ABSTRACT
BACKGROUND: The late effects of treatment for acute lymphoblastic leukemia (ALL) include disordered body composition, especially obesity. Less attention has been focused on the loss of skeletal muscle mass (SMM) and the combined morbidity of sarcopenic obesity. METHODS: A cross-sectional study of body composition was undertaken via dual-energy x-ray absorptiometry in 75 long-term survivors of ALL (more than 10 years after the diagnosis). Measures were obtained of the fat mass (FM), fat-free mass (equivalent to the lean body mass [LBM]), and whole-body bone mineral content. Health-related quality of life (HRQL) was measured with the Health Utilities Index. RESULTS: The sum of the FM, LBM, and whole-body bone mineral content matched the total body weight measured directly (r = 0.998). The appendicular lean mass (ALM) was derived from the LBM in all 4 limbs and accounted for approximately 75% of the SMM. According to the fat mass index (FMI; ie, FM/height2 ), 12% of females and 18% of males were frankly obese by World Health Organization criteria. The median FMI z score was + 0.40, whereas the median z score for the appendicular lean mass index (ALMI; ie, ALM/height2 ) was -0.40. Sarcopenic obesity, defined as a positive FMI z score with a negative ALMI z score, was present in 32 subjects (43%). There were statistically significant and clinically important differences in overall HRQL between subjects with and without sarcopenic obesity. CONCLUSIONS: Sarcopenic obesity is prevalent in long-term survivors of ALL, and this places them in double jeopardy from excess body fat and inadequate SMM (eg, a combination of metabolic and frailty syndromes). It is associated with an adverse impact on overall HRQL. Cancer 2018;124:1225-31. © 2017 American Cancer Society.
Subject(s)
Antineoplastic Agents/adverse effects , Body Composition/drug effects , Obesity/epidemiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Sarcopenia/epidemiology , Absorptiometry, Photon , Adolescent , Adult , Bone Density/drug effects , Cancer Survivors , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Muscle, Skeletal/diagnostic imaging , Obesity/diagnosis , Obesity/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Prevalence , Quality of Life , Sarcopenia/diagnosis , Sarcopenia/etiology , Time Factors , Young AdultABSTRACT
Measurements of body composition have evident value in evaluating growing children and adolescents, and dual-energy X-ray absorptiometry (DXA) is a tool that provides accurate measurements of whole-body bone mineral content (WBBMC), lean body mass (LBM), and fat mass (FM). To interpret such measurements in the context of ill health, normative values must be available. Such information could be expected to be regionally specific because of differences in ethnic, dietary, and physical activity determinants. In this study, DXA was performed with Hologic densitometers in normal girls (n = 91) and boys (n = 88) between 3 and 18 years of age. The derivation of normal ranges is presented for boys and girls. The correlation of the sum of WBBMC, LBM, and FM with directly measured body weight was almost perfect (r > 0.997). As expected, FM and body mass index correlated strongly. The normal values for WBBMC, LBM, and FM from this study are compared with other Canadian data and with published normative data from Argentina and the Netherlands, all of which use different densitometers. The results of this study allow the calculation of z scores for each facet of body composition and facilitate the use of DXA to report routine evaluations of body composition in children and adolescents.
Subject(s)
Adiposity , Body Composition , Body Mass Index , Bone Density , Absorptiometry, Photon , Adolescent , Canada , Child , Child, Preschool , Female , Humans , Male , Reference Values , Whole Body ImagingABSTRACT
We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children.
