title: Obesity in pediatric ALL survivors: a meta-analysis.
abstract: 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.
authors.affiliation: Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy and.
authors.forename: Fang Fang
authors.initials: FF
authors.lastname: Zhang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelly
authors.forename: Edward
authors.initials: E
authors.lastname: Saltzman
authors.forename: Aviva
authors.initials: A
authors.lastname: Must
authors.forename: Susan B
authors.initials: SB
authors.lastname: Roberts
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
mesh_terms: D015331:Cohort Studies; D006801:Humans; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D017741:Survivors
keywords: acute lymphoblastic leukemia; obesity; pediatric; survivors