormalities, and this critical vulnerability of the hypothalamus to irradiation should be taken into consideration in the development of future protective strategies for radiotherapy.
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Affiliation(s)
- Yiran Xu
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Yanyan Sun
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Kai Zhou
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Tao Li
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Cuicui Xie
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Yaodong Zhang
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Juan Rodriguez
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Yanling Wu
- Department of Physiology/Endocrinology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Min Hu
- Department of Physiology/Endocrinology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Linus R Shao
- Department of Physiology/Endocrinology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Perinatal Center, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, Ladhani S, Socha A, Shinuda J, Jaber S, Burrow S, Singh SK, Banfield L, de Souza RJ, Thabane L, Samaan MC. Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta-analysis. Clin Obes 2018; 8:55-67. [PMID: 29024558 DOI: 10.1111/cob.12224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/22/2022]
Abstract
Survivors of childhood brain tumours (SCBT) have increased cardiometabolic risks, but the determinants of these risks are unclear. This systematic review aims to compare the prevalence of overweight and obesity as well as adiposity measures between SCBT and non-cancer controls. The PubMed, EMBASE, MEDLINE, CINAHL and the Cochrane Library databases were searched. The primary outcomes were the prevalence of overweight and obesity based on body mass index. The secondary outcomes were adiposity measures including percent fat mass, waist-to-hip and waist-to-height ratios. Forty-one studies were included in the meta-analysis. The prevalence of overweight and obesity combined was similar between overall SCBT, SCBT excluding craniopharyngioma and non-cancer controls (42.6%, 95% CI 30.1-55.1 vs. 31.7%, 95% CI 20.4-43.0 vs. 40.4%, 95% CI 34.0-46.8). We also found that SCBT have higher percent fat mass (mean difference 4.1%, 95% CI 2.0-6.1), waist-to-hip ratio (mean difference 0.07, 95% CI 0.02-0.13) and waist-to-height ratio (mean difference 0.06, 95% CI 0.01-0.10) than non-cancer controls. We conclude that SCBT have similar overweight and obesity distribution but higher adiposity than non-cancer controls. More studies were needed to explore the determinants of adiposity and its contribution to cardiometabolic outcomes in SCBT.
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Affiliation(s)
- K-W Wang
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
| | - A Fleming
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Canada
| | - S R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
| | - S Ladhani
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - A Socha
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - J Shinuda
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Jaber
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Canada
| | - S K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Canada
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Canada
| | - L Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - R J de Souza
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - L Thabane
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - M C Samaan
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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22
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Wijnen M, Olsson DS, van den Heuvel-Eibrink MM, Hammarstrand C, Janssen JAMJL, van der Lely AJ, Johannsson G, Neggers SJCMM. The metabolic syndrome and its components in 178 patients treated for craniopharyngioma after 16 years of follow-up. Eur J Endocrinol 2018; 178:11-22. [PMID: 28882980 DOI: 10.1530/eje-17-0387] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients with craniopharyngioma are at an increased risk for cardio- and cerebrovascular mortality. The metabolic syndrome (MetS) is an important cardiometabolic risk factor, but barely studied in patients with craniopharyngioma. We aimed to investigate the prevalence of and risk factors for the MetS and its components in patients with craniopharyngioma. DESIGN Cross-sectional study with retrospective data. METHODS We studied the prevalence of and risk factors for the MetS and its components in 110 Dutch (median age 47 years, range 18-92) and 68 Swedish (median age 50 years, range 20-81) patients with craniopharyngioma with ≥3 years of follow-up (90 females (51%); 83 patients with childhood-onset craniopharyngioma (47%); median follow-up after craniopharyngioma diagnosis 16 years (range 3-62)). In Dutch patients aged 30-70 years and Swedish patients aged 45-69 years, we examined the prevalence of the MetS and its components relative to the general population. RESULTS Sixty-nine (46%) of 149 patients with complete data demonstrated the MetS. Prevalence of the MetS was significantly higher in patients with craniopharyngioma compared with the general population (40% vs 26% (P < 0.05) for Dutch patients; 52% vs 15% (P < 0.05) for Swedish patients). Multivariable logistic regression analysis identified visual impairment as a borderline significant predictor of the MetS (OR 2.54, 95% CI 0.95-6.81; P = 0.06) after adjustment for glucocorticoid replacement therapy and follow-up duration. Age, female sex, tumor location, radiological hypothalamic damage, 90Yttrium brachytherapy, glucocorticoid replacement therapy and follow-up duration significantly predicted components of the MetS. CONCLUSIONS Patients with craniopharyngioma are at an increased risk for the MetS, especially patients with visual impairment.
