title: A cross-sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL).
abstract: BACKGROUND
  Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for overweight, predisposing them to long-term morbidity. We examined the relationship between body mass index (BMI) and demographic and lifestyle factors in a cohort of ALL survivors.
  
  
  METHODS
  We enrolled consecutive ALL survivors who attended the institutional AfterCare Clinic over a 1-year period. BMI (kg/m(2) ) at diagnosis, end-therapy, and current time were calculated. Survivors were classified as overweight/obese (overweight group; BMI for age ≥ 85th percentile) or normal/underweight (normal weight group; BMI for age <85th percentile). We assessed the relationship between current BMI and self-reported current caloric intake, physical activity, and sedentary behavior.
  
  
  RESULTS
  102/157 (65%) eligible survivors consented to enrollment. Median age was 14.3 years (range 8.4-18.6) and time from end of treatment 7 years (2.5-15.6). The proportion of overweight survivors was 21%, 45%, and 35% at diagnosis, end-therapy, and current time, respectively. The overweight group reported less calories (Δ324 kcal, P = 0.018), fat (Δ14.5 g, P = 0.02), and carbohydrates (Δ39 g, P = 0.02) than the normal weight group. These differences disappeared after excluding patients classified as under-reporting their calorie intake according to the Goldberg cut-off method. There were no differences in sedentary behavior or activity between groups.
  
  
  CONCLUSIONS
  Many children with ALL gain weight during therapy and fail to return to normal weight after treatment concludes. Subsequent diet, physical activity, and sedentary behavior do not appear to differ between overweight and normal weight survivors. Clinicians should focus on ways to minimize weight gain during therapy rather than waiting for treatment to conclude.
authors.affiliation: Department of Clinical Dietetics, The Hospital for Sick Children, SickKids, Toronto, Ontario, Canada. erin.love@sickkids.ca
authors.forename: Erin
authors.initials: E
authors.lastname: Love
authors.forename: Jane E
authors.initials: JE
authors.lastname: Schneiderman
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Sylvia
authors.initials: S
authors.lastname: Lee
authors.forename: Mary
authors.initials: M
authors.lastname: Barron
authors.forename: Elena
authors.initials: E
authors.lastname: Tsangaris
authors.forename: Stacey
authors.initials: S
authors.lastname: Urbach
authors.forename: Patricia
authors.initials: P
authors.lastname: Staneland
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009043:Motor Activity; D050177:Overweight / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*