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Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis
Fang Fang Zhang1,2, Shanshan Liu1, Mei Chung3
1Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
Insights
Pediatric acute lymphoblastic leukemia (ALL) survivors gain significant unhealthy weight during and after treatment. Early interventions are crucial to prevent obesity and improve long-term health outcomes for these young patients.
Area of Science:
- Pediatric Oncology
- Growth and Development
- Obesity Research
Background:
- Pediatric acute lymphoblastic leukemia (ALL) survivors exhibit higher Body Mass Index (BMI) compared to peers.
- Understanding critical periods of weight gain vulnerability in pediatric ALL is essential for intervention development.
Purpose of the Study:
- To systematically review and meta-analyze growth patterns in pediatric ALL patients during and after treatment.
- To identify specific time points associated with unhealthy weight gain in pediatric ALL survivors.
Main Methods:
- Systematic review and meta-analysis of studies on pediatric ALL patients.
- Inclusion criteria: >=10 pediatric ALL patients, longitudinal BMI assessment at diagnosis and post-diagnosis.
- Searched MEDLINE, Scopus, and Web of Science up to May 2014.
Main Results:
- 1,514 pediatric ALL patients across 16 studies showed a mean BMI z-score increase of 0.81 during treatment.
- Substantial weight gain observed in early treatment (Δ=0.41) and maintenance phases (Δ=0.34).
- Weight gain persisted post-treatment (BMI z-score increase 0.52-0.89), irrespective of cranial radiation, sex, or initial weight status.
Conclusions:
- Pediatric ALL patients experience unhealthy weight gain early in treatment.
- Weight increases are sustained beyond treatment completion.
- Preventing early-onset obesity is a priority for improving pediatric ALL care and outcomes.
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.
