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Chen Y, Miao J, Liang X, Zhang J, Xu W, Song H, Tang Y, Fu J, Xu X. Height and Body Mass Index Changes in Chinese Children Undergoing Chemotherapy for Acute Lymphoblastic Leukemia. Nutr Cancer 2025:1-10. [PMID: 40396397 DOI: 10.1080/01635581.2025.2505261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 05/06/2025] [Accepted: 05/07/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND Children with acute lymphoblastic leukemia (ALL) have a higher risk of height deficit and obesity. Data on Chinese pediatric ALL patients treated on chemotherapy only are limited. METHODS Changes in z scores for height and body mass index (BMI) from the diagnosis to 2 years after the initial of treatment were analyzed in 805 ALL patients diagnosed at Children's Hospital of Zhejiang University School of Medicine. RESULTS A significant reduction in height z-scores and increase in BMI z-scores were documented during treatment (p < 0.001), the most pronounced changes observed in the first three months. Catch-up growth was noted after nine months. Children in middle-high-aged group showed the most significant decline in height z-scores after 24 months (p < 0.05). High-risk patients exhibited lower height z-scores at 9 and 12 months (p < 0.01). Children under 9 years or in non-high-risk group showed greater BMI z-scores increase during treatment (p < 0.05). There were no significant differences by gender. CONCLUSION Chemotherapy leads to height deficit and BMI increase in pediatric ALL patients. Height deficit is more pronounced in children aged 8-13 years, BMI increases are more significant in younger children. High-risk patients are more prone to lower height and smaller BMI increases.
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Affiliation(s)
- Yixiao Chen
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Jing Miao
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Xinyi Liang
- National Clinical Research Centre for Child Health, Hangzhou, PR China
- Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Jingying Zhang
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Weiqun Xu
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Hua Song
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Yongmin Tang
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
| | - Junfen Fu
- National Clinical Research Centre for Child Health, Hangzhou, PR China
- Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Xiaojun Xu
- Division of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- National Clinical Research Centre for Child Health, Hangzhou, PR China
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Body Composition in Patients with Follicular Lymphoma: Asso-Ciations between Changes in Radiomic Parameters in Patients Treated with R-CHOP-like and R-B Regimens: LyRa 01F. Cancers (Basel) 2023; 15:cancers15040999. [PMID: 36831345 PMCID: PMC9954461 DOI: 10.3390/cancers15040999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
In patients with follicular lymphoma (FL), therapeutic advances have led to improved survival, and within this framework, it is important to identify treatment strategies offering a better quality of life. Using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), in patients treated with R-CHOP-like or R-Bendamustine regimens, we assessed changes in the bone mineral density (BMD), musculoskeletal index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at disease onset and at the end of therapy. We evaluated whether the high-steroid regimen could lead to more significant radiological changes than those induced by the steroid-free regimen and whether a low BMD at disease onset is an unfavorable prognostic index. Seventy-nine patients between 60 and 80 years old with a new diagnosis of FL were included in the study. Evaluation of Delta values (pre- and post-therapy mean values) in the two immunochemotherapy regimens showed differences in radiomic parameters within the two patient cohorts. The R-CHOP-like regimen was associated with a significant reduction in BMD, an increase in SAT and VAT, and a reduction in skeletal muscle density (SMD) and SMI. Moreover, patients with high FLIPI showed a BMD below the cut-off value. This study represents the first study demonstrating a prognostic correlation between FLIPI and low BMD.
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Paiva ACM, Alves JFDR, Macêdo DJDN, Gonçalves MA. Evolução do Estado Nutricional de Crianças e Adolescentes com Leucemia Linfoide Aguda submetidos a Terapia Oncológica. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introdução: Quando se fala em câncer infantojuvenil, a leucemia linfoide aguda (LLA) ganha destaque por causa da sua elevada prevalência nessa população. De todos os tipos de câncer que atingem esse público, crianças e adolescentes parecem ser mais suscetíveis aos efeitos adversos como a má nutrição e/ou excesso de peso ao longo do tratamento. Objetivo: Avaliar a evolução do estado nutricional de crianças e adolescentes com LLA submetidos a terapia oncológica. Método: Estudo retrospectivo, longitudinal, com pacientes portadores de LLA submetidos a terapia antineoplásica, realizado com 69 crianças e adolescentes (até 19 anos), de ambos os sexos. As medidas de peso e altura foram coletadas em oito ocasiões distintas ao longo de todo o tratamento, tendo o primeiro registro acontecido no início e o ultimo ao termino de todas as sessões do tratamento antineoplásico. Resultados: Ao diagnostico, houve uma prevalência de pacientes classificados como estróficos. Quando correlacionados a faixa etária e o indicador Altura/Idade para idade, foi observado que crianças menores de 10 anos apresentaram valores mais baixos se comparados com os maiores de 10 anos no decorrer do tratamento, além de uma tendência de incremento no escore Peso/Idade de forma lenta ate o seu final. Conclusão: Os pacientes submetidos ao tratamento antineoplásico de LLA apresentaram uma redução na velocidade de crescimento, além de leve ganho de peso ao final da terapia, o que sugere uma interferência negativa da terapêutica empregada sobre o estado nutricional nessa população.