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Affiliation(s)
- Mark Wijnen
- Department of Medicine, Section Endocrinology, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Casper Hammarstrand
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joseph A M J L Janssen
- Department of Medicine, Section Endocrinology, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Aart-Jan van der Lely
- Department of Medicine, Section Endocrinology, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sebastian J C M M Neggers
- Department of Medicine, Section Endocrinology, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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23
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Wang KW, Souza RJD, Fleming A, Singh SK, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Scheinemann K, Thabane L, Samaan MC. Adiposity in childhood brain tumors: A report from the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE Study). Sci Rep 2017; 7:45078. [PMID: 28327649 PMCID: PMC5361156 DOI: 10.1038/srep45078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023] Open
Abstract
Children with brain tumors (CBT) are at high risk of cardiovascular diseases and type 2 diabetes compared to the general population. Recently, adiposity has been reported to be more informative for cardiometabolic risk stratification than body mass index (BMI) in the general population. The goal of this study is to describe the adiposity phenotype in CBT, and to establish adiposity determinants. We recruited CBT (n = 56) and non-cancer controls (n = 106). Percent body fat (%FM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured to determine total and central adiposity, respectively. Regression analyses were used to evaluate adiposity determinants. CBT had higher total and central adiposity compared to non-cancer controls despite having similar BMI measurements. Those with tumors at the supratentorial region had increased total and central adiposity, while those who received radiotherapy had increased total adiposity. In conclusion, CBT have increased total and central adiposity in the presence of similar BMI levels when compared to non-cancer controls. Adiposity, especially central adiposity, is a potential cardiometabolic risk factor present relatively early in life in CBT. Defining interventions to target adiposity may improve long-term outcomes by preventing cardiometabolic disorders in CBT.
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Affiliation(s)
- Kuan-Wen Wang
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adam Fleming
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sheila K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.,McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, University Children's Hospital, Basel, Switzerland
| | - Lehana Thabane
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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24
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Teixeira JFC, dos Santos Maia‐Lemos P, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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25
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Teixeira JFC, Maia-Lemos PDS, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. J Pediatr (Rio J) 2016; 92:559-566. [PMID: 27327565 DOI: 10.1016/j.jped.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Obesity is a late effect in survivors of childhood cancer and correlates with chronic complications. Survivors of leukemia, brain tumors, and hematopoietic stem cell transplantation are more likely to develop obesity resulting from treatment modalities such as radiotherapy and glucocorticoids. This paper analyzes and integrates the current data available to health professionals in order to clarify strategies that can be used to treat and prevent obesity in childhood cancer survivors. SOURCES This is a literature review from on scientifically reliable electronic databases. We selected articles published in the last five years and earlier articles of great scientific importance. DATA SYNTHESIS The mechanisms involved in the pathophysiology of obesity in cancer survivors are not completely understood, but it is believed that damage to the hypothalamus and endocrine disorders such as insulin resistance, leptin resistance, and hormone deficiency may be involved. The body composition of this group includes a predominance of adipose tissue, especially in those undergoing hematopoietic stem cell transplant and total body irradiation. The use of body mass index in these patients may lead to an underestimation of individuals' risk for metabolic complications. CONCLUSION Early identification of groups using accurate anthropometric assessments, interventional treatment, and/or preventative measures and counseling is essential to minimize the adverse effects of treatment. Physical activity and healthy eating to promote adequacy of weight in the whole population should be encouraged.
