Effect of glucocorticoid therapy on energy intake in children treated for acute lymphoblastic leukemia. A randomized nutrition counseling intervention in pediatric leukemia patients receiving steroids results in reduced caloric intake ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Fit4Life: a weight loss intervention for children who have survived childhood leukemia. The effect of weight loss magnitude on pro‐/anti‐inflammatory adipokines and carotid intima–media thickness in obese adolescents engaged in interdisciplinary weight loss therapy Fitness of Children With Standard-risk Acute Lymphoblastic Leukemia During Maintenance Therapy: Response to a Home-based Exercise and Nutrition Program Dietary intake and childhood leukemia: The Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) cohort study. A randomized trial investigating an exercise program to prevent reduction of bone mineral density and impairment of motor performance during treatment for childhood acute lymphoblastic leukemia. Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL).
Despite a widespread belief that glucocorticoid therapy is associated with positive energy balance and excess weight gain there is a dearth of quantitative evidence about its effects and the underlying mechanisms of any effects . The primary aim of the present study was to quantify the effect of dexamethasone and prednisone treatment on energy intake in children treated for childhood acute lymphoblastic leukemia . A secondary aim was to test for differences in excess weight gain between patients treated using the 2 glucocorticoids . We measured energy intake in 26 patients ( mean + /- SD age , 6.3 + /- 2.3 yr ) during a 5-d period " on " steroids and again in the week before steroid treatment .  Changes in body mass index from diagnosis to 1 and 2 yr postdiagnosis were expressed as SD scores . Steroid treatment was associated with a significant increase in energy intake of approximately 20 % ( mean paired difference , 1.7 MJ/d ; SD , 2.8 ; 95 % confidence interval , 0.7 - 2.8 MJ/d ) , with no significant difference between the 2 steroids . The mean change in body mass index SD score was + 0.38 ( SD , 1.10 ; P < 0.05 ) to 1 yr and + 0.68 ( SD , 1.38 ; P < 0.05 ) to 2 yr , with no significant difference between the 2 groups of patients .  Glucocorticoid treatment in childhood acute lymphoblastic leukemia increases energy intake markedly , and this effect contributes to the excess weight gain and obesity characteristic of patients being treated for acute lymphoblastic leukemia BACKGROUND Quality of life in survivors of pediatric acute lymphocytic leukemia ( ALL ) can be compromised by chronic diseases including increased risk of second cancers , cardiovascular disease , and diabetes . Overweight or obesity further increases these risks . Steroids are a component of chemotherapy for ALL , and weight gain is a common side effect . To impact behaviors associated with weight gain , we conducted a r and omized nutrition counseling intervention in ALL patients on treatment . PROCEDURE ALL patients on a steroid-based treatment regimen at the MD And erson Children 's Cancer Hospital were recruited and r and omized into control or intervention groups . The control group received st and ard care and nutrition education material s. The intervention group received monthly one-on-one nutrition counseling sessions , consisting of a baseline and 12 follow-up visits . Anthropometrics , dietary intake ( 3-day 24-hr dietary recalls ) and oxidative stress measures were collected at baseline , 6 months , and postintervention . Dietary recall data were analyzed using the Nutrition Data System for Research . RESULTS Twenty-two patients ( median age 11.5 years ) , all in the maintenance phase of treatment , were recruited . The intervention group ( n = 12 ) reported significantly lower calorie intake from baseline to 12-month follow-up and significant changes in glutamic acid and selenium intake ( P < 0.05 ) . Waist circumference was significantly associated with calorie , vitamin E , glutamic acid , and selenium intake . CONCLUSIONS A year-long dietary intervention was effective at reducing caloric intake in pediatric ALL patients receiving steroid-based chemotherapy  , indicating that this is a modality that can be built upon for obesity prevention and management Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies BACKGROUND Children surviving acute lymphoblastic leukemia ( ALL ) are at increased risk for overweight and obesity over that of the general population . Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested . PROCEDURE Thirty-eight youth 8 - 18 years with BMI ≥ 85 % who had survived ALL were recruited for a r and omized clinical trial evaluating a weight management intervention ( WMI ) tailored for childhood ALL survivors ( Fit4Life ) . Fit4Life recipients received a 4-month web , phone , and text message-delivered WMI tailored for cancer survivorship . Controls received a general WMI delivered via phone and mail . Assessment s were performed at baseline and 4 months . Outcome data were analyzed according to assigned treatment condition over time . RESULTS Most ( 80 % , ( 70 % , 100 % ) [ median ( IQR ) ] ) of the assigned curriculum was received by Fit4Life participants as compared to 50 % ( 40 % , 65 % ) among controls . Fit4Life recipients ≥ 14 years demonstrated less weight gain ( P = 0.05 ) and increased moderate-to-vigorous physical activity ( P < 0.01 ) while all Fit4Life recipients reported reduced negative mood ( P < 0.05 ) over time as compared to control counterparts . CONCLUSIONS We demonstrated acceptable feasibility of a WMI tailored for overweight and obese children surviving ALL utilizing a multimodal technology approach . Improved weight , weight-related behavior , and psychological outcomes were demonstrated among Fit4Life intervention as compared to youth receiving a generic WMI . Data from this pilot trial may be used to design a larger trial to determine whether youth of all ages also can derive a benefit from a cancer survivor-tailored WMI and whether short-term outcomes translate into improved long-term outcomes for childhood ALL survivors Obesity is a chronic disease defined by an excess amount of adipose tissue and presents a low‐ grade inflammatory state , increasing cardiovascular risk . Background Altered nutrient intake and decreased exercise in response to cancer therapies and their side effects , particularly corticosteroids , may be key factors in the increased body weight and differences in physical fitness reported in survivors of childhood acute lymphoblastic leukemia ( ALL ) . Purpose To assess ( 1 ) the effect of a home-based nutrition and exercise intervention program on cardiovascular fitness , strength , and flexibility in children with ALL during maintenance therapy and ( 2 ) the feasibility of conducting and evaluating a home-based exercise and nutrition program in this patient population . Design Children ages 4 to 10 years with st and ard-risk ALL were r and omized when starting maintenance therapy to a 12-month home-based exercise and nutrition program ( n=6 , 3 males/3 females ) or control ( n=7 , 4 males/3 females ) group . Assessment of anthropometrics , dietary intake , physical activity , and fitness was performed at baseline and 6 and 12 months of study . Results Although age , body size , and nutrient intakes were similar between both subject groups at 0 , 6 , and 12 months , exercise and nutrition program children had greater improvement in physical activity and cardiovascular fitness between 6 and 12 months than control children . Conclusions These results suggest that a home-based exercise intervention during maintenance therapy encouraged greater physical activity and improved cardiovascular fitness in children with st and ard-risk ALL . Further investigation involving larger population s of children with ALL is warranted OBJECTIVE Children with acute lymphoblastic leukemia ( ALL ) are at elevated risk for nutrition-related morbidity both during and after therapy . We present the demographic characteristics and nutrient intake at study entry of a prospect i ve cohort in which evaluating dietary intake in children diagnosed with ALL was investigated . METHODS Dietary intake data were collected for participants enrolled on the Dana-Farber Cancer Institute ALL Consortium Protocol .  