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Assessment of Nutritional Status and Malnutrition Risk at Diagnosis and Over a 6-Month Treatment Period in Pediatric Oncology Patients With Hematologic Malignancies and Solid Tumors. J Pediatr Hematol Oncol 2019; 41:e308-e321. [PMID: 30475301 DOI: 10.1097/mph.0000000000001350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (<-2 SD) and 6.8% overnutrition (>2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI<5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.
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Foster KL, Kern KD, Chambers TM, Lupo PJ, Kamdar KY, Scheurer ME, Brown AL. Weight trends in a multiethnic cohort of pediatric acute lymphoblastic leukemia survivors: A longitudinal analysis. PLoS One 2019; 14:e0217932. [PMID: 31150521 PMCID: PMC6544325 DOI: 10.1371/journal.pone.0217932] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As survival rates for childhood acute lymphoblastic leukemia (ALL) continue to improve, there is growing concern over the chronic health conditions that survivors face. Given that survivors of childhood ALL are at increased risk of cardiovascular complications and obesity, we sought to characterize BMI trends from diagnosis through early survivorship in a multi-ethnic, contemporary cohort of childhood ALL patients and determine if early weight change was predictive of long-term weight status. METHODS The study population consisted of ALL patients aged 2-15 years at diagnosis who were treated with chemotherapy alone at Texas Children's Hospital. Each patient had BMI z-scores collected at diagnosis, 30-days post-diagnosis, and annually for five years. Linear regression models were estimated to evaluate the association between: 1) BMI z-score change in the first 30 days and BMI z-scores at five-years post-diagnosis; and 2) BMI z-score change in the first year post-diagnosis and BMI z-scores at five-years post-diagnosis. RESULTS This retrospective cohort study included longitudinal data from 121 eligible patients. The mean BMI z-scores for the population increased significantly (p-value<0.001) from baseline (mean = 0.25) to 30 days post-diagnosis (mean = 1.17) before plateauing after one year post-diagnosis (mean = 0.99). Baseline BMI z-scores were statistically significant predictors to five year BMI z-scores (p <0.001). Independent of baseline BMI z-score and other clinical factors, the BMI z-score at one year post-diagnosis was significantly associated with BMI z-score at five-years post-diagnosis (β = 0.63, p <0.001), while BMI z-score at 30 days post-diagnosis was not (β = 0.10, p = 0.23). CONCLUSION Our results suggest that weight gain within the first year after diagnosis is more strongly associated with long-term BMI than early weight gain (within 30 days). If confirmed, this information may help identify a window of time during therapy when ALL patients would benefit most from weight management directed interventions.
