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Body composition in young adult survivors of childhood acute lymphoblastic leukaemia

¹ Department of Pediatrics, Division of Haematology and Oncology, ² Göteborg Paediatric Growth Research Center, ³ Department of Clinical Nutrition, ⁴ Research Center for Endocrinology and Metabolism Sahlgrenska Academy at Göteborg, University of Göteborg, Göteborg, Sweden and ⁵ Department of Pediatrics, Landspitali University Hospital, Iceland

(Correspondence should be addressed to M Jarfelt; Email: marianne.jarfelt{at}vgregion.se)

Objective: Obesity is frequently reported in patients treated for childhood leukaemia. Obesity, particularly abdominal obesity, is one of the main characteristics of the metabolic syndrome and a risk factor for cardiovascular disease and non-insulin-dependent diabetes mellitus (NIDDM).

Design: All patients treated for acute lymphoblastic leukaemia (ALL) before the onset of puberty in the region of western Sweden, between 1973 and 1985, and in first remission, were included. 35 out of 47 patients aged 20–32 years participated. 19 patients had received cranial radiotherapy, and the median follow-up time was 20 years. The focus of this report was to study body composition and signs of the metabolic syndrome and correlate the findings to spontaneous growth hormone (GH) secretion.

Methods: Body composition was assessed using dual-energy X-ray absorbtiometry (DEXA). We analyzed serum concentrations of insulin, glucose, leptin and lipids.

Results: No patient was obese according to World Health Organization criteria (body mass index, BMI 30 kg/m²) but one-third were overweight (BMI 25–29.9 kg/m²). The maximal GH peak during 24 h (GH_max) was correlated to percentage of total body fat (r = –0.42; P = 0.017), trunk fat (r = –0.5; P = 0.005) and fat-free mass (r = 0.42; P = 0.017). GH_max was also correlated to s-triglycerides (r = –0.54; P = 0.001), low-density lipoprotein-cholesterol (r = –0.382; P = 0.024) and high-density lipoprotein-cholesterol (r = 0.45; P = 0.007).

Conclusions: We found little effect on BMI but an increased percentage of total body fat, especially trunk fat, and a tendency for an unfavourable lipid profile in adult survivors of childhood leukaemia. These findings were related to low endogenous GH secretion due to cranial irradiation.

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