Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia

Background Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patient...

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Veröffentlicht in:Pediatric blood & cancer 2011-03, Vol.56 (3), p.372-378
Hauptverfasser: Esbenshade, Adam J., Simmons, Jill H., Koyama, Tatsuki, Koehler, Elizabeth, Whitlock, James A., Friedman, Debra L.
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container_end_page 378
container_issue 3
container_start_page 372
container_title Pediatric blood & cancer
container_volume 56
creator Esbenshade, Adam J.
Simmons, Jill H.
Koyama, Tatsuki
Koehler, Elizabeth
Whitlock, James A.
Friedman, Debra L.
description Background Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. Results At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z‐score at diagnosis was associated with increased z‐score during maintenance (P 
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However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. Results At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z‐score at diagnosis was associated with increased z‐score during maintenance (P &lt; 0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z‐score increased over the first 22 months of maintenance (P &lt; 0.001). Patients with high risk disease had lower BMI z‐scores regardless of cranial radiotherapy exposure (P &lt; 0.001). Pre‐hypertension was prevalent over the course of therapy (31.1% with systolic pre‐hypertension and 18.6% with diastolic pre‐hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. Conclusions During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family‐based diet and exercise intervention during maintenance therapy. Pediatr Blood Cancer 2011;56:372–378. © 2010 Wiley‐Liss, Inc.</description><identifier>ISSN: 1545-5009</identifier><identifier>ISSN: 1545-5017</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.22782</identifier><identifier>PMID: 20860019</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>acute lymphoblastic leukemia ; Adolescent ; Adult ; Blood Pressure ; Body Mass Index ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; hypertension ; Hypertension - etiology ; Infant ; Male ; metabolic syndrome ; obesity ; Obesity - etiology ; Overweight - etiology ; pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - physiopathology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Young Adult</subject><ispartof>Pediatric blood &amp; cancer, 2011-03, Vol.56 (3), p.372-378</ispartof><rights>Copyright © 2010 Wiley‐Liss, Inc.</rights><rights>2010 Wiley-Liss, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5182-889e6fb565414d004798af95632ddb2f66e915e7dd76273b85051b33b9d35a33</citedby><cites>FETCH-LOGICAL-c5182-889e6fb565414d004798af95632ddb2f66e915e7dd76273b85051b33b9d35a33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpbc.22782$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpbc.22782$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20860019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Esbenshade, Adam J.</creatorcontrib><creatorcontrib>Simmons, Jill H.</creatorcontrib><creatorcontrib>Koyama, Tatsuki</creatorcontrib><creatorcontrib>Koehler, Elizabeth</creatorcontrib><creatorcontrib>Whitlock, James A.</creatorcontrib><creatorcontrib>Friedman, Debra L.</creatorcontrib><title>Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia</title><title>Pediatric blood &amp; cancer</title><addtitle>Pediatr. Blood Cancer</addtitle><description>Background Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. Results At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z‐score at diagnosis was associated with increased z‐score during maintenance (P &lt; 0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z‐score increased over the first 22 months of maintenance (P &lt; 0.001). Patients with high risk disease had lower BMI z‐scores regardless of cranial radiotherapy exposure (P &lt; 0.001). Pre‐hypertension was prevalent over the course of therapy (31.1% with systolic pre‐hypertension and 18.6% with diastolic pre‐hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. Conclusions During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family‐based diet and exercise intervention during maintenance therapy. Pediatr Blood Cancer 2011;56:372–378. © 2010 Wiley‐Liss, Inc.