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Pedersen LL, Gerbek T, Sørum ME, Muhic E, Christiansen T, Kok K, Sørensen K, Mølgaard C, Müller K. Dietary intake and risk of metabolic syndrome in long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02412-1. [PMID: 39294427 DOI: 10.1038/s41409-024-02412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/30/2024] [Accepted: 09/02/2024] [Indexed: 09/20/2024]
Abstract
We explored the dietary intake and metabolic syndrome (MetS) in 85 survivors of pediatric stem cell transplantation (median age 30 years, median follow-up time 20 years). Overall, the distribution of fatty acid deviated from the recommendations with a higher intake of saturated fat and a lower intake of unsaturated fat but was comparable to that of the background population. The prevalence of MetS was 27%, corresponding to that of the elderly background population. We compared the intake of macronutrients between those with MetS and those without MetS and found that overall fat intake was higher in patients with MetS (36.7E% [range, 27.2-51.2E%] vs. 33,5E% (range, 23.4-45.1E%), P = 0.016). Within the subgroup of patients treated with total body irradiation (TBI), we found a higher fat intake in those with MetS (36.8E% (range, 27.2-51.2E%) versus 32.0E% (range, 24.6-42.1E%), P = 0.013). This was confirmed in a multivariate analysis adjusted for TBI, sex, and age at follow-up (OR 1.20 (1.06-1.39), P = 0.008). Our findings suggest that conditioning with the use of TBI may induce a state of hypersensitivity to the potentially harmful effects of fat in the diet and suggest that this risk of MetS after TBI treatment may be modifiable by dietary changes.
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Affiliation(s)
- Louise Lindkvist Pedersen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tina Gerbek
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Maria Ebbesen Sørum
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ena Muhic
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Terkel Christiansen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karin Kok
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kaspar Sørensen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Mølgaard
- Pediatric Nutrition Unit, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Müller
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
- Institute for Inflammation Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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Sundholm JKM, Litwin L, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T. Ultra-high frequency ultrasound delineated changes in carotid and muscular artery intima-media and adventitia thickness in obese early middle-aged women. Diab Vasc Dis Res 2022; 19:14791641221094321. [PMID: 35637577 PMCID: PMC9160911 DOI: 10.1177/14791641221094321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obesity is linked to increased arterial size, carotid intima-media thickness and arterial stiffness. The effects of obesity and body composition on muscular artery intima-media and adventitia thickness has previously not been established. The aim of this study was to explore associations between carotid and muscular artery wall layer thickness with body composition and cardiovascular risk factors in early middle-aged women. This is a cross-sectional study including 199 women aged 40±4 years. Arterial lumen (LD), intima-media (IMT) and adventitia thickness (AT) were measured from carotid, brachial and radial arteries using ultra-high frequency ultrasound (22-71 MHz). Women with obesity had increased IMT in carotid (0.47 vs 0.45 mm), brachial (0.19 vs 0.17 mm) and radial arteries (0.16 vs 0.15 mm) and increased brachial AT (0.14 vs 0.13 mm). In multiple regression models all arterial LD (β-range 0.02-0.03 mm/kg/m2), IMT (β-range 0.91-3.37 µm/kg/m2), AT (β-range 0.73-1.38 µm/kg/m2) were significantly associated with BMI. The IMT of all arteries were significantly associated with systolic blood pressure (β-range 0.36-0.85 µm/mmHg), attenuating the association between IMT and BMI (β-range 0.18-2.24 µm/kg/m2). Obese early middle-aged women have increased arterial intima media thickness and brachial artery adventitia thickness compared to non-obese counterparts. The association between BMI and intima-media thickness is partly mediated through blood pressure levels.
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Affiliation(s)
- Johnny KM Sundholm
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Johnny KM Sundholm, Children’s Hospital, Helsinki University Hospital, Stenbäckinkatu 9, POB 281, FIN-00029, Helsinki 00029, Finland.
