title: Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia.
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.
  
  
  METHODS
  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 < 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 < 0.001). Patients with high risk disease had lower BMI z-scores regardless of cranial radiotherapy exposure (P < 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.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232, USA. Adam.esbenshade@vanderbilt.edu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Esbenshade
authors.forename: Jill H
authors.initials: JH
authors.lastname: Simmons
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Koehler
authors.forename: James A
authors.initials: JA
authors.lastname: Whitlock
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007223:Infant; D008297:Male; D009765:Obesity / Q000209:etiology*; D050177:Overweight / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult