Adipokines, body fatness, and insulin resistance among survivors of childhood leukemia.
BACKGROUND
Following our previous reports of an increased prevalence of insulin resistance and adiposity among acute lymphoblastic leukemia (ALL) survivors, particularly women treated with cranial radiotherapy (CRT), we aimed to (1) assess the relationships between adipokines (leptin and adiponectin), CRT, and measures of body fatness and (2) determine correlates of insulin resistance, by gender.


METHODS
We conducted cross-sectional evaluation of 116 ALL survivors (median age: 23.0 years; range: 18-37; average time from treatment: 17.5 years), including fasting laboratory testing (adiponectin, leptin, insulin, and glucose), anthropometric measurements (weight, height, and waist circumference), DXA (total body fat and truncal-to-lower-body-fat ratio), and abdominal CT (visceral fat). We estimated insulin resistance using the homeostasis model for assessment of insulin resistance (HOMA-IR). Analytic approaches included regression models and Wilcoxon rank sum testing.


RESULTS
Mean leptin per kilogram fat mass was higher for females (0.7 ng/ml/kg) than males (0.4 ng/ml/kg, P < 0.01), and among subjects who had received CRT compared to those who had not received CRT (females CRT =0.9 ng/ml/kg, no CRT = 0.7 ng/ml/kg; P = 0.1; males CRT = 0.5 ng/ml/kg, no CRT = 0.3 ng/ml/kg; P < 0.01). Elevated HOMA-IR was nearly uniformly present, even among subjects with BMI < 25 kg/m(2), and was associated with higher leptin:adiponectin ratio (LA ratio; P < 0.01).


CONCLUSIONS
Among survivors of childhood leukemia, higher leptin levels were associated with measures of body fat and insulin resistance. Anthropomorphic and metabolic changes many years after ALL treatment remain a major health problem facing survivors and may be related to central leptin resistance.
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Emily S
ES
Tonorezos
Gloria L
GL
Vega
Charles A
CA
Sklar
Joanne F
JF
Chou
Chaya S
CS
Moskowitz
Qianxing
Q
Mo
Timothy S
TS
Church
Robert
R
Ross
Peter M
PM
Janiszewski
Kevin C
KC
Oeffinger
D054392:Adipokines / Q000378:metabolism*; D000273:Adipose Tissue; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D016371:Cranial Irradiation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D033581:Stem Cell Transplantation; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult
D054392:Adipokines
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