The association between glucocorticoid therapy and BMI z-score changes in children with acute lymphoblastic leukemia

Few studies have addressed the common issue of weight gain in children with acute lymphoblastic leukemia (ALL) during early phases of treatment, and even fewer have used the appropriate measure for weight fluctuation in children, BMI-for-age z-scores (BAZs). The purpose of this study is thus to measure the extent of the weight gain in BAZ during the 150 first days of treatment and to identify factors associated with the weight gain. Furthermore, we wish to raise the question of whether changes in treatment protocols automatically should be followed by an evaluation of the nutritional guidelines. In this retrospective study, the medical records of 51 children with ALL treated with the NOPHO ALL 2008 protocol at Copenhagen University Hospital were assessed. Patient characteristics were extracted, and height, weight, and age during the first 150 days of treatment were converted to BAZ. During 150 days of treatment, the proportion of overweight/obese patients increased significantly from 9.8 to 33.3 %. The mean change in BAZ (a dagger BAZ) was +1 standard deviation (0.02 +/- 1.16 vs. 1.12 +/- 1.44; p < 0.001) and BAZ increased significantly during periods with glucocorticoid (GC) treatment but not in periods without GC. Delta BAZ was larger in boys compared to girls, and Delta BAZ was higher in patients who were under/normal weight at diagnosis, compared to patients who were overweight/obese (1.26 +/- 1.29 vs. -0.04 +/- 0.41; p = 0.032). BAZ increased significantly in children with ALL during the initial treatment with the NOPHO ALL 2008 protocol. This is likely associated with the GC administration and influenced by gender and initial BAZ.