High prevalence of Sarcopenic Obesity among survivors of childhood ALL-study

Obesity is recognized as a common chronic health problem among survivors of childhood cancer; is also known to increase risk of metabolic syndrome and cardiovascular disease. As Acute Lymphoblastic leukemia(ALL) is commonest childhood cancer, researchers from Rajiv Gandhi Cancer Institute, Delhi aimed to study prevalence of childhood obesity and sarcopenia among survivors of childhood ALL.

In this case control study, 65 cases who were survivors of ALL (<18yrs at diagnosis) were analysed at 5 years of completion of therapy and matched with healthy sibling controls. All the cases received BFM protocol for treatment of ALL. Dual energy Xray absorbometry(DEXA) and BMI were used to study body fat composition.

Key findings of the study are:

1. The mean body fat percentage (BF%) was significantly higher among ALL survivors as compared to sibling controls(p=0.001).

2. Obesity was observed among 21.5 %( 14 out of 65) cases and overweight among 55% of cases at follow up.

3. Also body fat mass index(BFMI) was significantly higher among survivors of ALL(p<0.001)

4. High prevalence of sarcopenic obesity was observed among survivors which was not seen in controls.

There are several studies predicting obesity but the indicators used were BMI, height, weight, waist-hip circumference which underestimate the prevalence of obesity as it cannot identify normal or underweight individuals with high body fat. Henceforth Payal et all in the present study used DEXA to quantify adiposity and sarcopenia which are considered better predictors of obesity.

Authors say-"Prevalence of obesity and overweight was not influenced by study participants' nutritional status at diagnosis, since thin and normally nourished children treated for ALL were equally affected".

It been concluded that-since obesity and sarcopenia are believed to be forerunners of cardio-metabolic syndrome, the results of study emphasize on early recognition and aggressive preventive strategies on this sub-population of children.

Source: Malhotra P, Kapoor G, Jain S, Jain S, Sharma A. Obesity and Sarcopenia in Survivors of Childhood Acute Lymphoblastic Leukemia. Indian Pediatr. 2021 May 15;58(5):436-440.