| | - Linda Litwin
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, SMDZ in Zabrze, SUM, Katowice, Poland
| | - Kristiina Rönö
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saila B Koivusalo
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Gynecology and Obstetrics, University of Turku and Turku University Hospital, Turku Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Niemelä J, Ylänen K, Suominen A, Pushparajah K, Mathur S, Sarkola T, Jahnukainen K, Eerola A, Poutanen T, Vettenranta K, Ojala T. Cardiac Function After Cardiotoxic Treatments for Childhood Cancer-Left Ventricular Longitudinal Strain in Screening. Front Cardiovasc Med 2021; 8:715953. [PMID: 34733890 PMCID: PMC8558299 DOI: 10.3389/fcvm.2021.715953] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The majority of childhood cancer survivors (CCSs) have been exposed to cardiotoxic treatments and often present with modifiable cardiovascular risk factors. Our aim was to evaluate the value of left ventricular (LV) longitudinal strain for increasing the sensitivity of cardiac dysfunction detection among CCSs. Methods: We combined two national cohorts: neuroblastoma and other childhood cancer survivors treated with anthracyclines. The final data consisted of 90 long-term CCSs exposed to anthracyclines and/or high-dose chemotherapy with autologous stem cell rescue and followed up for > 5 years and their controls (n = 86). LV longitudinal strain was assessed with speckle tracking (Qlab) and LV ejection fraction (EF) by three-dimensional echocardiography (3DE). Results: Of the CCSs, 11% (10/90) had abnormal LV longitudinal strain (i.e., < -17.5%); of those, 70% (7/10) had normal 3DE LV EF. Multivariable linear model analysis demonstrated that follow-up time (p = 0.027), sex (p = 0.020), and BMI (p = 0.002) were significantly associated with LV longitudinal strain. Conversely, cardiac risk group, hypertension, age, cumulative anthracycline dose or exposure to chest radiation were not. Conclusion: LV longitudinal strain is a more sensitive method than LV EF for the detection of cardiac dysfunction among CCSs. Therefore, LV longitudinal strain should be added to the screening panel, especially for those with modifiable cardiovascular risk factors.
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Affiliation(s)
- Jussi Niemelä
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Kaisa Ylänen
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Center for Child Health Research, Tampere, Finland.,Department of Pediatrics, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Anu Suominen
- Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sujeev Mathur
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy's & St. Thomas' NHS Trust, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Taisto Sarkola
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Minerva Foundation Institute for Medical Research, Biomedicum Helsinki, Helsinki, Finland
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Anneli Eerola
- Center for Child Health Research, Tampere, Finland.,Department of Pediatrics, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Tuija Poutanen
- Center for Child Health Research, Tampere, Finland.,Department of Pediatrics, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Kim Vettenranta
- Department of Pediatrics, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Broberg O, Øra I, Wiebe T, Weismann CG, Liuba P. Characterization of Cardiac, Vascular, and Metabolic Changes in Young Childhood Cancer Survivors. Front Pediatr 2021; 9:764679. [PMID: 34956978 PMCID: PMC8692667 DOI: 10.3389/fped.2021.764679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Childhood cancer survivors (CCS) are at an increased risk for cardiovascular diseases (CVD). It was the primary aim of this study to determine different measures of cardiac, carotid, lipid, and apolipoprotein status in young adult CCS and in healthy controls. Methods: Cardiac and common carotid artery (CCA) structure and function were measured by ultrasonography. Lipids and apolipoproteins were measured in the blood. Peripheral arterial endothelial vasomotor function was assessed by measuring digital reactive hyperemia index (PAT-RHI) using the Endo-PAT 2000. Results: Fifty-three CCS (20-30 years, 35 men) and 53 sex-matched controls were studied. The CCS cohort was divided by the median dose of anthracyclines into a low anthracycline dose (LAD) group (50-197 mg/m2, n = 26) and a high anthracycline dose (HAD) group (200-486 mg/m2, n = 27). Carotid distensibility index (DI) and endothelial function determined by PAT-RHI were both lower in the CCS groups compared with controls (p < 0.05 and p = 0.02). There was no difference in carotid intima media thickness. Atherogenic apolipoprotein-B (Apo-B) and the ratio between Apo-B and Apoliprotein-A1 (Apo-A1) were higher in the HAD group compared with controls (p < 0.01). Apo-B/Apo-A1-ratio was over reference limit in 29.6% of the HAD group, in 15.4% of LAD group, and in 7.5% of controls (p = 0.03). Measured lipid markers (low density lipoprotein and total cholesterol and triglycerides) were higher in both CCS groups compared with controls (p < 0.05). Systolic and diastolic function were measurably decreased in the HAD group, as evidenced by lower EF (p < 0.001) and lower é-wave (p < 0.005) compared with controls. CCA DI correlated with Apo-B/Apo-A1-ratio and Apo-A1. Follow-up time after treatment correlated with decreased left ventricular ejection fraction (p = 0.001). Conclusion: Young asymptomatic CCS exhibit cardiac, vascular, lipid, and apolipoprotein changes that could account for increased risk for CVD later in life. These findings emphasize the importance of cardiometabolic monitoring even in young CCS.
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Affiliation(s)
- Olof Broberg
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
| | - Ingrid Øra
- Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden.,Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Thomas Wiebe
- Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Constance G Weismann
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
| | - Petru Liuba
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
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