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Affiliation(s)
| | - Priscila Dos Santos Maia-Lemos
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
| | - Mônica Dos Santos Cypriano
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
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26
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Jahnukainen K, Heikkinen R, Henriksson M, Andersson S, Ivaska KK, Puukko-Viertomies LR, Mäkitie O. Increased Body Adiposity and Serum Leptin Concentrations in Very Long-Term Adult Male Survivors of Childhood Acute Lymphoblastic Leukemia. Horm Res Paediatr 2016; 84:108-15. [PMID: 26088403 DOI: 10.1159/000431092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We evaluated the body composition and its association with hypogonadism in adult male long-term acute lymphoblastic leukemia (ALL) survivors. METHODS The cohort included 49 long-term male ALL survivors and 55 age-matched healthy controls. Fat and lean mass was assessed by dual-energy X-ray absorptiometry; blood biochemistry was obtained for adipokines and testicular endocrine markers. RESULTS As compared with controls, the ALL survivors (median age 29 years, range 25-38), assessed 10-28 years after ALL diagnosis, had higher percentages of body (p < 0.05) and trunk fat mass (p < 0.05), and a lower body lean mass (p < 0.001). Survivors had significantly higher levels of leptin and adiponectin and lower levels of insulin-like growth factor-binding protein 3. Body fat mass and percent fat mass correlated with serum leptin and sex hormone-binding globulin (SHBG) levels. Altogether, 15% of the ALL survivors and 9% of age-matched controls were obese (BMI ≥ 30). Obese survivors more often had hypogonadism, had received testicular irradiation, and needed testosterone replacement therapy compared to nonobese survivors. CONCLUSION At young adulthood, long-term male ALL survivors have significantly increased body adiposity despite normal weight and BMI. Potential indicators of increased adiposity included high leptin and low SHBG levels. Serum testicular endocrine markers did not correlate with body adiposity.
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Affiliation(s)
- Kirsi Jahnukainen
- Divisions of Hematology-Oncology and Stem Cell Transplantation, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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27
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Pluijm SMF, den Hoed MA, van den Heuvel-Eibrink MM. Comment on "acute lymphoblastic leukemia and adiponcosis" by M. Bifilco and AM Malfitano. Haematologica 2015; 100:e432-3. [PMID: 26432384 DOI: 10.3324/haematol.2015.130500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Saskia M F Pluijm
- Department of Pediatric Oncology, Erasmus MC, Rotterdam and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marissa A den Hoed
- Department of Pediatric Oncology, Erasmus MC, Rotterdam and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology, Erasmus MC, Rotterdam and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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28
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Murphy AJ, White M, Elliott SA, Lockwood L, Hallahan A, Davies PS. Body composition of children with cancer during treatment and in survivorship. Am J Clin Nutr 2015; 102:891-6. [PMID: 26269368 DOI: 10.3945/ajcn.114.099697] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 07/16/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Malnutrition as assessed with the use of body-composition measurements is a poorly understood short- and long-term complication of childhood cancer. OBJECTIVES We aimed to evaluate the body composition of 2 childhood cancer cohorts as follows: 1) children currently undergoing cancer treatment and 2) childhood cancer survivors. We also aimed to compare the prevalence of obesity and undernutrition between the cancer groups and investigate the impact of cancer type on body composition. DESIGN Eighty-two children during the treatment of cancer and 53 childhood cancer survivors were involved in the study. Height, weight, body cell mass, percentage of fat, fat mass index, and fat-free mass index were assessed. Subjects were compared with age- and sex-matched healthy controls. RESULTS The on-treatment group had a higher percentage of fat (P = 0.0001) and fat mass index (P = 0.0001) and a significantly lower body cell mass index (P = 0.0001) and fat-free mass index (P = 0.003) than did matched controls. The survivor group had a significantly higher percentage of fat (P = 0.03) and fat mass index (P = 0.04) and significantly lower body cell mass index (P = 0.0001) than did matched controls. The prevalence of undernutrition was high in both groups with 48% (95% CI: 36%, 60%) of the on-treatment group and 53% (95% CI: 40%, 66%) of the survivors considered undernourished. According to the percentage of fat cutoffs, significantly more on-treatment patients were obese (55%; 95% CI: 40%, 60%) than were survivors (26%; 95% CI: 14%, 38%) (P = 0.005). There were no statistically significant differences in body composition between cancer types in either the on-treatment or the survivor group. CONCLUSIONS Overnutrition and undernutrition are major concerns in the short and long term for children with cancer. Children treated for cancer have increased fat mass and decreased body cell mass, which are evident during treatment and in survivorship. This trial was registered at http://www.ANZCTR.org.au as ACTRN12614001279617 and ACTRN12614001269628.