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Affiliation(s)
- Kayla L. Foster
- St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Kathleen D. Kern
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Tiffany M. Chambers
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Philip J. Lupo
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Kala Y. Kamdar
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Michael E. Scheurer
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
| | - Austin L. Brown
- Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children’s Cancer and Hematology Centers, Houston, Texas, United States of America
- * E-mail:
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Belle FN, Kasteler R, Schindera C, Bochud M, Ammann RA, von der Weid NX, Kuehni CE. No evidence of overweight in long-term survivors of childhood cancer after glucocorticoid treatment. Cancer 2018; 124:3576-3585. [DOI: 10.1002/cncr.31599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/09/2018] [Accepted: 05/18/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Fabiën N. Belle
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
- Division of Chronic Diseases, Institute of Social and Preventive Medicine; Lausanne University Hospital; Lausanne Switzerland
| | - Rahel Kasteler
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
| | - Christina Schindera
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
- Department of Hematology, University Children's Hospital Basel; Basel Switzerland
| | - Murielle Bochud
- Division of Chronic Diseases, Institute of Social and Preventive Medicine; Lausanne University Hospital; Lausanne Switzerland
| | - Roland A. Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | | | - Claudia E. Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
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Hill R, Hamby T, Bashore L, Rapisand S, Galipp K, Heym K, Bowman WP. Early Nutrition Intervention Attenuates Weight Gain for Pediatric Acute Lymphoblastic Leukemia Patients in Maintenance Therapy. J Pediatr Hematol Oncol 2018; 40:104-110. [PMID: 29045268 DOI: 10.1097/mph.0000000000000975] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obesity following treatment of pediatric acute lymphoblastic leukemia (ALL) has become a significant long-term concern. Excessive weight gain often occurs during treatment, particularly during induction and the first 6 months of maintenance therapy, and it may be potentially modifiable. This retrospective study aimed to evaluate the impact of an early, 3-visit nutrition intervention on weight gain during maintenance therapy in ALL patients. Medical records of the intervention group were compared with historical controls who were treated on the same ALL treatment protocols during an earlier time period. Anthropometrics were collected throughout intensive therapy and at every monthly visit during the first 12 months of maintenance therapy. In total, 67 patients were evaluated (33 in the intervention group and 34 in the control group). After controlling for significant predictors of body mass index (BMI) z-scores in maintenance therapy-including higher BMI at diagnosis and weight gain throughout intensive therapy-the intervention group demonstrated more controlled weight gain during maintenance therapy (P<0.0001). A 3-visit nutrition intervention was effective in attenuating weight gain trends during ALL maintenance therapy.
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Affiliation(s)
- Rachel Hill
- Departments of Pediatric Hematology/Oncology
| | - Tyler Hamby
- Research Operations, Cook Children's Health Care System.,Texas College of Osteopathic Medicine, University of North Texas Health Science Center
| | - Lisa Bashore
- Departments of Pediatric Hematology/Oncology.,Harris College of Nursing and Health Science, Texas Christian University, Fort Worth, TX
| | | | - Kari Galipp
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center
| | | | - W Paul Bowman
- Departments of Pediatric Hematology/Oncology.,Texas College of Osteopathic Medicine, University of North Texas Health Science Center
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So E, Kim J, Joo S, Lee J, Joung H. Association of dietary patterns with overweight risk and all-cause mortality in children with cancer. Nutr Res Pract 2017; 11:492-499. [PMID: 29209460 PMCID: PMC5712500 DOI: 10.4162/nrp.2017.11.6.492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/27/2017] [Accepted: 10/11/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the association of dietary patterns with overweight risk and all-cause mortality in pediatric cancer patients. SUBJECTS/METHODS Prospective cohort study was undertaken; 83 cancer patients admitted to the pediatric cancer ward at a university hospital in Seoul were included and followed for obesity and death over 24 months. Food consumption data were collected from patients using validated meal order sheets for breakfast, lunch, and dinner at the pediatric cancer ward over 3 days. Using principal component analysis, three dietary patterns were derived from 29 food groups. RESULTS Eighteen deaths occurred among the patient cohort during the follow-up period. The “spicy & fried meat and fish” dietary pattern was positively associated with overweight risk at both baseline [odds ratio (OR) = 4.396, 95% confidence interval (CI) = 1.111-17.385, P for trend = 0.023] and after 6 months (OR = 4.088, 95% CI = 1.122-14.896, P for trend = 0.025) as well as all-cause mortality (hazard ratios = 5.124, 95% CI = 1.080-24.320, P for trend = 0.042), when comparing the highest and lowest tertiles after adjusting for covariates. The “fish, egg, meat, and fruits & vegetables” dietary pattern was associated with lower overweight risk after 24 months (OR = 0.157, 95% CI = 0.046-0.982, P for trend = 0.084). CONCLUSION The results imply that dietary patterns might be associated with weight gain and premature death among pediatric cancer patients.
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Affiliation(s)
- Eunjin So
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea.,Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
| | - Jeeyeon Kim
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Sehwa Joo
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Jisun Lee
- Department of Clinical Nutrition, The Catholic University of Korea Seoul St, Mary's Hospital, Seoul 06591, Korea
| | - Hyojee Joung
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.,Institute of Health and Environment, Seoul National University, Seoul 08826, Korea
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Collins L, Beaumont L, Cranston A, Savoie S, Nayiager T, Barr R. Anthropometry in Long-Term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence. J Adolesc Young Adult Oncol 2017; 6:294-298. [DOI: 10.1089/jayao.2016.0091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Laura Collins
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lesley Beaumont
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amy Cranston
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Stefanie Savoie
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Trishana Nayiager
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ronald Barr
- Service of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents. Arch Med Res 2016; 47:585-592. [DOI: 10.1016/j.arcmed.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022]
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Prevalence and Predictors of Overweight and Obesity Among a Multiethnic Population of Pediatric Acute Lymphoblastic Leukemia Survivors: A Cross-Sectional Assessment. J Pediatr Hematol Oncol 2016; 38:429-36. [PMID: 26989911 PMCID: PMC4955650 DOI: 10.1097/mph.0000000000000555] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
As previous studies of obesity in survivors of pediatric acute lymphoblastic leukemia (ALL) have primarily been conducted among non-Hispanic white survivors or children treated on older protocols, our objective was to describe the prevalence and correlates of overweight status among an ethnically diverse population of pediatric ALL survivors, largely treated with more contemporary therapies. We evaluated the overweight/obesity status of pediatric ALL survivors (n=406) followed in the Texas Children's Cancer Center between 2004 and 2014. Survivors were classified as underweight, normal weight, overweight, or obese on the basis of their body mass index at their most current follow-up visit. Our results showed that Hispanic ethnicity (39% of the subjects) was associated with being overweight (adjusted odds ratio=1.88; 95% confidence interval, 1.13-3.14) or obese (adjusted odds ratio=2.84; 95% confidence interval, 1.59-5.06) at follow-up, even after adjusting for cranial radiotherapy (CRT) exposure. Body mass index z-score at diagnosis was also associated with overweight/obesity at follow-up. In addition, there was a statistically significant interaction between younger age at diagnosis and CRT, indicating that younger age at diagnosis was associated with obesity among patients who received CRT. These findings may help identify pediatric ALL patients that are at increased risk of being overweight or obese after treatment.
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Barr RD, Mosby TT. Nutritional status in children and adolescents with leukemia: An emphasis on clinical outcomes in low and middle income countries. Hematology 2016; 21:199-205. [DOI: 10.1080/10245332.2015.1101968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ronald D. Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terezie T. Mosby
- College of Agriculture and Human Ecology, Tennessee Technological University, Cookeville, USA
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Gunn HM, Emilsson H, Gabriel M, Maguire AM, Steinbeck KS. Metabolic Health in Childhood Cancer Survivors: A Longitudinal Study in a Long-Term Follow-Up Clinic. J Adolesc Young Adult Oncol 2015; 5:24-30. [PMID: 26812459 DOI: 10.1089/jayao.2015.0036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Childhood cancer survivors (CCS) are at increased risk of metabolic dysfunction as a late effect of cancer treatment. However, pediatric metabolic syndrome (MetS) lacks a unified definition, limiting the diagnosis of MetS in CCS. This study evaluated individual metabolic health risk factors and potential areas for intervention in this at-risk population. METHODS This single center, retrospective observational longitudinal study evaluated the metabolic health of all CCS attending an oncology long-term follow-up clinic at a university hospital in Sydney, Australia (January 2012-August 2014). Participants were 276 CCS (52.2% male; mean age 18.0 years; range 6.8-37.9 years), at least 5 years disease free with a broad spectrum of oncological diagnoses. Primary metabolic health risk factors included raised body mass index, hypertension, and hypertransaminasemia. Participants treated with cranial radiotherapy (n = 47; 17.0% of cohort) had additional biochemical variables analyzed: fasting glucose/insulin, HDL/LDL cholesterol, and triglycerides. RESULTS Hypertension was common (19.0%), with male sex (p < 0.01) and being aged 18 years or above (p < 0.01) identified as risk factors. Cranial irradiation was a risk factor for overweight/obesity (47.8% in cranial radiotherapy-treated participants vs. 30.4%; p = 0.02). Hypertransaminasemia was more prevalent among participants treated with radiotherapy (15.6% vs. 7.3%; p = 0.03), and overweight/obese participants (17.6% vs. 8.2%; p = 0.04). CONCLUSION Metabolic health risk factors comprising MetS are common in CCS, placing this population at risk of premature adverse cardiovascular consequences. Proactive surveillance and targeted interventions are required to minimize these metabolic complications, and a unified definition for pediatric MetS would improve identification and monitoring.
