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Body Mass Index of
Adolescent and Adult Survivors of
Pediatric Acute Lymphoblastic
Leukemia – A Meta-Analysis
Gina Nam, BA...
INTRODUCTION
• Over 60% of adolescent or adult survivors of pediatric cancer
experience at least one late effect in first ...
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)
3%
57%
78%
92%
Survival Rates
1964 20091987
• ALL is the most common pediatric
cancer i...
BODY MASS INDEX (BMI)
Adults Adolescents
Underweight ≤ 18.5 kg/m2 ≤ 5th percentile
Normal 18.5 – 25 kg/m2 5th – 85th perce...
EXISTING LITERATURE
• Existing systematic reviews suggest that during childhood, survivors
of pediatric ALL have higher BM...
OBJECTIVES
• Conduct a meta-analysis of studies that investigate the BMI of
adolescent and adult survivors of pediatric AL...
METHODS
Identified Studies
(N=109)
• PRISMA Guidelines.
• Multiple search engines.
• Search phrases: e.g.
ALL, body
compos...
STUDY EFFECT SIZE
Long-Term BMI Health Outcome in
Adolescents or Adults
Overweight/Obese Normal
ALL Survivors a b
Controls...
STUDIES (N=11)
Author Year Location N ALL Survivors N Controls Stratification
Birkebæk et al 1998 Denmark 33 NA Treatment
...
FOREST PLOT for ODDS RATIO (N=7*)
STUDY OR Plot OR (95% CI) %WEIGHT
*4 studies do not provide enough information to comput...
FEMALE SURVIVORS in the U.S. (N=4)
STUDY OR Plot OR (95% CI) %WEIGHT
Overall (I-squared = 74.3%, p = 0.001)
Warner
Oeffing...
MALE SURVIVORS in the U.S. (N=4)
STUDY OR Plot OR (95% CI) %WEIGHT
Overall (I-squared = 77.5%, p = 0.000)
Oeffinger
Warner...
GAPS IN EXISTING LITERATURE
• Identified only 11 quality studies, of which 6 were conducted in the U.S.
• Reporting standa...
CONCLUSIONS/RECOMMENDATIONS
• Overall effect size for survivors in the U.S.
• OR= 1.11; 95% CI= 1.04-1.19.
• Female surviv...
LIMITATIONS
• BMI is an indirect measurement of body fat, and does not reflect
changes in muscle mass or changes that occu...
Thank you!
gina.nam@hci.utah.edu
Collaborators:
 Richard Nelson, PhD
 Sapna Kaul, PhD, MA
Yelena Wu, PhD
 Anne Kirchho...
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Body Mass Index of Adolescent and Adult Survivors of Pediatric Acute Lymphoblastic Leukemia – A Meta-Analysis

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Body Mass Index of Adolescent and Adult Survivors of Pediatric Acute Lymphoblastic Leukemia – A Meta-Analysis