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Affiliation(s)
- Alexia J Murphy
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
| | - Melinda White
- Department of Dietetics and Food Service, Lady Cilento Children's Hospital, Brisbane, Australia; and
| | - Sarah A Elliott
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
| | - Liane Lockwood
- Oncology Service, Children's Health Queensland, Brisbane, Australia
| | - Andrew Hallahan
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia; Oncology Service, Children's Health Queensland, Brisbane, Australia
| | - Peter Sw Davies
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
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29
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Zhang FF, Liu S, Chung M, Kelly MJ. Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis. Pediatr Blood Cancer 2015; 62:1452-60. [PMID: 25808413 PMCID: PMC4482769 DOI: 10.1002/pbc.25519] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/25/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Survivors of pediatric acute lymphoblastic leukemia (ALL) have a significantly higher body mass index (BMI) than their peers. Understanding the critical time periods in which patients with pediatric ALL are vulnerable to unhealthy weight gain will lay the groundwork for developing effectively timed interventions. PROCEDURE We determined the growth patterns of patients with pediatric ALL during and after treatment through the conduct of a systematic review and meta-analysis. A search of MEDLINE, Scopus, and Web of Science was performed from its inception through May 2014. Studies met the inclusion criteria if they included at least 10 patients of pediatric ALL, and longitudinally assessed BMI at diagnosis and at least one time point after diagnosis RESULTS Twenty-one studies met the inclusion criteria for the systematic review and 16 were included in meta-analysis. The mean increase in BMI z-score during treatment in 1,514 patients with pediatric ALL was 0.81 (95% CI: 0.25-1.38). Specifically, patients experienced substantial weight gain in early treatment (Δ = 0.41, 95% CI: -0.34, 1.17) and again during maintenance (Δ = 0.34, 95% CI:-0.22, 0.90). The mean increase in BMI z-score ranged between 0.52 and 0.89 beyond treatment completion. Subgroup analyses found unhealthy weight gain occurred regardless of patients' receipt of cranial radiation therapy, sex, and, weight status at diagnosis. CONCLUSIONS Patients with pediatric ALL experience unhealthy weight gain early in treatment, and increases in weight are maintained beyond treatment completion. Preventing early onset of obesity is a priority for improving the care and outcomes for patients with pediatric ALL.
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Affiliation(s)
- Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Shanshan Liu
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mei Chung
- Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Michael J. Kelly
- Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
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30
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van den Heuvel-Eibrink MM, van Tinteren H, Bergeron C, Coulomb-L'Hermine A, de Camargo B, Leuschner I, Sandstedt B, Acha T, Godzinski J, Oldenburger F, Gooskens SL, de Kraker J, Vujanic GM, Pritchard-Jones K, Graf N. Outcome of localised blastemal-type Wilms tumour patients treated according to intensified treatment in the SIOP WT 2001 protocol, a report of the SIOP Renal Tumour Study Group (SIOP-RTSG). Eur J Cancer 2015; 51:498-506. [PMID: 25592561 DOI: 10.1016/j.ejca.2014.12.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/20/2014] [Accepted: 12/14/2014] [Indexed: 11/18/2022]
Abstract
Blastemal-type Wilms tumour (BT-WT) has been identified as a high risk histological subgroup in WT assessed after pre-nephrectomy chemotherapy in trials of the International Society of Paediatric Oncology (SIOP) Renal Tumour Study Group. Therefore, in SIOPWT2001, post-operative chemotherapy for BT-WT was intensified aiming to improve survival. Survival analysis of all unilateral BT-WT patients (SIOPWT2001) (n=238), was compared with historical BT-WT controls (SIOP93-01) (n=113). 351/4061 (8.6%) unilateral non-metastatic BT-WT patients (SIOP93-01/SIOPWT2001) were studied. Median age at diagnosis was 43 months (Inter Quartile Range (IQR) 24-68 months), stages: I (n=140, 40%), II (n=106, 30%), III (n=105, 30%). BT-WTs were higher staged, showed greater volume decrease after pre-operative chemotherapy and were diagnosed at an older median age compared to other WT patients. Patient characteristics did not differ substantially between SIOP93-01 and SIOPWT2001. Univariate analysis showed a 5-year event-free survival (EFS) of 80% (95% confidence interval (CI): 75-86%) (SIOPWT2001) compared to 67% in SIOP93-01 (95% CI: 59-76%; p=0.006) and overall survival (OS) of 88% (95% CI: 83-93%) (SIOPWT2001) compared to 84% (95% CI: 77-91%; p=0.4) in SIOP93-01. 95% of relapses were distant metastases (SIOP93-01/SIOPWT2001). Treatment protocol, age at diagnosis, tumour stage (III versus I/II) and volume (at surgery), were prognostic variables for EFS (uni- and multivariate Cox regression analysis). Independent prognosticators for OS were age at diagnosis, tumour stage and volume (at surgery). The most significant survival benefit of intensified treatment, was observed in Stage I (EFS 96% in SIOPWT2001 (OS 100%), 71% in SIOP93-01 (OS 90%)). BT-WT derived benefits from more intensive chemotherapy as reflected by a reduction in relapse risk. However, the benefit of the more intensive chemotherapy to improve OS was only observed in stage I BT-WTs, by adding doxorubicin.