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Affiliation(s)
- Harriet M Gunn
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Westmead, Australia .,2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia
| | - Hanna Emilsson
- 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden
| | - Melissa Gabriel
- 4 Long-Term Follow-Up Clinic, Department of Oncology, The Children's Hospital at Westmead , Westmead, Australia
| | - Ann M Maguire
- 2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia .,5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead , Westmead, Australia
| | - Katharine S Steinbeck
- 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Westmead, Australia .,2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia
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Murphy AJ, White M, Elliott SA, Lockwood L, Hallahan A, Davies PS. Body composition of children with cancer during treatment and in survivorship. Am J Clin Nutr 2015; 102:891-6. [PMID: 26269368 DOI: 10.3945/ajcn.114.099697] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 07/16/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Malnutrition as assessed with the use of body-composition measurements is a poorly understood short- and long-term complication of childhood cancer. OBJECTIVES We aimed to evaluate the body composition of 2 childhood cancer cohorts as follows: 1) children currently undergoing cancer treatment and 2) childhood cancer survivors. We also aimed to compare the prevalence of obesity and undernutrition between the cancer groups and investigate the impact of cancer type on body composition. DESIGN Eighty-two children during the treatment of cancer and 53 childhood cancer survivors were involved in the study. Height, weight, body cell mass, percentage of fat, fat mass index, and fat-free mass index were assessed. Subjects were compared with age- and sex-matched healthy controls. RESULTS The on-treatment group had a higher percentage of fat (P = 0.0001) and fat mass index (P = 0.0001) and a significantly lower body cell mass index (P = 0.0001) and fat-free mass index (P = 0.003) than did matched controls. The survivor group had a significantly higher percentage of fat (P = 0.03) and fat mass index (P = 0.04) and significantly lower body cell mass index (P = 0.0001) than did matched controls. The prevalence of undernutrition was high in both groups with 48% (95% CI: 36%, 60%) of the on-treatment group and 53% (95% CI: 40%, 66%) of the survivors considered undernourished. According to the percentage of fat cutoffs, significantly more on-treatment patients were obese (55%; 95% CI: 40%, 60%) than were survivors (26%; 95% CI: 14%, 38%) (P = 0.005). There were no statistically significant differences in body composition between cancer types in either the on-treatment or the survivor group. CONCLUSIONS Overnutrition and undernutrition are major concerns in the short and long term for children with cancer. Children treated for cancer have increased fat mass and decreased body cell mass, which are evident during treatment and in survivorship. This trial was registered at http://www.ANZCTR.org.au as ACTRN12614001279617 and ACTRN12614001269628.
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Affiliation(s)
- Alexia J Murphy
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
| | - Melinda White
- Department of Dietetics and Food Service, Lady Cilento Children's Hospital, Brisbane, Australia; and
| | - Sarah A Elliott
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
| | - Liane Lockwood
- Oncology Service, Children's Health Queensland, Brisbane, Australia
| | - Andrew Hallahan
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia; Oncology Service, Children's Health Queensland, Brisbane, Australia
| | - Peter Sw Davies
- Children's Nutrition Research Centre, Child Health Research Centre, School of Medicine, and
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15
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Zhang FF, Liu S, Chung M, Kelly MJ. Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis. Pediatr Blood Cancer 2015; 62:1452-60. [PMID: 25808413 PMCID: PMC4482769 DOI: 10.1002/pbc.25519] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/25/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Survivors of pediatric acute lymphoblastic leukemia (ALL) have a significantly higher body mass index (BMI) than their peers. Understanding the critical time periods in which patients with pediatric ALL are vulnerable to unhealthy weight gain will lay the groundwork for developing effectively timed interventions. PROCEDURE We determined the growth patterns of patients with pediatric ALL during and after treatment through the conduct of a systematic review and meta-analysis. A search of MEDLINE, Scopus, and Web of Science was performed from its inception through May 2014. Studies met the inclusion criteria if they included at least 10 patients of pediatric ALL, and longitudinally assessed BMI at diagnosis and at least one time point after diagnosis RESULTS Twenty-one studies met the inclusion criteria for the systematic review and 16 were included in meta-analysis. The mean increase in BMI z-score during treatment in 1,514 patients with pediatric ALL was 0.81 (95% CI: 0.25-1.38). Specifically, patients experienced substantial weight gain in early treatment (Δ = 0.41, 95% CI: -0.34, 1.17) and again during maintenance (Δ = 0.34, 95% CI:-0.22, 0.90). The mean increase in BMI z-score ranged between 0.52 and 0.89 beyond treatment completion. Subgroup analyses found unhealthy weight gain occurred regardless of patients' receipt of cranial radiation therapy, sex, and, weight status at diagnosis. CONCLUSIONS Patients with pediatric ALL experience unhealthy weight gain early in treatment, and increases in weight are maintained beyond treatment completion. Preventing early onset of obesity is a priority for improving the care and outcomes for patients with pediatric ALL.
