Body mass index predicts insulin resistance in survivors of pediatric acute lymphoblastic leukemia

Stefanie Lowas, Suman Malempati, Daniel Marks

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background. Pediatric acute lymphoblastic leukemia (ALL) therapies have been associated with many late effects, including obesity, hyperglycemia, and insulin resistance. Few data are available linking these abnormalities to specific risk factors present during ALL treatment. Methods. Retrospective cohort study with prospective follow-up. Subjects had been diagnosed with ALL at ages 1-18 years and had been off chemotherapy for >9 months. Oral glucose tolerance testing (OGTT) was performed and these results compared to demographic, treatment, and anthropomorphic data from medical records. Results. Twenty-seven subjects (11 female) were evaluated. Mean (±SD) diagnosis age 5.7 ± 3.5 years, mean study age 11.3 ± 3.7 years, mean time off therapy 2.8 ± 1.5 years. Six subjects had transient hyperglycemia during ALL treatment. At study time, one subject had prediabetes; eight (29.6%) had insulin resistance. Insulin resistance was not predicted by glucose levels during treatment, cumulative steroid or asparaginase dose, or type of steroid received. Body mass index (BMI) for age correlated significantly with several measures of insulin resistance, including fasting insulin, HOMA index, Matsuda index and insulin AUC (P=0.001-0.009). Waist/hip ratio and BMI at ALL diagnosis also correlated with insulin resistance, but these factors' effects could not be separated from BMI at study time. Conclusions. Variations in ALL therapy and presence of transient hyperglycemia do not appear to increase risk of glucose intolerance or insulin resistance in the first few years after completion of therapy. Elevated BMI strongly predicted insulin resistance in this study, as it does in the general population.

Original languageEnglish (US)
Pages (from-to)58-63
Number of pages6
JournalPediatric Blood and Cancer
Volume53
Issue number1
DOIs
StatePublished - Jul 15 2009

Fingerprint

Precursor Cell Lymphoblastic Leukemia-Lymphoma
Survivors
Insulin Resistance
Body Mass Index
Pediatrics
Hyperglycemia
Therapeutics
Steroids
Insulin
Prediabetic State
Asparaginase
Glucose Intolerance
Waist-Hip Ratio
R Factors
Glucose Tolerance Test
Area Under Curve
Medical Records
Fasting
Cohort Studies
Retrospective Studies

Keywords

  • ALL
  • Hematology/Oncology
  • Pediatric Endocrinology

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Medicine(all)

Cite this

Body mass index predicts insulin resistance in survivors of pediatric acute lymphoblastic leukemia. / Lowas, Stefanie; Malempati, Suman; Marks, Daniel.

In: Pediatric Blood and Cancer, Vol. 53, No. 1, 15.07.2009, p. 58-63.

Research output: Contribution to journalArticle

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abstract = "Background. Pediatric acute lymphoblastic leukemia (ALL) therapies have been associated with many late effects, including obesity, hyperglycemia, and insulin resistance. Few data are available linking these abnormalities to specific risk factors present during ALL treatment. Methods. Retrospective cohort study with prospective follow-up. Subjects had been diagnosed with ALL at ages 1-18 years and had been off chemotherapy for >9 months. Oral glucose tolerance testing (OGTT) was performed and these results compared to demographic, treatment, and anthropomorphic data from medical records. Results. Twenty-seven subjects (11 female) were evaluated. Mean (±SD) diagnosis age 5.7 ± 3.5 years, mean study age 11.3 ± 3.7 years, mean time off therapy 2.8 ± 1.5 years. Six subjects had transient hyperglycemia during ALL treatment. At study time, one subject had prediabetes; eight (29.6{\%}) had insulin resistance. Insulin resistance was not predicted by glucose levels during treatment, cumulative steroid or asparaginase dose, or type of steroid received. Body mass index (BMI) for age correlated significantly with several measures of insulin resistance, including fasting insulin, HOMA index, Matsuda index and insulin AUC (P=0.001-0.009). Waist/hip ratio and BMI at ALL diagnosis also correlated with insulin resistance, but these factors' effects could not be separated from BMI at study time. Conclusions. Variations in ALL therapy and presence of transient hyperglycemia do not appear to increase risk of glucose intolerance or insulin resistance in the first few years after completion of therapy. Elevated BMI strongly predicted insulin resistance in this study, as it does in the general population.",
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N2 - Background. Pediatric acute lymphoblastic leukemia (ALL) therapies have been associated with many late effects, including obesity, hyperglycemia, and insulin resistance. Few data are available linking these abnormalities to specific risk factors present during ALL treatment. Methods. Retrospective cohort study with prospective follow-up. Subjects had been diagnosed with ALL at ages 1-18 years and had been off chemotherapy for >9 months. Oral glucose tolerance testing (OGTT) was performed and these results compared to demographic, treatment, and anthropomorphic data from medical records. Results. Twenty-seven subjects (11 female) were evaluated. Mean (±SD) diagnosis age 5.7 ± 3.5 years, mean study age 11.3 ± 3.7 years, mean time off therapy 2.8 ± 1.5 years. Six subjects had transient hyperglycemia during ALL treatment. At study time, one subject had prediabetes; eight (29.6%) had insulin resistance. Insulin resistance was not predicted by glucose levels during treatment, cumulative steroid or asparaginase dose, or type of steroid received. Body mass index (BMI) for age correlated significantly with several measures of insulin resistance, including fasting insulin, HOMA index, Matsuda index and insulin AUC (P=0.001-0.009). Waist/hip ratio and BMI at ALL diagnosis also correlated with insulin resistance, but these factors' effects could not be separated from BMI at study time. Conclusions. Variations in ALL therapy and presence of transient hyperglycemia do not appear to increase risk of glucose intolerance or insulin resistance in the first few years after completion of therapy. Elevated BMI strongly predicted insulin resistance in this study, as it does in the general population.

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