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Affiliation(s)
- M M van den Heuvel-Eibrink
- Department of Pediatric Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Dutch Childhood Oncology Group, The Hague, The Netherlands.
| | - H van Tinteren
- Biometrics Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Bergeron
- Centre Léon Bérard, Pediatrie, Lyon, France
| | | | - B de Camargo
- Instituto Nacional do Cancer, Pediatric Hematology Program, Rio de Janeiro, Brazil
| | - I Leuschner
- Kiel Pediatric Tumour Registry, University of Kiel, Kiel, Germany
| | - B Sandstedt
- Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - T Acha
- Hospital Materno-Infantil "Carlos Haya", Malaga, Spain
| | - J Godzinski
- Department of Pediatric Surgery, Marciniak Hospital Wroclaw and Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - F Oldenburger
- Department of Radiation Oncology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - S L Gooskens
- Department of Pediatric Oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - J de Kraker
- Department of Pediatric Oncology-Hematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - G M Vujanic
- Department of Histopathology, School of Medicine Cardiff University, Cardiff, United Kingdom
| | - K Pritchard-Jones
- Institute of Child Health, University College London, London, United Kingdom
| | - N Graf
- Department of Pediatric Hematology/Oncology, University Hospital for Children, Homburg, Germany
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Karlage RE, Wilson CL, Zhang N, Kaste S, Green DM, Armstrong GT, Robison LL, Chemaitilly W, Srivastava DK, Hudson MM, Ness KK. Validity of anthropometric measurements for characterizing obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study. Cancer 2015; 121:2036-43. [PMID: 25728221 DOI: 10.1002/cncr.29300] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) are at risk for obesity. The purpose of this project was to determine which clinical measures of body composition are most accurate among CCSs in comparison with dual-energy x-ray absorptiometry (DXA). METHODS The agreement between the body mass index (BMI), skinfold percent body fat, and waist-to-height ratio (WHtR) and DXA was evaluated among 1361 CCSs (mean age, 32.4 ± 7.7 years) 10 or more years after the diagnosis. The sensitivity and specificity of BMI, skinfold, and WHtR obesity classifications were calculated with respect to DXA. Log-binomial regression, stratified by sex, was used to evaluate treatment-related factors for misclassification as nonobese by BMI, skinfolds, and WHtR. RESULTS The mean body fat values were 23.3% ± 7.7% (males) and 32.3% ± 8.1% (females) for skinfolds and 26.9% ± 7.4% (males) and 38.4% ± 7.7% (females) for DXA. Pearson correlations between skinfolds and DXA were high (R = 0.83 for males, R = 0.84 for females). Skinfolds incorrectly classified 34.5% of obese males and 27.3% of obese females. BMI measures were the least sensitive with false-negative rates of 46.4% (males) and 53.1% (females). Males exposed to abdominal/pelvic radiation were at increased risk for misclassification as nonobese by BMI (relative risk, 1.57; 95% confidence interval, 1.25-1.95). The percentages classified as obese were highest with DXA (males, 63.1%; females, 84.8%) and lowest with BMI (males, 35.7%; females, 39.7%). Although skinfolds and WHtR underestimated the percentage classified as obese in comparison with DXA, the differences were not as large. CONCLUSIONS Findings suggest that skinfolds and WHtR are better than BMI for obesity classification in CCSs. Clinicians should be aware of the high risk of misclassifying obese CCSs as nonobese.