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Affiliation(s)
- Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Shanshan Liu
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mei Chung
- Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Michael J. Kelly
- Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
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16
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Muhammad S, Milford DV, Carson A, Young H, Martin CR. COPING IN YOUNG PEOPLE WITH CHRONIC KIDNEY DISEASE (CKD). J Ren Care 2015; 42:34-42. [PMID: 26041710 DOI: 10.1111/jorc.12131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - David V. Milford
- Department of Nephrology; Birmingham Children's Hospital NHS Foundation Trust; UK
| | - Amanda Carson
- University of the West of Scotland, Nursing and Midwifery; Paisley UK
| | - Harry Young
- Royston Youth Club; Youth Action; Glasgow UK
| | - Colin R. Martin
- Faculty of Society and Health; Buckinghamshire New University; Uxbridge UK
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17
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Abu-Ouf NM, Jan MM. Metabolic syndrome in the survivors of childhood acute lymphoblastic leukaemia. Obes Res Clin Pract 2015; 9:114-24. [DOI: 10.1016/j.orcp.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/21/2014] [Accepted: 06/26/2014] [Indexed: 12/28/2022]
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18
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Barr R, Nayiager T, Gordon C, Marriott C, Athale U. Body composition and bone health in long-term survivors of acute lymphoblastic leukaemia in childhood and adolescence: the protocol for a cross-sectional cohort study. BMJ Open 2015; 5:e006191. [PMID: 25603918 PMCID: PMC4305072 DOI: 10.1136/bmjopen-2014-006191] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Success in the treatment of young people with cancer, as measured conventionally by survival rates, is mitigated by late effects of therapy that impose a burden of morbidity and limit life expectancy. Among these adverse sequelae are altered body composition, especially obesity, and compromised bone health in the form of osteoporosis and increased fragility. These outcomes are potentially reversible and even preventable. This study will examine measures of body composition and bone health in long-term survivors of acute lymphoblastic leukaemia (ALL) in childhood and adolescence. These measures will be complemented by measures of physical activity and health-related quality of life (HRQL). METHODS AND ANALYSIS Survivors of ALL who are at least 10 years from diagnosis, following treatment on uniform protocols, will undergo measurements of body mass index; triceps skin fold thickness and mid-upper arm circumference; fat mass, lean body mass, skeletal muscle mass and bone mineral density by dual energy X-ray absorptiometry; trabecular and cortical bone indices and muscle density by peripheral quantitative CT; physical activity by the Habitual Activity Estimation Scale; and HRQL by Health Utilities Index instruments. Descriptive measures will be used for continuous variables and number (percent) for categorical variables. Associations between variables will be assessed using Fisher's exact t test and the χ(2) test; correlations will be tested by the Pearson correlation coefficient. ETHICS AND DISSEMINATION The study is approved by the institutional research ethics board and is supported by a competitive funding award. Dissemination of the results will occur by presentations to scientific meetings and publications in peer-reviewed journals, and by posting summaries of the results on websites accessed by adolescent and young adult survivors of cancer.
