Endocrine Abstracts

Obesity and excess adiposity may occur following treatment for childhood acute lymphoblastic leukaemia (ALL) even in those not administered cranial irradiation. Prior glucocorticoid treatment may be contributory as glucocorticoids have direct effects on fat mass (FM) and adipocytes. From 1997 to 2003 children treated for ALL in the UK were randomised to receive either prednisolone or dexamethasone.

Objectives: In survivors of childhood ALL not treated with cranial irradiation, to evaluate i) body composition ii) metabolic profile and adipocyte function iii) compare the effects of dexamethasone and prednisolone treatment.

Methods: Children treated for ALL according to the MRC ALL 97/99 protocol were recruited. Height, weight, BMI, blood pressure, skin fold thickness, waist circumference, lipid profile, HOMA and serum markers of adipocyte function (leptin, adiponectin, resistin, TNF-α, IL-6 & adjusted for FM) were obtained. Percentage FM was calculated using BOD POD and BIA. Results were compared to age-matched controls.

Results: Twenty-nine subjects (16 male) and 27 controls (14 male) were recruited. FM measured using BOD POD was greater in ALL survivors compared to controls (P=0.049). Survivors showed greater insulin resistance (P=0.014) but there were no differences in lipid profile and adipocyte function between these groups. Comparison of dexamethasone (n=14) with the prednisolone (n=15) treated subjects showed greater BMI SDS and central adiposity in the dexamethasone group (P=0.001 and P=0.004 respectively). Dexamethasone-treated subjects had a different regional adiposity with greater sub-scapular skin fold thickness (P=0.003) and greater mid-arm circumference (P=0.001). There was no difference in FM when measured by BOD POD, BIA or skin folds; metabolic profile or adipocyte function between the dexamethasone and prednisolone-treated groups. Correlations to number of years off treatment with BMI SDS, waist circumference, FM measured using BOD POD, BIA and skin folds, found no significant difference in the two treatment groups.

Conclusions: Survivors of childhood ALL showed a trend towards increased FM and insulin resistance. The dexamethasone-treated group show regional changes in adiposity and increased BMI. These findings highlight the need for risk-stratified follow-up, which may enable prevention of excess adiposity by early intervention with life-style modification.