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Reduced energy expenditure in preobese children treated for acute lymphoblastic leukemia
J J Reilly1, J C Ventham, J M Ralston
1University of Glasgow Department of Human Nutrition, Yorkhill Hospitals, Scotland, United Kingdom.
Insights
Children treated for acute lymphoblastic leukaemia (ALL) experience reduced energy expenditure, primarily due to lower physical activity, leading to excess weight gain and obesity. Interventions should focus on increasing activity and moderating diet.
Area of Science:
- Pediatric Oncology
- Metabolic Research
- Obesity Studies
Background:
- Children with acute lymphoblastic leukaemia (ALL) often exhibit excessive weight gain during and after treatment, with a high prevalence of obesity in survivors.
- Previous research has not identified the specific energy balance abnormalities contributing to this weight gain.
- This study investigates the hypothesis that reduced energy expenditure underlies obesity risk in ALL survivors.
Purpose of the Study:
- To determine the cause of excess weight gain in children treated for ALL.
- To test the hypothesis that reduced energy expenditure predisposes these children to obesity.
Main Methods:
- Matched case-control study comparing 20 children treated for ALL with 20 healthy controls.
- Measurement of total energy expenditure (doubly-labeled water), resting energy expenditure, habitual physical activity energy expenditure, and energy intake in all participants.
- Participants were children treated for ALL with excess weight gain but not yet obese, matched for age and sex with healthy controls.
Main Results:
- Total energy expenditure was significantly lower in children treated for ALL compared to controls (mean difference 1185 kJ/d).
- Reduced energy expenditure in ALL patients was primarily attributed to lower habitual physical activity levels.
- Resting energy expenditure and energy intake were also lower in the ALL patient group.
Conclusions:
- Children treated for ALL are predisposed to excess weight gain and obesity due to reduced total energy expenditure, stemming from decreased habitual physical activity.
- Obesity prevention strategies for ALL survivors should incorporate modest increases in physical activity and dietary intake moderation, alongside weight monitoring.
Abstract:
Children with acute lymphoblastic leukaemia (ALL) typically gain weight at excessive rates during and after therapy, and a high proportion of young adult survivors are obese. Previous studies have failed to identify the abnormalities in energy balance that predispose these children to obesity. The aim of this study was to determine the cause of excess weight gain in children treated for ALL by testing the hypothesis that energy expenditure is reduced in these patients. Twenty children [9 boys, 11 girls; mean age 10.9 (3.2) y] treated for ALL who had shown excess weight gain, but were not obese [mean body mass index SD score 0.70 (1.04)], were closely and individually matched with 20 healthy control children [9 boys, 11 girls; mean age 10.7 (3.0) y; mean body mass index SD score 0.27 (0.91)]. In each child we measured total energy expenditure by doubly-labeled water method, resting energy expenditure, energy expended on habitual physical activity, and energy intake. Total energy expenditure was significantly higher in control subjects than in patients: mean paired difference 1185 kJ/d (282 kcal/d), 95% confidence interval (CI) 218-2152. This difference was largely due to reduced energy expended on habitual physical activity in the patients. Resting energy expenditure was lower in the patients: mean paired difference 321 kJ/d (76 kcal/d), 95% CI 100-541. Energy intake was also lower in the patients: mean paired difference 1001 kJ/d (238 kcal/d), 95% CI 93-1909. Children treated for ALL are predisposed to excess weight gain, and subsequently obesity, by reduced total energy expenditure secondary to reduced habitual physical activity. Prevention of obesity in ALL should focus on modest increases in habitual physical activity, modest restriction of dietary intake, and monitoring of excess weight gain.