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Affiliation(s)
- Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Trishana Nayiager
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Christopher Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christopher Marriott
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Zhang FF, Rodday AM, Kelly MJ, Must A, MacPherson C, Roberts SB, Saltzman E, Parsons SK. Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer 2014; 61:1263-9. [PMID: 24482072 PMCID: PMC4435552 DOI: 10.1002/pbc.24960] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND A high prevalence of obesity has been increasingly recognized in survivors of pediatric ALL. However, longitudinal patterns of weight change during and after treatment, and associated factors, are less well elucidated. PROCEDURE In a retrospective cohort of 83 pediatric patients with ALL diagnosed between 1985 and 2010, we examined body mass index (BMI) status at several key time points: diagnosis; end of induction; end of consolidation; every 6 months during maintenance; and yearly for up to 5 years post-treatment. RESULTS At diagnosis, 21% were overweight (BMI = 85-94.9th percentile) or obese (BMI ≥ 95th percentile). At the end of treatment and 5 years post-treatment, approximately 40% were overweight or obese. The mean BMI z-score was 0.2 (58th percentile) at diagnosis and increased significantly during induction (Δ = 0.5, P < 0.0001). It increased again during the first 6 months of maintenance (Δ = 0.2, P < 0.01) and did not significantly change over the remainder of maintenance (BMI z-score at the end of treatment = 0.8, 79th percentile) and 5 years post-treatment (BMI z-score = 0.7, 76th percentile). High BMI z-score at diagnosis was associated with an increased risk of being overweight/obese at treatment completion (OR = 2.9, 95% CI: 1.6-5.1). Weight gain during treatment was associated with being overweight/obese 5 years post-treatment (OR = 3.8, 95% CI: 1.1-12.5). CONCLUSION Children with ALL are at risk of becoming overweight/obese early in treatment. Increases in weight are maintained throughout treatment and beyond. Lifestyle interventions are needed targeting weight control early during treatment, particularly for patients overweight/obese at diagnosis and those who experience substantial weight gain during treatment.
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Affiliation(s)
- Fang Fang Zhang
- Department of Nutrition Science, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts,Correspondence to: Fang Fang Zhang, Department of Nutrition Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 20111.
| | - Angie Mae Rodday
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Michael J. Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Cathy MacPherson
- Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Susan B. Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Edward Saltzman
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Susan K. Parsons
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts,Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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20
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Zhang FF, Kelly MJ, Saltzman E, Must A, Roberts SB, Parsons SK. Obesity in pediatric ALL survivors: a meta-analysis. Pediatrics 2014; 133:e704-15. [PMID: 24534408 PMCID: PMC3934345 DOI: 10.1542/peds.2013-3332] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis. METHODS A MEDLINE search was performed from its inception through 2013. Studies met the inclusion criteria if they (1) included at least 10 survivors of pediatric ALL; (2) assessed the prevalence or indicators of obesity; and (3) compared obesity among ALL survivors to a reference population or external control group. Extracted data included patient and treatment characteristics, study design, population used for comparison, and prevalence of obesity. RESULTS Forty-seven studies met the inclusion criteria. Despite significant heterogeneity among the studies (I(2) = 96%), the mean BMI z score in 1742 pediatric ALL survivors was 0.83 (95% confidence interval: 0.60-1.06), which corresponds to the 80th BMI percentile, indicating a significantly higher BMI in pediatric ALL survivors than the reference population. Subgroup analyses found a high prevalence of obesity in ALL survivors regardless of survivors' receipt of cranial irradiation, gender, or age at diagnosis. CONCLUSIONS Obesity is prevalent in pediatric ALL survivors and is independent of patient- and treatment-related characteristics. Clinicians need to screen for obesity and its associated health conditions early in survivorship.
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Affiliation(s)
- Fang Fang Zhang
- Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy and,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Michael J. Kelly
- Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts;,Departments of Pediatrics
| | - Edward Saltzman
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Aviva Must
- Public Health and Community Medicine, and
| | - Susan B. Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Susan K. Parsons
- Departments of Pediatrics,,Medicine, Tufts University School of Medicine, Boston, Massachusetts; and,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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21
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Annaloro C, Airaghi L, Saporiti G, Onida F, Cortelezzi A, Deliliers GL. Metabolic syndrome in patients with hematological diseases. Expert Rev Hematol 2014; 5:439-58. [DOI: 10.1586/ehm.12.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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22
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Muhammad S, Noble H, Banks P, Carson A, Martin CR. How young people cope with chronic kidney disease: literature review. J Ren Care 2013; 38:182-90. [PMID: 23176577 DOI: 10.1111/j.1755-6686.2012.00324.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a complex, long-term condition occurring in all age groups. It has been reported that the incidence of renal replacement therapy in young people is 7-8 per million population. Notwithstanding those individuals who may receive a donor kidney, many individuals may be disenfranchised by perceptions of helplessness and feelings of powerlessness against a backdrop of diminished health outlook, consequently impacting on capacity for effective coping. AIM The aim of this review is to explore how young people cope with CKD. METHODS Three hundred and thirty-seven abstracts were identified. Sixty-three papers were cross-examined using a Critical Appraisal Skills Checklist Tool. RESULTS Young people face various demands; these may be episodic or ongoing, depending on health and circumstance. The themes this review uncovers are: 'Lack of a Coping Definition'; 'Coping Strategies in Young People'; and 'Barriers to the Understanding of Coping in Young People'. CONCLUSION More qualitative research is vital to retrieve 'real-life' perceptions from young people coping with kidney disease to identify how care should be made more explicit for them.
