Body composition in long‐term survivors of acute lymphoblastic leukemia diagnosed in childhood and adolescence: A focus on sarcopenic obesity

• Published in: Cancer Vol. 124; no. 6; pp. 1225 - 1231
• Main Authors: Marriott, Christopher J. C., Beaumont, Lesley F., Farncombe, Troy H., Cranston, Amy N., Athale, Uma H., Yakemchuk, Valerie N., Webber, Colin E., Barr, Ronald D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.03.2018
• Subjects: Absorptiometry, Photon; Acute lymphoblastic leukemia; acute lymphoblastic leukemia (ALL); Adolescence; Adolescent; Adolescents; Adult; Antineoplastic Agents - adverse effects; Body composition; Body Composition - drug effects; Body fat; Body mass; Body weight; Bone Density - drug effects; Bone mass; Bone mineral content; Cancer; Cancer Survivors; Child; Child, Preschool; Childhood; Children; Cross-Sectional Studies; Female; Females; Health; Humans; Infant; Lean body mass; Leukemia; long term; Lymphatic leukemia; Male; Males; Morbidity; Muscle, Skeletal - diagnostic imaging; Muscles; Obesity; Obesity - diagnosis; Obesity - epidemiology; Obesity - etiology; Oncology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prevalence; Quality of Life; Sarcopenia; Sarcopenia - diagnosis; Sarcopenia - epidemiology; Sarcopenia - etiology; Skeletal muscle; Statistical analysis; survivors; Teenagers; Time Factors; Utilities; Young Adult; long term; survivors; acute lymphoblastic leukemia (ALL); obesity; sarcopenia
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.31191

BACKGROUND The late effects of treatment for acute lymphoblastic leukemia (ALL) include disordered body composition, especially obesity. Less attention has been focused on the loss of skeletal muscle mass (SMM) and the combined morbidity of sarcopenic obesity. METHODS A cross‐sectional study of body composition was undertaken via dual‐energy x‐ray absorptiometry in 75 long‐term survivors of ALL (more than 10 years after the diagnosis). Measures were obtained of the fat mass (FM), fat‐free mass (equivalent to the lean body mass [LBM]), and whole‐body bone mineral content. Health‐related quality of life (HRQL) was measured with the Health Utilities Index. RESULTS The sum of the FM, LBM, and whole‐body bone mineral content matched the total body weight measured directly (r = 0.998). The appendicular lean mass (ALM) was derived from the LBM in all 4 limbs and accounted for approximately 75% of the SMM. According to the fat mass index (FMI; ie, FM/height2), 12% of females and 18% of males were frankly obese by World Health Organization criteria. The median FMI z score was + 0.40, whereas the median z score for the appendicular lean mass index (ALMI; ie, ALM/height2) was –0.40. Sarcopenic obesity, defined as a positive FMI z score with a negative ALMI z score, was present in 32 subjects (43%). There were statistically significant and clinically important differences in overall HRQL between subjects with and without sarcopenic obesity. CONCLUSIONS Sarcopenic obesity is prevalent in long‐term survivors of ALL, and this places them in double jeopardy from excess body fat and inadequate SMM (eg, a combination of metabolic and frailty syndromes). It is associated with an adverse impact on overall HRQL. Cancer 2018;124:1225‐31. © 2017 American Cancer Society. Sarcopenic obesity is common in long‐term survivors of acute lymphoblastic leukemia in childhood. It portends multiple morbidities and is associated with compromised health‐related quality of life.