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Affiliation(s)
- Robyn E Karlage
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carmen L Wilson
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nan Zhang
- Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue Kaste
- Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel M Green
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Melissa M Hudson
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Brinksma A, Roodbol PF, Sulkers E, Kamps WA, de Bont ES, Boot AM, Burgerhof JG, Tamminga RY, Tissing WJ. Changes in nutritional status in childhood cancer patients: A prospective cohort study. Clin Nutr 2015; 34:66-73. [DOI: 10.1016/j.clnu.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
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Abstract
Treatment for childhood cancer with chemotherapy, radiation and/or hematopoietic cell transplant can result in adverse sequelae that may not become evident for many years. A clear understanding of the association between therapeutic exposures and specific long-term complications, and an understanding of the magnitude of the burden of morbidity borne by childhood cancer survivors, has led to the development of guidelines to support lifelong risk-based follow up for this population. It is important to develop interventions to reduce the impact of treatment-related late effects on morbidity and mortality and to continue research regarding the etiopathogenesis of therapy-related cancers and other late effects.
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Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA.
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Wilson CL, Gawade PL, Ness KK. Impairments that influence physical function among survivors of childhood cancer. CHILDREN (BASEL, SWITZERLAND) 2015; 2:1-36. [PMID: 25692094 PMCID: PMC4327873 DOI: 10.3390/children2010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.
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Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS-735 Memphis, TN 38105, USA; E-Mails: (P.L.G.); (K.K.N.)
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Dubern B. Activité physique en pédiatrie. NUTR CLIN METAB 2014. [DOI: 10.1016/j.nupar.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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den Hoed MAH, Pluijm SMF, de Groot-Kruseman HA, te Winkel ML, Fiocco M, van den Akker ELT, Hoogerbrugge P, van den Berg H, Leeuw JA, Bruin MCA, Bresters D, Veerman AJP, Pieters R, van den Heuvel-Eibrink MM. The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia. Haematologica 2014; 100:62-9. [PMID: 25304613 DOI: 10.3324/haematol.2014.110668] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Body mass index and change in body mass index during treatment may influence treatment outcome of pediatric patients with acute lymphoblastic leukemia. However, previous studies in pediatric acute lymphoblastic leukemia reported contradictory results. We prospectively collected data on body composition from a cohort of newly diagnosed Dutch pediatric patients with acute lymphoblastic leukemia (n=762, age 2-17 years). Patients were treated from 1997-2004 and the median follow-up was 9 years (range, 0-10). Body mass index at diagnosis was expressed as age- and gender-matched standard deviation scores and on the basis of these scores the patients were categorized as being underweight, of normal weight or overweight. Multivariate analyses showed that patients who were underweight (8%) had a higher risk of relapse [hazard ratio: 1.88, 95% confidence interval (1.13-3.13)], but similar overall survival and event-free survival as patients who had a normal weight or who were overweight. Patients with loss of body mass index during the first 32 weeks of treatment had a similar risk of relapse and event-free survival, but decreased overall survival [hazard ratio: 2.10, 95% confidence interval (1.14-3.87)] compared to patients without a loss of body mass index. In addition, dual X-ray absorptiometry scans were performed in a nested, single-center cohort. Data from these scans revealed that a loss of body mass consisted mainly of a loss of lean body mass, while there was a gain in the percentage of fat. In conclusion, being underweight at diagnosis is a risk factor for relapse, and a decrease in body mass index early during treatment is associated with decreased survival. In addition, loss of body mass during treatment seems to consist mainly of a loss of lean body mass. This study was approved by the Medical Ethical Committee in 1996 (trial number NTR460/SNWLK-ALL-9).
