title: Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy.
abstract: Obesity as defined by body mass index percentile (BMI%) is strongly associated with relapse and poorer survival in childhood ALL. Whether BMI% accurately reflects body fat percentage (BF%) in this population is unknown. We conducted a prospective study assessing body composition during frontline ALL therapy. Dual-energy X-ray absorptiometry measured BF% and lean muscle mass (LMM) at diagnosis, end of Induction, and end of Delayed Intensification. Sarcopenic obesity (gain in BF% with loss of LMM) was surprisingly common during ALL treatment, resulting in poor correlation between changes in BMI% (expressed as Z-score) and BF% overall (r = -0.05) and within patients (r = -0.09). BMI Z-score and BF% changed in opposite directions in >50% of interval assessments. While BMI% at diagnosis is a suitable predictor of obesity/BF% for epidemiological studies, change in BMI% (as expressed as Z-score) does not reflect body composition. Studies evaluating obesity in leukemia should consider using direct measures of body composition.
authors.affiliation: a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.|b Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach , Long Beach , CA , USA.|c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.
authors.forename: Etan
authors.initials: E
authors.lastname: Orgel
authors.affiliation: d Children's Orthopaedic Center, Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Mueske
authors.affiliation: a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.|c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: e Department of Radiology , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gilsanz
authors.affiliation: a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.|c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Freyer
authors.affiliation: c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.|f Center for Endocrinology, Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mittelman
mesh_terms: D015502:Absorptiometry, Photon; D050154:Adiposity; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000628:therapy; D008297:Male; D009765:Obesity / Q000150:complications* / Q000175:diagnosis*; D055815:Young Adult
keywords: Adiposity; DXA scan; body fat; body mass index; childhood ALL; obesity
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