title: Association of body mass index and survival in pediatric leukemia: a meta-analysis.
abstract: BACKGROUND
  Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemia-related mortality; whether a similar effect exists in childhood leukemia remains controversial.
  
  
  OBJECTIVE
  We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR).
  
  
  METHODS
  We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese (≥95%) or overweight/obese (≥85%), was compared with lower BMI [nonoverweight/obese (<85%)]. Summary risk estimates for EFS, OS, and CIR (ALL only) were calculated with random- or fixed-effects models according to tests for between-study heterogeneity.
  
  
  RESULTS
  Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95% CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI.
  
  
  CONCLUSIONS
  Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.
authors: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA;
authors: Etan
authors: E
authors: Orgel
authors: Mailman School of Public Health, Herbert Irving Comprehensive Cancer Center.
authors: Jeanine M
authors: JM
authors: Genkinger
authors: Institute of Human Nutrition, College of Physicians and Surgeons, and.
authors: Divya
authors: D
authors: Aggarwal
authors: Division of Haemotology/Oncology, The Hospital for Sick Kids, Toronto, Canada; and.
authors: Lillian
authors: L
authors: Sung
authors: Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL.
authors: Michael
authors: M
authors: Nieder
authors: Herbert Irving Comprehensive Cancer Center, Institute of Human Nutrition, College of Physicians and Surgeons, and Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY; ejd14@cumc.columbia.edu.
authors: Elena J
authors: EJ
authors: Ladas
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007938:Leukemia / Q000401:mortality*; D050177:Overweight / Q000150:complications; D063766:Pediatric Obesity / Q000150:complications*; D012008:Recurrence; D055815:Young Adult
keywords: nutritional status; obesity; pediatric leukemia; relapse; survival