The Nutritional Trajectory of Children with Acute Lymphoblastic Leukemia: A 10-Year Follow up Study from a Referral Center in South India

Abstract

Objective

Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to late adverse events such as obesity and an associated metabolic syndrome.

Methods

Children treated for ALL from 2002 to 2012 were included. BMI was calculated at diagnosis, end of treatment, and 5, 8, and 10-years from diagnosis. BMI-centiles were used to categorize the patients: underweight (<5th-percentile), normal (5th–85th percentile), overweight (85th–95th percentile), and obese (≥95th centile).

Results

The study included 179 children with ALL (median age: 59-months). The proportions of patients who were underweight, normal, overweight/obese, were 37%, 56% and 7%, respectively, at diagnosis; and 15%, 51% and 34%, respectively, at 5-years from diagnosis. The median (IQR) BMI Z-score at diagnosis was −1.12(−2.40, −0.26). The median (IQR) BMI z-score of the cohort was higher after 5 [0.22(−0.83,1.24), P < 0.001] and 10-years of diagnosis [0.30(−0.69,0.99), P < 0.001], respectively. The proportion of overweight/obese individuals was higher after 5 (34%, P < 0.001) and 10 (26%, P = 0.001) years. There was a significant correlation between the baseline BMI Z-score and that observed after 5-years (ρ = 0.49, P < 0.001), and 10-years (ρ = 0.55, P < 0.001).

Conclusion

At 10-years of follow-up, >25% of children with ALL were overweight/obese. The BMI Z-score at the time of diagnosis continued to correlate with the Z-score after 10-years.

Acknowledgments

We would like to express our gratitude to Ms. A. Ranjini Saran, our research technologist for her meticulous maintenance of the data.

Author’s contributions

LGM, ST, DB, and RJ contributed to the conception and study design. MR, ST, LLJ, and HNS contributed to the data collection. ST performed the data analysis, drafted the initial version, and implemented revisions suggested by the coauthors. All authors reviewed the final version of the manuscript.

Consent for publication

There is no personal information regarding any patients in our article.

Ethical approval and consent to participate

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and was approved by the Institute Review Board of the Christian Medical College, Vellore, India, vide no. 14053 [Retro] dated: 30.06.2021

Disclosure statement

None of the authors declared any conflicts of interest.

Funding

This study had no sources of funding.