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Affiliation(s)
- Marissa A H den Hoed
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | - Saskia M F Pluijm
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | | | - Mariël L te Winkel
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | - Martha Fiocco
- Dutch Childhood Oncology Group, The Hague Department of Medical Statistics and Bioinformatics, Leiden University Medical Center
| | | | - Peter Hoogerbrugge
- Department of Pediatric Hemato-Oncology, Nijmegen, Radboud University Medical Center Nijmegen
| | | | - Jan A Leeuw
- Dutch Childhood Oncology Group, The Hague Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
| | - Marrie C A Bruin
- Dutch Childhood Oncology Group, The Hague University Medical Center Utrecht
| | - Dorine Bresters
- Dutch Childhood Oncology Group, The Hague Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden
| | - Anjo J P Veerman
- Dutch Childhood Oncology Group, The Hague VU University Medical Center, Amsterdam
| | - Rob Pieters
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Dutch Childhood Oncology Group, The Hague
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Blijdorp K, van Dorp W, Laven JSE, Pieters R, de Jong FH, Pluijm SMF, van der Lely AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Obesity independently influences gonadal function in very long-term adult male survivors of childhood cancer. Obesity (Silver Spring) 2014; 22:1896-903. [PMID: 24753296 DOI: 10.1002/oby.20766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although obesity is associated with gonadal dysfunction in the general population, gonadotoxic treatment might diminish the impact of obesity in childhood cancer survivors (CCS). The aim was to evaluate whether altered body composition is associated with gonadal dysfunction in male CCS, independent of gonadotoxic cancer treatment. METHODS Three hundred fifty-one male CCS were included. Median age at diagnosis was 5.9 years (0-17.8) and median age at follow-up 25.6 years (18.0-45.8). Total and non-SHBG-bound testosterone, sex hormone-binding globulin, inhibin B, and follicle-stimulating hormone (FSH) were studied. Potential determinants were BMI, waist circumference, waist-hip ratio, and body composition measures (dual energy X-ray absorptiometry). RESULTS Non-SHBG-bound testosterone was significantly decreased in survivors with BMI ≥ 30 kg/m(2) (adjusted mean 9.1 nmol/L vs. 10.2 nmol/L, P = 0.015), high fat percentage (10.0 vs. 11.2, P = 0.004), and high waist circumference (>102 cm) (9.0 vs. 11.0, P = 0.020). Survivors with high fat percentage (≥25%) had significantly lower inhibin B/FSH ratios (inhibin B/FSH ratio: β -34%, P = 0.041). CONCLUSION Obesity is associated with gonadal dysfunction in male CCS, independent of the irreversible effect of previous cancer treatment. Randomized controlled trials are required to evaluate whether weight normalization could improve gonadal function, especially in obese survivors with potential other mechanisms than lifestyle causing their obesity.
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Affiliation(s)
- Karin Blijdorp
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Medicine - Section Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Chemaitilly W, Hudson MM. Update on endocrine and metabolic therapy-related late effects observed in survivors of childhood neoplasia. Curr Opin Endocrinol Diabetes Obes 2014; 21:71-6. [PMID: 24275618 DOI: 10.1097/med.0000000000000029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW To provide a summary of the most recent research pertaining to the endocrine and metabolic complications observed in childhood cancer survivors. RECENT FINDINGS Data on prevalence and risk associations are increasingly available from large cohorts of childhood cancer survivors. New directions in research include novel risk-prediction strategies and the study of genetic predisposition. SUMMARY Endocrine complications are observed in more than 50% of adult childhood cancer survivors. Some continue to develop decades following cancer treatment exposures. The present review provides a summary of the most recent outcomes research pertaining to growth, thyroid, gonadal-reproductive, bone and body composition with emphasis on new directions and challenges in each area.
