title: Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis.
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.
  
  
  METHODS
  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.
authors: Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.|Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors: Fang Fang
authors: FF
authors: Zhang
authors: Department of Nutrition Sciences, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors: Shanshan
authors: S
authors: Liu
authors: Department of Public Health and Community Medicine, Nutrition/Infection Unit, Tufts University School of Medicine, Boston, Massachusetts.
authors: Mei
authors: M
authors: Chung
authors: Division of Pediatric Hematology/ Oncology, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts.|Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
authors: Michael J
authors: MJ
authors: Kelly
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D017741:Survivors; D015430:Weight Gain
chemical_list: D000970:Antineoplastic Agents
keywords: acute lymphoblastic leukemia; growth; obesity; pediatric; survivors