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Resting metabolic rate and obesity in childhood acute lymphoblastic leukaemia
J J Reilly1, C J Blacklock, E Dale
1University of Glasgow Department of Human Nutrition, Scotland.
Insights
Children with acute lymphoblastic leukaemia (ALL) gain excess weight during treatment. This study found no evidence that a reduced resting metabolic rate (RMR) causes this weight gain in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Metabolic Research
- Clinical Nutrition
Background:
- Children undergoing treatment for acute lymphoblastic leukaemia (ALL) often experience significant weight gain.
- The underlying mechanisms, particularly metabolic factors, contributing to this excess weight gain require further investigation.
- Cranial radiotherapy, a previous treatment modality, was associated with metabolic changes; however, current treatments without it also show this effect.
Purpose of the Study:
- To describe excess weight gain in children with acute lymphoblastic leukaemia (ALL) treated without cranial radiotherapy.
- To test the hypothesis that a reduced resting metabolic rate (RMR) predisposes these children to weight gain.
- To compare RMR between pediatric ALL patients and healthy controls.
Main Methods:
- Longitudinal assessment of Body Mass Index (BMI) standard deviation (s.d.) scores in 35 children with ALL from diagnosis to 2 years post-diagnosis.
- Resting metabolic rate (RMR) measurement using ventilated hood indirect calorimetry in 27 ALL patients in positive energy balance and 27 matched healthy controls.
- Statistical analysis including paired t-tests and analysis of covariance to compare RMR and BMI changes.
Main Results:
- A significant increase in BMI s.d. score was observed in children with ALL over 2 years (+1.0 s.d., P < 0.01).
- No significant differences in RMR were found between children with ALL and healthy controls, even when accounting for gender and fat-free mass.
- The findings indicate that excess weight gain occurs irrespective of cranial radiotherapy in pediatric ALL treatment.
Conclusions:
- Excess weight gain is a common occurrence during acute lymphoblastic leukaemia therapy, even without cranial radiotherapy.
- Reduced resting metabolic rate (RMR) does not appear to be the primary factor predisposing children with ALL to excess weight gain.
- Further research is needed to identify the specific factors contributing to weight gain in pediatric ALL patients undergoing contemporary treatment protocols.
Abstract:
The present study described excess weight gain in children with acute lymphoblastic leukaemia (ALL) treated without cranial radiotherapy, and tested the hypothesis that reduced resting metabolic rate (RMR) predisposes children with ALL to excess weight gain. Changes in relative weight in 35 children were expressed as BMI standard deviation (s.d.) scores from diagnosis to 2 y post diagnosis. RMR was measured by ventilated hood indirect calorimetry in 27 patients who had been in positive energy balance and 27 healthy control children matched pairwise for gender and fat free mass (FFM). Mean change in BMI s.d. score to 2 y was +1.0 (s.d. 1.3), 95% CI +0.5 to +1.5 (paired t, P < 0.01). No significant differences in RMR were observed between patients and controls (paired t-test; analysis of covariance). We conclude that excess weight gain occurs during ALL therapy, even in the absence of cranial radiotherapy. Children with ALL who have been in positive energy balance do not appear to show abnormalities in RMR.