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Affiliation(s)
- Shahid Muhammad
- School of Nursing & Midwifery, Hamilton Campus, University of the West of Scotland, Paisley, Hamilton, UK.
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Bailey LC, Milov DE, Kelleher K, Kahn MG, Del Beccaro M, Yu F, Richards T, Forrest CB. Multi-Institutional Sharing of Electronic Health Record Data to Assess Childhood Obesity. PLoS One 2013; 8:e66192. [PMID: 23823186 PMCID: PMC3688837 DOI: 10.1371/journal.pone.0066192] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/07/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the validity of multi-institutional electronic health record (EHR) data sharing for surveillance and study of childhood obesity. METHODS We conducted a non-concurrent cohort study of 528,340 children with outpatient visits to six pediatric academic medical centers during 2007-08, with sufficient data in the EHR for body mass index (BMI) assessment. EHR data were compared with data from the 2007-08 National Health and Nutrition Examination Survey (NHANES). RESULTS Among children 2-17 years, BMI was evaluable for 1,398,655 visits (56%). The EHR dataset contained over 6,000 BMI measurements per month of age up to 16 years, yielding precise estimates of BMI. In the EHR dataset, 18% of children were obese versus 18% in NHANES, while 35% were obese or overweight versus 34% in NHANES. BMI for an individual was highly reliable over time (intraclass correlation coefficient 0.90 for obese children and 0.97 for all children). Only 14% of visits with measured obesity (BMI ≥95%) had a diagnosis of obesity recorded, and only 20% of children with measured obesity had the diagnosis documented during the study period. Obese children had higher primary care (4.8 versus 4.0 visits, p<0.001) and specialty care (3.7 versus 2.7 visits, p<0.001) utilization than non-obese counterparts, and higher prevalence of diverse co-morbidities. The cohort size in the EHR dataset permitted detection of associations with rare diagnoses. Data sharing did not require investment of extensive institutional resources, yet yielded high data quality. CONCLUSIONS Multi-institutional EHR data sharing is a promising, feasible, and valid approach for population health surveillance. It provides a valuable complement to more resource-intensive national surveys, particularly for iterative surveillance and quality improvement. Low rates of obesity diagnosis present a significant obstacle to surveillance and quality improvement for care of children with obesity.
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Affiliation(s)
- L. Charles Bailey
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - David E. Milov
- Nemours Children’s Hospital, Orlando, Florida, United States of America
| | - Kelly Kelleher
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Michael G. Kahn
- Children’s Hospital of Colorado, Aurora, Colorado, United States of America
| | | | - Feliciano Yu
- St. Louis Children’s Hospital, St. Louis, Missouri, United States of America
| | - Thomas Richards
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Christopher B. Forrest
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Co-Reyes E, Li R, Huh W, Chandra J. Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatr Blood Cancer 2012; 59:1160-7. [PMID: 22948929 PMCID: PMC3468697 DOI: 10.1002/pbc.24272] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/05/2012] [Indexed: 01/06/2023]
Abstract
In children with cancer, suboptimal nutrition states are common consequences of the disease and its treatment. These nutrition states have been attributed to a number of etiologies dependent on the patient's tumor type and treatment, and are associated with increased morbidity and mortality. Interventions vary from psychosocial to pharmacological and surgical management. Further research is necessary to understand the epidemiology and etiology of these nutrition states. Of great importance is the development and implementation of effective interventions to optimize nutritional status among children with cancer during and after therapy.
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Affiliation(s)
| | - Rhea Li
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Winston Huh
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joya Chandra
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
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