title: Adipokines, insulin resistance, and adiposity as a predictors of metabolic syndrome in child survivors of lymphoma and acute lymphoblastic leukemia of a developing country.
abstract: There is a growing body of evidence indicating that pediatric survivors of cancer are at a greater risk of developing metabolic syndrome. This study evaluated some probable predictors of metabolic syndrome (MS), such as leptin and adiponectin concentrations, the leptin/adiponectin ratio, insulin resistance, and adiposity, in a sample of child survivors of lymphoma and leukemia in Mexico City.
  
  
  
  Fifty two children (leukemia n = 26, lymphoma n = 26), who were within the first 5 years after cessation of therapy, were considered as eligible to participate in the study. Testing included fasting insulin, glucose, adipokines and lipids; body fat mass was measured by DXA. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. Comparisons between continuous variables were performed according to the data distribution. The MS components were analyzed according to tertiles of adipokines, insulin resistance, and adiposity. With the purpose of assessing the risk of a present MS diagnosis, odds ratios (OR) with a 95% confidence interval (95% IC) were obtained using logistic regression analysis according to the various metabolic markers.
  
  
  
  The median children age was 12.1 years, and the interval time from the completion of therapy to study enrollment was 4 years. Among the MS components, the prevalence of HDL-C low was most common (42%), followed by central obesity (29%). The HOMA-IR (OR 9.0, 95% CI 2.0; 41.1), body fat (OR 5.5, 95% CI 1.6; 19.3), leptin level (OR 5.7, 95% CI 1.6; 20.2) and leptin/adiponectin ratio (OR 9.4, 95% CI 2.0; 49.8) in the highest tertile, were predictive factors of developing MS; whereas the lowest tertile of adiponectin was associated with a protective effect but not significant.
  
  
  
  Biomarkers such as HOMA-IR, leptin and leptin/adiponectin are associated with each of the components of the MS and with a heightened risk of suffering MS among children survivors of cancer. Given the close relationship between MS with risk of developing type 2 diabetes and cardiovascular disease, it is imperative to implement prevention measures in this population and especially in developing countries where these pathologies have become the leading cause of death.
authors.affiliation: Medical Nutrition Research Unit, 21st Century Pediatric Hospital, National Medical Center, MexicanInstitute of Social Security, México City, México. bcmariade@hotmail.com.|Medical Nutrition Research Unit, 21st Century Pediatric Hospital, National Medical Center, Mexican Institute of Social Security, Avenida Cuauhtémoc 330 Col. Doctores, México City, C.P. 06720, México. bcmariade@hotmail.com.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Barbosa-Cortés
authors.affiliation: Medical Nutrition Research Unit, 21st Century Pediatric Hospital, National Medical Center, MexicanInstitute of Social Security, México City, México.
authors.forename: Mardia
authors.initials: M
authors.lastname: López-Alarcón
authors.affiliation: Health Research Coordination, 21st Century Pediatric Hospital, National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Mejía-Aranguré
authors.affiliation: Department of Community Health Research, Federico Gómez Children's, México Secretary of Health, and Research Committee, Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN), México City, México.
authors.forename: Miguel
authors.initials: M
authors.lastname: Klünder-Klünder
authors.affiliation: Department of Hematology, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: María
authors.initials: M
authors.lastname: Del Carmen Rodríguez-Zepeda
authors.affiliation: Department of Hemato-Oncology, General Hospital of México, México Secretary of Health, México City, México.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rivera-Márquez
authors.affiliation: Medical Nutrition Research Unit, 21st Century Pediatric Hospital, National Medical Center, MexicanInstitute of Social Security, México City, México.
authors.forename: Alan
authors.initials: A
authors.lastname: de la Vega-Martínez
authors.affiliation: Department of Hematology, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Martin-Trejo
authors.affiliation: Department of Hematology, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: Juan
authors.initials: J
authors.lastname: Shum-Luis
authors.affiliation: Department of Hematology, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: Karina
authors.initials: K
authors.lastname: Solis-Labastida
authors.affiliation: Department of Oncology, Pediatric Hospital, 21st Century National Medical Center, Mexican Institute of Social Security, México City, México.
authors.forename: Enrique
authors.initials: E
authors.lastname: López-Aguilar
authors.affiliation: Medical Nutrition Research Unit, 21st Century Pediatric Hospital, National Medical Center, MexicanInstitute of Social Security, México City, México.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Matute-González
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernaldez-Rios
mesh_terms: D052242:Adiponectin / Q000378:metabolism*; D050154:Adiposity; D015415:Biomarkers / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D008223:Lymphoma / Q000150:complications*; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D009765:Obesity / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers
keywords: Acute lymphoblastic leukemia and lymphoma; Adipokines; Childhood cancer survivors; Insulin resistance; Metabolic syndrome; Obesity