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Childhood leukaemia: a model of pre-obesity
1Department of Human Nutrition, University of Glasgow, Yorkhill Hospital, UK.
Insights
Children undergoing acute lymphoblastic leukaemia (ALL) therapy gain excess weight due to reduced total energy expenditure (TEE) and lower physical activity. This highlights lifestyle factors in childhood obesity development.
Area of Science:
- Pediatric Oncology
- Metabolic Research
- Obesity Studies
Background:
- Childhood obesity is a growing concern with unclear causes.
- Patients with acute lymphoblastic leukaemia (ALL) often experience significant weight gain during and after treatment.
- Existing models of the pre-obese state have limitations.
Purpose of the Study:
- To investigate the causes of excessive weight gain in children with ALL.
- To test the hypothesis that reduced total energy expenditure (TEE) contributes to obesity in ALL patients.
- To identify risk factors for weight gain in this population.
Main Methods:
- Utilized the doubly-labelled water method to measure TEE in pre-obese children with ALL.
- Compared physical activity levels and TEE between ALL patients and their peers.
- Identified risk factors associated with excess weight gain.
Main Results:
- Pre-obese children with ALL in the active weight gain phase exhibited reduced physical activity.
- A significantly lower TEE (approx. 1.2 MJ/d) was observed in these children.
- Reduced habitual physical activity was identified as a central factor in weight gain.
Conclusions:
- Lifestyle factors, specifically reduced physical activity, play a critical role in the development of obesity in children with ALL.
- Children with ALL may serve as a valuable model for studying the pre-obese state due to the critical role of lifestyle.
- ALL is a relatively common, treatable childhood cancer with high survival rates, offering accessibility for research.
Abstract:
The prevalence of obesity in children, as in adults, is increasing dramatically. The extent to which this is due to reduced energy expenditure, increased energy intake, or both, is unclear at present. This in part reflects the limitations of existing models of the pre-obese state. In childhood acute lymphoblastic leukaemia (ALL), patients typically gain weight excessively during and after 2 years of therapy, and are at high risk of becoming obese. Previous studies have failed to identify the cause of obesity in these patients. We have tested the hypothesis that excess weight gain in ALL is due to reduced total energy expenditure (TEE), measured using the doubly-labelled water method, and have identified risk factors for excess weight gain in ALL. Pre-obese children with ALL in the dynamic phase of weight gain are less physically active than their peers, with a reduced TEE of approximately 1.2 (95% CI 0.2, 2.2) MJ/d. While other factors might contribute to excess weight gain, lifestyle (i.e. reduced habitual physical activity) plays a central role in ALL. Several considerations suggest that ALL might be a useful model of the pre-obese state: lifestyle is critical to development of obesity in ALL; ALL is relatively common; approximately 70% of patients survive; patients are readily accessible during the 2 years of therapy and beyond.