</description><subject>acute lymphoblastic leukemia</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Blood Pressure</subject><subject>Body Mass Index</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>hypertension</subject><subject>Hypertension - etiology</subject><subject>Infant</subject><subject>Male</subject><subject>metabolic syndrome</subject><subject>obesity</subject><subject>Obesity - etiology</subject><subject>Overweight - etiology</subject><subject>pediatrics</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - physiopathology</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Young Adult</subject><issn>1545-5009</issn><issn>1545-5017</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9vFCEYhydGY2v14Bcw3NTDtPxZYLiYtButJlvtodEjgeGdLnZmmAJTu99e6rYbPWg8AS_P--SFX1W9JPiQYEyPJtseUiob-qjaJ3zBa46JfLzbY7VXPUvpe0EF5s3Tao_iRmBM1H51fRLcBg0mJeRHB7fIjA7ZPgSHpggpzRFQuzbjJSQUbiCivC6FMMcEKHQoRzB5gDHfHSZw3uToW2TaOQPqN8O0DrY3KZdaD_MVDN48r550pk_w4n49qC4-vL9YfqxXX04_LY9XdctJQ-umUSA6ywVfkIXDeCFVYzrFBaPOWdoJAYpwkM5JQSWzDcecWMascowbxg6qd1vtNNsBXFtmjKbXU_SDiRsdjNd_3ox-rS_DjWaSMEp5Eby-F8RwPUPKevCphb43I4Q56YYpSagSuJBv_kkSXP6bKUL4f6JCUVrQt1u0jSGlCN1udoL1Xey6xK5_xV7YV78_dkc-5FyAoy3ww_ew-btJn58sH5T1tsOnDLe7DhOvtJBMcv3t86mWK3J-xr6u9Bn7CX9oxuE</recordid><startdate>201103</startdate><enddate>201103</enddate><creator>Esbenshade, Adam J.</creator><creator>Simmons, Jill H.</creator><creator>Koyama, Tatsuki</creator><creator>Koehler, Elizabeth</creator><creator>Whitlock, James A.</creator><creator>Friedman, Debra L.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201103</creationdate><title>Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia</title><author>Esbenshade, Adam J. ; Simmons, Jill H. ; Koyama, Tatsuki ; Koehler, Elizabeth ; Whitlock, James A. ; Friedman, Debra L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5182-889e6fb565414d004798af95632ddb2f66e915e7dd76273b85051b33b9d35a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>acute lymphoblastic leukemia</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Blood Pressure</topic><topic>Body Mass Index</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>hypertension</topic><topic>Hypertension - etiology</topic><topic>Infant</topic><topic>Male</topic><topic>metabolic syndrome</topic><topic>obesity</topic><topic>Obesity - etiology</topic><topic>Overweight - etiology</topic><topic>pediatrics</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - physiopathology</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Esbenshade, Adam J.</creatorcontrib><creatorcontrib>Simmons, Jill H.</creatorcontrib><creatorcontrib>Koyama, Tatsuki</creatorcontrib><creatorcontrib>Koehler, Elizabeth</creatorcontrib><creatorcontrib>Whitlock, James A.</creatorcontrib><creatorcontrib>Friedman, Debra L.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric blood &amp; cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Esbenshade, Adam J.</au><au>Simmons, Jill H.</au><au>Koyama, Tatsuki</au><au>Koehler, Elizabeth</au><au>Whitlock, James A.</au><au>Friedman, Debra L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia</atitle><jtitle>Pediatric blood &amp; cancer</jtitle><addtitle>Pediatr. Blood Cancer</addtitle><date>2011-03</date><risdate>2011</risdate><volume>56</volume><issue>3</issue><spage>372</spage><epage>378</epage><pages>372-378</pages><issn>1545-5009</issn><issn>1545-5017</issn><eissn>1545-5017</eissn><abstract>Background Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. Procedure In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. Results At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z‐score at diagnosis was associated with increased z‐score during maintenance (P &lt; 0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z‐score increased over the first 22 months of maintenance (P &lt; 0.001). Patients with high risk disease had lower BMI z‐scores regardless of cranial radiotherapy exposure (P &lt; 0.001). Pre‐hypertension was prevalent over the course of therapy (31.1% with systolic pre‐hypertension and 18.6% with diastolic pre‐hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. Conclusions During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family‐based diet and exercise intervention during maintenance therapy. Pediatr Blood Cancer 2011;56:372–378. © 2010 Wiley‐Liss, Inc.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>20860019</pmid><doi>10.1002/pbc.22782</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects acute lymphoblastic leukemia
Adolescent
Adult
Blood Pressure
Body Mass Index
Child
Child, Preschool
Cohort Studies
Female
Humans
hypertension
Hypertension - etiology
Infant
Male
metabolic syndrome
obesity
Obesity - etiology
Overweight - etiology
pediatrics
Precursor Cell Lymphoblastic Leukemia-Lymphoma - physiopathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Prognosis
Retrospective Studies
Risk Factors
Young Adult
title Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia
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