  1. 1. Body Mass Index of Adolescent and Adult Survivors of Pediatric Acute Lymphoblastic Leukemia – A Meta-Analysis Gina Nam, BA, BS Research Assistant HuntsmanCancer Institute, Cancer Control and Population Sciences
  2. 2. INTRODUCTION • Over 60% of adolescent or adult survivors of pediatric cancer experience at least one late effect in first decade following their diagnosis. • Late effects include cardiovascular disease, second cancers, and alterations in growth and development. • A possible late effect is the development of an abnormal body composition (e.g., being overweight or obese) that can potentially increase the risk of developing other chronic health conditions.
  3. 3. ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 3% 57% 78% 92% Survival Rates 1964 20091987 • ALL is the most common pediatric cancer in the U.S. • About 3,000 children and adolescents are diagnosed in the U.S. with ALL every year. Source:American Childhood Cancer Organization
  4. 4. BODY MASS INDEX (BMI) Adults Adolescents Underweight ≤ 18.5 kg/m2 ≤ 5th percentile Normal 18.5 – 25 kg/m2 5th – 85th percentile Overweight 25 – 30 kg/m2 85th – 95th percentile Obese ≥ 30 kg/m2 ≥ 95th percentile
  5. 5. EXISTING LITERATURE • Existing systematic reviews suggest that during childhood, survivors of pediatric ALL have higher BMIs than normative populations. • However, mixed evidence exists on the risk of overweight/obesity among adolescent and adult survivors of pediatric ALL. • No meta-analyses on BMI among adolescent and adult survivors of pediatric ALL.
  6. 6. OBJECTIVES • Conduct a meta-analysis of studies that investigate the BMI of adolescent and adult survivors of pediatric ALL. • Systematically summarize literature. • Quantify overall effect size and effect sizes for sex differences. • Critical assessment of existing gaps in literature.
  7. 7. METHODS Identified Studies (N=109) • PRISMA Guidelines. • Multiple search engines. • Search phrases: e.g. ALL, body composition, BMI, overwe ight, adiposity etc. • Time frame: 1994-2014. InclusionCriteria (N=11) • ALL diagnosed at <21 years of age. • Age at study ≥16 years. • BMI at the end of the primary therapy phase. • Comparison sample or population norms. • Peer-reviewed. Coding & Analyses • Coding into Excel by 2 investigators. • Cross-checked by 2 other researchers. • Reliability analysis in progress. • Effect size analysis in Stata and R.
  8. 8. STUDY EFFECT SIZE Long-Term BMI Health Outcome in Adolescents or Adults Overweight/Obese Normal ALL Survivors a b Controls c d BMI cutoff points for overweight/obese are based on BMI classification guidelines for adolescents and adults as appropriate.
  9. 9. STUDIES (N=11) Author Year Location N ALL Survivors N Controls Stratification Birkebæk et al 1998 Denmark 33 NA Treatment Garmey et al 2008 U.S. 1,451 2,167 Sex, Treatment Geenen et al 2010 Netherlands 141 69 Treatment Jarfelt et al 2005 Sweden 35 5,439 Sex, Treatment Meacham et al 2005 U.S. 1,665 40,899 Sex Ness et al 2007 U.S. 75 NA Sex Oeffinger et al 2003 U.S. 1,765 2,565 Sex, Age, Treatment Shaw et al 2000 United Kingdom 33 66 Sex Tylavsky et al 2010 U.S. 164 NA Age Veringa et al 2012 Netherlands 68 6,555 Sex, Treatment Warner et al 2013 U.S. 165 5,410 Sex
  10. 10. FOREST PLOT for ODDS RATIO (N=7*) STUDY OR Plot OR (95% CI) %WEIGHT *4 studies do not provide enough information to compute OR. Non U.S. Studies 1.11 (1.04-1.19)
  11. 11. FEMALE SURVIVORS in the U.S. (N=4) STUDY OR Plot OR (95% CI) %WEIGHT Overall (I-squared = 74.3%, p = 0.001) Warner Oeffinger Study Oeffinger ID Oeffinger Garmey Oeffinger Meacham 1.32 (1.20, 1.45) 1.14 (0.73, 1.78) 1.29 (0.62, 2.67) 1.76 (1.31, 2.36) OR (95% CI) 1.67 (1.05, 2.65) 1.72 (1.42, 2.07) 1.32 (0.93, 1.88) 1.04 (0.91, 1.20) 100.00 4.76 1.69 % 9.32 Weight 3.71 22.70 7.26 50.55 1.32 (1.20, 1.45) 1.14 (0.73, 1.78) 1.29 (0.62, 2.67) 1.76 (1.31, 2.36) OR (95% CI) 1.67 (1.05, 2.65) 1.72 (1.42, 2.07) 1.32 (0.93, 1.88) 1.04 (0.91, 1.20) 100.00 4.76 1.69 % 9.32 Weight 3.71 22.70 7.26 50.55 10 1 3
  12. 12. MALE SURVIVORS in the U.S. (N=4) STUDY OR Plot OR (95% CI) %WEIGHT Overall (I-squared = 77.5%, p = 0.000) Oeffinger Warner Oeffinger Meacham Oeffinger ID Study Garmey Oeffinger 0.93 (0.85, 1.03) 1.46 (1.11, 1.92) 1.29 (0.85, 1.95) 0.80 (0.49, 1.29) 0.76 (0.66, 0.87) 2.60 (0.97, 6.97) OR (95% CI) 1.03 (0.84, 1.26) 0.89 (0.63, 1.26) 100.00 9.99 4.56 4.19 51.90 0.70 Weight % 20.84 7.82 0.93 (0.85, 1.03) 1.46 (1.11, 1.92) 1.29 (0.85, 1.95) 0.80 (0.49, 1.29) 0.76 (0.66, 0.87) 2.60 (0.97, 6.97) OR (95% CI) 1.03 (0.84, 1.26) 0.89 (0.63, 1.26) 100.00 9.99 4.56 4.19 51.90 0.70 Weight % 20.84 7.82 10 1 7
  13. 13. GAPS IN EXISTING LITERATURE • Identified only 11 quality studies, of which 6 were conducted in the U.S. • Reporting standards not unique. • 9 studies report BMI proportions. • 7 studies report mean BMI. • 2 studies report BMI Z-score relative to reference values. • Missing information on a host of important variables. • Cancer relapse. • Detailed treatment and BMI. • Family medical history. • Sample size of controls.
  14. 14. CONCLUSIONS/RECOMMENDATIONS • Overall effect size for survivors in the U.S. • OR= 1.11; 95% CI= 1.04-1.19. • Female survivors (OR=1.32; 95% CI=1.20-1.45 ) may be overweight/obese at greater numbers than male survivors (OR=0.93; 95% CI=0.85-1.03). • Recommendations: • Long-term health management programs for adolescent and adult survivors of pediatric ALL. • More emphasis on addressing weight-related health behaviors for female survivors of pediatric ALL. • Standardized reporting of results for robust meta-analyses.
  15. 15. LIMITATIONS • BMI is an indirect measurement of body fat, and does not reflect changes in muscle mass or changes that occur with age in adulthood. • With the limited number of available studies, characteristics of control population, treatment etc. are inconclusive.
  16. 16. Thank you! gina.nam@hci.utah.edu Collaborators:  Richard Nelson, PhD  Sapna Kaul, PhD, MA Yelena Wu, PhD  Anne Kirchhoff, PhD, MPH Funded by the Center for Children’s Cancer Research at the Huntsman Cancer Institute

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