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Affiliation(s)
- Wassim Chemaitilly
- aDepartment of Pediatric Medicine - Division of Endocrinology bDepartment of Epidemiology and Cancer Control cDepartment of Oncology-Division of Survivorship3, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Rook MK, McEvoy CS, Greiner R, Brown H, Marchese V. Exploring the Feasibility of Performing Objective Screening Tools on Survivors of Pediatric Cancers as Part of a Long-term Survivorship Clinic. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432040-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Beltran A, Li R, Ater J, Baranowski J, Buday R, Thompson D, Chandra J, Baranowski T. Adapting a Videogame to the Needs of Pediatric Cancer Patients and Survivors. Games Health J 2013; 2:213-21. [PMID: 26192225 DOI: 10.1089/g4h.2013.0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study assessed whether two serious videogames, "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) (both from Archimage, Inc., Houston, TX) shown to effect change in healthy children's diet and possibly physical activity are acceptable for obesity prevention among pediatric cancer patients and survivors at high risk of obesity. PATIENTS AND METHODS Pediatric (9-12-year-old) cancer patients and survivors (n=28) were randomly assigned to one of three groups: Group A, watched film adaptations of both game stories and played the first two episodes of each game; Group B, played all of Diab; or Group C, played all of Nano. Qualitative interviews about what the children liked and didn't like and what should be changed were conducted midway and at the end of each group's participation. Data were analyzed using thematic analysis. RESULTS Pediatric cancer patients and survivors enjoyed playing both games. Two themes emerged to guide future modifications of the game: Three patients reported difficulty with the energy balance and meal selection portion of Nano, and four patients stated endings showing a character dying made them sad. CONCLUSIONS Two serious videogames designed to promote healthier diet and increased physical activity among healthy children were also found to be acceptable by pediatric cancer patients and survivors. Easier options needed to be programmed into energy balance games in Nano. To avoid possible emotional reactions, such as sadness, Nano's ending will be revised so that a character does not die from his affliction. Minor changes will be made in other gameplay mechanics and storylines to meet target audience needs and preferences.
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Affiliation(s)
- Alicia Beltran
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | - Rhea Li
- 2 Pediatrics Research, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Joann Ater
- 3 Division of Pediatrics, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Janice Baranowski
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | | | - Debbe Thompson
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | - Joya Chandra
- 5 The University of Texas Graduate School of Biomedical Sciences at Houston , Houston, Texas
| | - Tom Baranowski
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
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Krachler B, Völgyi E, Savonen K, Tylavsky FA, Alén M, Cheng S. BMI and an anthropometry-based estimate of fat mass percentage are both valid discriminators of cardiometabolic risk: a comparison with DXA and bioimpedance. J Obes 2013; 2013:862514. [PMID: 24455216 PMCID: PMC3886548 DOI: 10.1155/2013/862514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/03/2013] [Accepted: 11/14/2013] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine whether categories of obesity based on BMI and an anthropometry-based estimate of fat mass percentage (FM% equation) have similar discriminative ability for markers of cardiometabolic risk as measurements of FM% by dual-energy X-ray absorptiometry (DXA) or bioimpedance analysis (BIA). DESIGN AND METHODS A study of 40-79-year-old male (n = 205) and female (n = 388) Finns. Weight, height, blood pressure, triacylglycerols, HDL cholesterol, and fasting blood glucose were measured. Body composition was assessed by DXA and BIA and a FM%-equation. RESULTS For grade 1 hypertension, dyslipidaemia, and impaired fasting glucose >6.1 mmol/L, the categories of obesity as defined by BMI and the FM% equation had 1.9% to 3.7% (P < 0.01) higher discriminative power compared to DXA. For grade 2 hypertension the FM% equation discriminated 1.2% (P = 0.05) lower than DXA and 2.8% (P < 0.01) lower than BIA. Receiver operation characteristics confirmed BIA as best predictor of grade 2 hypertension and the FM% equation as best predictor of grade 1 hypertension. All other differences in area under curve were small (≤0.04) and 95% confidence intervals included 0. CONCLUSIONS Both BMI and FM% equations may predict cardiometabolic risk with similar discriminative ability as FM% measured by DXA or BIA.
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Affiliation(s)
- Benno Krachler
- Department of Health Sciences, University of Jyväskylä, P.O. BOX 35 (L), 40014 Jyväskylä, Finland
- Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Eszter Völgyi
- Department of Health Sciences, University of Jyväskylä, P.O. BOX 35 (L), 40014 Jyväskylä, Finland
- Department of Preventive Medicine, University of TN Health Science Center, Memphis, Tennessee 38163, USA
| | - Kai Savonen
- Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Frances A. Tylavsky
- Department of Preventive Medicine, University of TN Health Science Center, Memphis, Tennessee 38163, USA
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital and Institute of Health Sciences, University of Oulu, 90029 Oulu, Finland
| | - Sulin Cheng
- Department of Health Sciences, University of Jyväskylä, P.O. BOX 35 (L), 40014 Jyväskylä, Finland
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
- *Sulin Cheng:
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