Dietary intake was assessed with a food frequency question naire and was compared with the dietary reference intake by ALL risk group ( st and ard and high risk ) . RESULTS Dietary intake data were collected from 81 % of participants ( n = 640 ) . We found that 27 % of participants were overweight/obese . Intake of total calories and other nutrients exceeded the dietary reference intake in up to 79 % of children . This was evident in both risk groups and was pronounced among younger children . For micronutrients , dietary intake of calcium , vitamin D ( females only ) , and zinc differed significantly between patients with st and ard-risk and those with high-risk ALL . CONCLUSIONS This study was successful in collecting dietary intake data at the time of cancer diagnosis in a multicenter setting in a pediatric population at high-risk for nutrition-related morbidity . We identified " at-risk " dietary intakes , which vary by sex and ALL risk group ; such patients may benefit from future dietary interventions BACKGROUND Reduced bone mineral density ( BMD ) , altered body composition , impaired motor performance and passive ankle dorsiflexion are side effects of acute lymphoblastic leukemia ( ALL ) treatment . We performed a r and omized study investigating whether an exercise program could prevent these side effects . PROCEDURE At diagnosis we r and omized 51 ALL patients ( median age : 5.4 years ) into a group receiving a 2-year exercise program or a control group receiving st and ard care .  BMD of total body ( BMD(TB ) ) , lumbar spine ( BMD(LS ) ) and body composition were measured using dual energy X-ray absorptiometry , motor performance with Bayley Scales of Infant Development or Movement-ABC , and passive ankle dorsiflexion with a goniometer . The investigator was blinded to the r and omization . RESULTS Body fat increased equally during treatment in both groups . One year after cessation of therapy more rapid decline of excessive body fat was observed in the intervention group than in the controls ( P = 0.01 ) . Lean body mass , BMD(TB ) and BMD(LS ) of both groups decreased equally during treatment and increased equally thereafter . Both groups showed a similar decrease in passive ankle dorsiflexion and motor performance during treatment . Adherence to the intervention program varied considerably . Adherence to intervention : 11 % of children exercised daily , 37 % > once a week , 16 % once weekly , 36 % < once a week . CONCLUSIONS The exercise program was not more beneficial than st and ard care in preventing reduction in BMD , motor performance and passive ankle dorsiflexion than st and ard care , most likely due to unsatisfactory compliance . Increased BMI and body fat in the intervention group normalized faster after cessation of chemotherapy BACKGROUND A high prevalence of obesity has been increasingly recognized in survivors of pediatric ALL . However , longitudinal patterns of weight change during and after treatment , and associated factors , are less well eluci date d. PROCEDURE In a retrospective cohort of 83 pediatric patients with ALL diagnosed between 1985 and 2010 , we examined  body mass index ( BMI ) status  at several key time points : diagnosis ; end of induction ; end of consolidation ; every 6 months during maintenance ; and yearly for up to 5 years post-treatment . RESULTS At diagnosis , 21 % were overweight ( BMI = 85 - 94.9th percentile ) or obese ( BMI ≥ 95th percentile ) . At the end of treatment and 5 years post-treatment , approximately 40 % were overweight or obese . The mean BMI z-score was 0.2 ( 58th percentile ) at diagnosis and increased significantly during induction ( Δ = 0.5 , P < 0.0001 ) . It increased again during the first 6 months of maintenance ( Δ = 0.2 , P < 0.01 ) and did not significantly change over the remainder of maintenance ( BMI z-score at the end of treatment = 0.8 , 79th percentile ) and 5 years post-treatment ( BMI z-score = 0.7 , 76th percentile ) . High BMI z-score at diagnosis was associated with an increased risk of being overweight/obese at treatment completion ( OR = 2.9 , 95 % CI : 1.6 - 5.1 ) . Weight gain during treatment was associated with being overweight/obese 5 years post-treatment ( OR = 3.8 , 95 % CI : 1.1 - 12.5 ) . CONCLUSION Children with ALL are at risk of becoming overweight/obese early in treatment . Increases in weight are maintained throughout treatment and beyond . Lifestyle interventions are needed targeting weight control early during treatment , particularly for patients overweight/obese at diagnosis and those who experience substantial weight gain during treatment
Most children are surviving acute lymphoblastic leukemia ( ALL ) today .
Yet , the emergence of cardiometabolic comorbidities in this population may impact long-term outcomes including the quality of life and lifespan .
Obesity is a major driver of cardiometabolic disorders in the general population , and in ALL patients it is associated with increased risk of hypertension , dysglycemia , and febrile neutropenia when compared with lean ALL patients undergoing therapy .
This systematic review aims to assess the current evidence for bariatric interventions to manage obesity in children with ALL .