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      Impact of body mass index at diagnosis on outcomes of pediatric acute leukemia: A systematic review and meta-analysis

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      Author(s): , , * ,
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      Publication date (Electronic):
      Journal: PLOS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          The incidence of childhood malnutrition i.e., both obesity and undernutrition, is on a rise. While there is extensive evidence of the influence of body mass index (BMI) on the survival and other important outcomes of adult cancers, the impact of childhood BMI on one of the common pediatric cancers i.e., leukemia is not well studied.

          Methods

          Systematic search of PubMed, Scopus, and Google Scholar databases was done to identify studies that were conducted among pediatric patients with leukemia and had examined outcomes of interest based on BMI at the time of diagnosis.

          Results

          Effect sizes were reported as pooled hazards ratio (HR) along with 95% confidence intervals (CI). A total of 17 studies were included. Compared to pediatric leukemia patients with normal BMI, underweight (HR 1.07, 95% CI: 1.04, 1.11) and obese (HR 1.42, 95% CI: 1.18, 1.71) children with leukemia had higher risks of overall mortality. Underweight (HR 1.10, 95% CI: 1.02, 1.19) and obese (HR 1.34, 95% CI: 1.15, 1.55) pediatric leukemia patients had a tendency to lower event-free survival compared to children with normal BMI. The risk of relapse was not significant for underweight, overweight, and obese children.

          Conclusions

          Both underweight and obese status at the time of diagnosis were associated with poor survival outcomes in pediatric patients with leukemia.

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          Most cited references47

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          Childhood and adolescent cancer statistics, 2014.

          Elizabeth Ward, Carol DeSantis, Anthony Robbins … (2014)
          In this article, the American Cancer Society provides estimates of the number of new cancer cases and deaths for children and adolescents in the United States and summarizes the most recent and comprehensive data on cancer incidence, mortality, and survival from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries (which are reported in detail for the first time here and include high-quality data from 45 states and the District of Columbia, covering 90% of the US population). In 2014, an estimated 15,780 new cases of cancer will be diagnosed and 1960 deaths from cancer will occur among children and adolescents aged birth to 19 years. The annual incidence rate of cancer in children and adolescents is 186.6 per 1 million children aged birth to 19 years. Approximately 1 in 285 children will be diagnosed with cancer before age 20 years, and approximately 1 in 530 young adults between the ages of 20 and 39 years is a childhood cancer survivor. It is therefore likely that most pediatric and primary care practices will be involved in the diagnosis, treatment, and follow-up of young patients and survivors. In addition to cancer statistics, this article will provide an overview of risk factors, symptoms, treatment, and long-term and late effects for common pediatric cancers. © 2014 American Cancer Society, Inc.
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            Acute lymphoblastic leukemia: a comprehensive review and 2017 update

            T Terwilliger, M Abdul-Hay (2017)
            Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults, with an incidence of over 6500 cases per year in the United States alone. The hallmark of ALL is chromosomal abnormalities and genetic alterations involved in differentiation and proliferation of lymphoid precursor cells. In adults, 75% of cases develop from precursors of the B-cell lineage, with the remainder of cases consisting of malignant T-cell precursors. Traditionally, risk stratification has been based on clinical factors such age, white blood cell count and response to chemotherapy; however, the identification of recurrent genetic alterations has helped refine individual prognosis and guide management. Despite advances in management, the backbone of therapy remains multi-agent chemotherapy with vincristine, corticosteroids and an anthracycline with allogeneic stem cell transplantation for eligible candidates. Elderly patients are often unable to tolerate such regimens and carry a particularly poor prognosis. Here, we review the major recent advances in the treatment of ALL.
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              Childhood obesity: causes and consequences

              Krushnapriya Sahoo, Bishnupriya Sahoo, Ashok Choudhury … (2015)
              Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.
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                Author and article information

                Contributors
                Ling Dong: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – original draft
                Guixing Dai: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Jing Zhao:
                ORCID: https://orcid.org/0009-0004-6347-493X
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: ResourcesRole: Writing – original draft
                Guoying Wang: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 6 May 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 5
                Electronic Location Identifier: e0302879
                Affiliations
                [001] Department of Pediatrics, Changxing People’s Hospital, Huzhou City, Zhejiang Province, China
                Johns Hopkins University Bloomberg School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ LD and GD are contributed equally to this work and co-first authors.

                Author information
                https://orcid.org/0009-0004-6347-493X
                Article
                Publisher ID: PONE-D-24-02141
                DOI: 10.1371/journal.pone.0302879
                PMC ID: 11073705
                PubMed ID: 38709714
                SO-VID: 228f3c9a-3de5-424c-bf72-a7e4d395131d
                Copyright © © 2024 Dong et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 16 January 2024
                Date accepted : 14 April 2024
                Page count
                Figures: 4, Tables: 1, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Body Mass Index
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Childhood Obesity
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancers and Neoplasms
                Subject: Hematologic Cancers and Related Disorders
                Subject: Leukemia
                Subject: Medicine and Health Sciences
                Subject: Hematology
                Subject: Hematologic Cancers and Related Disorders
                Subject: Leukemia
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Overweight
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Obesity
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancers and Neoplasms
                Subject: Hematologic Cancers and Related Disorders
                Subject: Leukemia
                Subject: Myeloid Leukemia
                Subject: Acute Myeloid Leukemia
                Subject: Medicine and Health Sciences
                Subject: Hematology
                Subject: Hematologic Cancers and Related Disorders
                Subject: Leukemia
                Subject: Myeloid Leukemia
                Subject: Acute Myeloid Leukemia
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Medical Risk Factors
                Subject: Cancer Risk Factors
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancer Risk Factors
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting information files.

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