Non-alcoholic fatty liver disease is associated with early left ventricular dysfunction in childhood acute lymphoblastic leukaemia survivors
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Maurizio Delvecchio1, Paola Muggeo1, Mariantonietta Monteduro2
1Department of Biomedicine and Human OncologyPediatric Section, University 'A. Moro' of Bari, Bari, Italy.
Insights
Childhood acute lymphoblastic leukemia (ALL) survivors show a higher rate of non-alcoholic fatty liver disease (NAFLD), linked to early heart problems. Lifestyle interventions are crucial for managing risks in these survivors.
Area of Science:
- Pediatric Oncology
- Cardiology
- Hepatology
Background:
- Childhood acute lymphoblastic leukemia (ALL) survivors face elevated risks of metabolic and cardiovascular diseases.
- Non-alcoholic fatty liver disease (NAFLD) is a growing concern in this population.
- Early detection of NAFLD and associated cardiovascular dysfunction is critical.
Purpose of the Study:
- To assess the prevalence of NAFLD in childhood ALL survivors.
- To investigate the association between NAFLD and early cardiovascular dysfunction in these survivors.
Main Methods:
- A cohort of 53 childhood ALL survivors and 34 controls underwent comprehensive evaluations.
- Methods included auxological assessment, biochemical assays, and liver, heart, and vascular ultrasound studies.
Main Results:
- NAFLD was significantly more frequent in ALL survivors (39.6%) compared to controls (11.7%).
- ALL patients with NAFLD exhibited higher rates of obesity and insulin resistance.
- ALL survivors showed impaired flow-mediated dilatation, reduced interventricular septum, and lower left ventricular ejection fraction, particularly those with NAFLD.
Conclusions:
- Childhood ALL survivors have a higher prevalence of NAFLD, which is associated with early left ventricular impairment.
- Comprehensive cardiac evaluation is mandatory for ALL survivors with fatty liver.
- Preventing visceral adiposity and addressing metabolic syndrome components through lifestyle interventions are strongly recommended during follow-up.
Background:
Childhood acute lymphoblastic leukaemia (ALL) survivors have an increased risk of metabolic and cardiovascular disease. We aimed to assess the presence of non-alcoholic fatty liver disease (NAFLD) in childhood ALL and if it is associated with early cardiovascular dysfunction.
Methods:
In total, 53 childhood ALL survivors and 34 controls underwent auxological evaluation, biochemical assay, liver, heart and vascular ultrasound study.
Results:
NAFLD was more frequent in ALL patients than in controls (39.6% vs 11.7%, P < 0.01). Patients with NAFLD were more obese and insulin resistant than patients without NAFLD. Flow-mediated dilatation and interventricular septum were lower in the ALL group than those in the control group (P < 0.001 for both). The patients with NAFLD showed lower left ventricular ejection fraction than those without NAFLD (P = 0.011). In ALL survivors, BMI-SDS and subcutaneous fat were the strongest predictors of NAFLD, whereas preperitoneal adipose tissue and C-reactive protein were the strongest predictors of left ventricular ejection fraction.
Conclusions:
Childhood ALL survivors had higher prevalence of NAFLD than healthy controls, which is associated with early left ventricular impairment. In the case of fatty liver, a comprehensive heart evaluation is mandatory. We strongly recommend to prevent visceral adiposity in ALL survivors, to search for metabolic syndrome or its components and to reinforce the need of intervention on diet and lifestyle during the follow-up of these patients.
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