Exercise and QUality diet After Leukemia

白血病后的锻炼和优质饮食

基本信息

批准号：
8750911
负责人：
Emily Smith Tonorezos
金额：
$ 69.8万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-19 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8750911
关键词：
Accounting Acute Lymphocytic Leukemia Adherence Adult Adult Acute Lymphocytic Leukemia Age Behavioral Biological Markers Body Weight decreased Body mass index Cancer Center Cancer Survivor Cardiovascular Diseases Cephalic Cessation of life Child Childhood Acute Lymphocytic Leukemia Childhood Cancer Survivor Study Childhood Leukemia Communities Consumption Diagnosis Diastolic blood pressure Diet Diet Habits Disease Dyslipidemias Effectiveness Enrollment Exercise Fasting Goals Guidelines Health Hypertension Individual Insulin Insulin Resistance Intervention Journals Leptin Life Style Long-Term Survivors Low-Density Lipoproteins Malignant Childhood Neoplasm Malignant Neoplasms Meat Medicine Metabolic Metabolic Pathway Metabolism Methods New England Nutritional Obesity Online Systems Participant Phenotype Physical activity Population Premature aging syndrome Prevalence Printing Proteins Publishing Radiation therapy Randomized Recording of previous events Relative (related person)Reporting Research Research Personnel Risk Risk Factors Role Sampling Self Efficacy Stroke Sum Survivors Telephone Testing Time Visceral Weight Gain Work adiponectin cancer therapy cardiovascular risk factor childhood cancer survivor cohort experience fitness fruits and vegetables group intervention high risk leukemia meetings muscle strength obesity in children risk perception sarcopenia sedentary waist circumference web page weight loss intervention

项目摘要

DESCRIPTION (provided by applicant): Childhood acute lymphoblastic leukemia (ALL) is the most common childhood cancer, accounting for almost one-quarter of childhood cancer survivors. We and others have demonstrated that ALL survivors develop a deleterious cardiometabolic phenotype following cancer therapy including: obesity (and sarcopenia), insulin resistance, chronically elevated c- reactive protein levels, dyslipidemia (especially increases in small, dense highly atherogenic LDL), hypertension, stroke, and ultimately an increased risk for cardiovascular death. The recognized causes of this adverse metabolic profile include: unhealthy diet, a sedentary lifestyle, reduced cardiorespiratory fitness, altered leptin:adiponecti metabolism, and decreased muscle strength and coordination directly and indirectly attributable to the cancer therapy. While those treated with cranial radiotherapy (CRT) are at the highest risk, all ALL survivors have an excess risk compared with individuals without a history of cancer. While treatment exposures are not modifiable, evidence suggests that ALL survivors may be able to ameliorate their cardiovascular risk through improvements in diet and physical activity. A 2008 study by Robien et al. evaluated 72 ALL survivors from the Childhood Cancer Survivor Study (CCSS) and found poor adherence to dietary guidelines. In a separate population of ALL survivors, we reported an association between unhealthy diet and increased visceral adiposity, higher systolic and diastolic blood pressure, greater waist circumference, and increased body mass index; small improvements in diet appeared to be metabolically beneficial. Therefore, methods to promote weight loss and increase levels of physical activity are urgently needed to mitigate the progression of this deleterious cardiometabolic phenotype. A landmark study by Appel, Clark, and colleagues, published in the New England Journal of Medicine in 2011, demonstrated that significant weight loss could be achieved entirely through phone- and web- based support, compared to self-directed weight loss via printed materials and a static web page, among obese community-dwelling adults. In this study, Exercise and Quality diet After Leukemia (EQUAL), we will test the effectiveness of a remotely-delivered diet and physical activity intervention, compared to self-directed weight loss, on the deleterious cardiometabolic phenotype observed among ALL survivors. Participants (200 CRT, 200 no CRT) will be a nationwide sample of ALL survivors enrolled in the CCSS. While CRT is an important risk factor for cardiovascular disease, and thus requires consideration among long-term survivors, the contemporary use of CRT is limited. Concurrent with the decline in use of CRT over the past 35 years, the prevalence of childhood obesity has increased dramatically. Today, many children are obese at the time of diagnosis, and so remain at risk for becoming obese long-term survivors despite non-irradiating therapies. Hence, a diet and physical activity intervention for weight loss is critically important for obese ALL survivors, regardless of whether they were treated with CRT. The EQUAL study brings together a research team with the necessary expertise and experience in obesity among adult survivors of childhood leukemia and in successful diet and physical activity interventions. This will be the first large scale weight loss study among childhood cancer survivors.

描述（由申请人提供）：儿童急性淋巴细胞白血病（ALL）是最常见的儿童癌症，占儿童癌症幸存者的几乎四分之一。我们和其他人已经证明，所有幸存者在癌症治疗后都会发展出有害的心脏代谢表型，包括：肥胖（和肌肉症），胰岛素抵抗，持续升高的C-反应性蛋白质水平，血脂异常（尤其是小型，高度高度的高度ldl）的高度症状，以及最终的死亡，以及Cardie的风险增加。这种不良代谢特征的公认原因包括：不健康的饮食，一种久坐的生活方式，培训降低，瘦素改变：脂肪核代谢，以及肌肉力量和肌肉力量和降低，直接且间接地归因于癌症治疗。尽管接受颅骨放疗（CRT）治疗的人的风险最高，但与没有癌症史的人相比，所有幸存者的风险都过高。尽管治疗暴露是无法修改的，但有证据表明，所有幸存者都可以通过改善饮食和体育锻炼来改善其心血管风险。 Robien等2008年的一项研究。评估了来自儿童癌症幸存者研究（CCSS）的72名幸存者，发现对饮食指南的依从性差。在所有幸存者的单独人群中，我们报告了不健康饮食与内脏肥胖，更高的收缩压和舒张压，更大的腰围和体重指数增加之间的关联；饮食的较小改善似乎在代谢上是有益的。因此，迫切需要促进体重减轻和增加体育锻炼水平的方法来减轻这种有害的心脏代谢表型的进展。 Appel，Clark及其同事在2011年发表在《新英格兰医学杂志》上的一项具有里程碑意义的研究表明，与通过印刷材料和静态网页进行自我指导的体重减轻相比，可以完全通过基于电话和网络的支持来实现重大体重减轻。在这项研究中，与自我指导的体重减轻，在所有幸存者中观察到的有害心脏代谢表型中，与自我指导的体重减轻相比，我们将在白血病后的运动和质量饮食（相等）后（相等）。参与者（200个CRT，200名CRT）将是CCSS入学的所有幸存者的全国样本。尽管CRT是心血管疾病的重要危险因素，因此需要考虑长期幸存者，但当代使用CRT是有限的。与过去35年中CRT使用的使用同时，儿童肥胖症的患病率显着增加。如今，在诊断时，许多儿童肥胖，因此尽管疗法没有乳突疗法，仍然有可能成为肥胖的长期幸存者的风险。因此，无论是否接受过CRT治疗，饮食和体育活动干预对肥胖者来说至关重要。平等研究汇集了一个研究团队，具有儿童白血病成人幸存者以及成功饮食和体育锻炼干预措施的必要专业知识和经验。这将是第一个大规模减肥儿童癌症幸存者的研究。