Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood
Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood
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DOI：
10.1159/000023566
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发表时间：
2000-01-01
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影响因子：
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通讯作者：
Ranke, MB
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文献类型：
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作者：
Mayer, EIE;Reuter, M;Ranke, MB
目的：探讨儿童急性淋巴细胞白血病（ALL）治疗后肥胖的患病率及潜在危险因素。研究设计：39例ALL患者（年龄10.7-20.5岁）接受化疗加颅脑照射（n = 25）或单独化疗（n = 14）的标准化治疗后首次缓解3.4-14.6年。禁食过夜后，调查以下参数：患者及其父母的体重指数（BMI）；ALL治疗前患者BMI；血清游离甲状腺素、生长激素依赖因子、雌二醇、睾酮、皮质醇、瘦素、c肽；无脂质量（生物电阻抗）；静息代谢率（RMR，间接量热）；热量摄入（24小时回忆）；身体活动（问卷）。RMR数据应用于无脂质量，并与83个对照进行比较。结果：ALL治疗后肥胖患病率（标准：BMI bbbb2 SDS）（38%，放疗组为48%，未放疗组为21%）显著高于治疗前（3%）（p < 0.05）。与未放疗患者相比，放疗患者的rmr显著降低（-1.07 +/- 0.24 vs -0.32 +/- 0.21 SDS, p < 0.05），体力活动水平降低（1.41 +/- 0.03 vs. 1.52 +/- 0.03, p < 0.05），胰岛素样生长因子结合蛋白-3浓度降低（-0.65 +/- 0.17 vs. 0.25 +/- 0.33 SDS, p < 0.05），游离甲状腺素浓度降低（1.17 +/- 0.06 vs. 1.38 +/- 0.08 ng/dl, p < 0.05）。热量摄入是足够的。结论：儿童期ALL后，患者面临较高的肥胖风险。在颅脑照射患者中，可能的原因是体力活动少，rmr和激素不足。版权所有(C) 2000 S. Karger AG，巴塞尔。
Objectives: To investigate the prevalence and potential risk factors of obesity after therapy for childhood acute lymphoblastic leukemia (ALL). Study Design: 39 ALL patients (age 10.7-20.5 years) who were in first remission for 3.4-14.6 years after standardized treatment with chemotherapy plus cranial irradiation (n = 25) or with chemotherapy alone (n = 14) were examined. After fasting overnight, the following parameters were investigated: body mass index (BMI) of patients and their parents; patients' BMI before ALL therapy; serum free thyroxin, growth hormone-dependent factors, estradiol, testosterone, cortisol, leptin and c-peptide; fat-free mass (bioelectrical impedance); resting metabolic rate (RMR, indirect calorimetry); caloric intake (24-hour recall); and physical activity (questionnaire). RMR data were applied to the fat-free mass and compared with 83 controls. Results: The prevalence of obesity (criterion: BMI >2 SDS) was significantly (p < 0.05) higher after ALL therapy (38%; irradiated patients 48%, non-irradiated patients 21%) than before therapy (3%). Compared to non- irradiated patients, irradiated patients had significantly lower RMRs (-1.07 +/- 0.24 vs. -0.32 +/- 0.21 SDS; p < 0.05), reduced physical activity levels (1.41 +/- 0.03 vs. 1.52 +/- 0.03; p < 0.05), and lower concentrations of insulin-like growth factor-binding protein-3 (-0.65 +/- 0.17 vs. 0.25 +/- 0.33 SDS; p < 0.05) and of free thyroxin (1.17 +/- 0.06 vs. 1.38 +/- 0.08 ng/dl; p < 0.05). Caloric intake was adequate. Conclusions: After ALL during childhood, patients face a higher risk of obesity. In the cranially irradiated patients, the likely causes are low physical activity, RMRs and hormonal insufficiency. Copyright (C) 2000 S. Karger AG, Basel.