Association of body mass index and survival in pediatric leukemia: a meta-analysis

被引:122
作者
Orgel, Etan [1 ,2 ,3 ]
Genkinger, Jeanine M. [4 ,5 ]
Aggarwal, Divya [6 ]
Sung, Lillian [8 ]
Nieder, Michael [9 ]
Ladas, Elena J. [5 ,6 ,7 ]
机构
[1] Childrens Hosp Los Angeles, Childrens Ctr Canc & Blood Dis, Los Angeles, CA 90027 USA
[2] Miller Childrens Hosp Long Beach, Jonathan Jaques Childrens Canc Ctr, Long Beach, CA USA
[3] Univ So Calif, Keck Sch Med, Los Angeles, CA 90033 USA
[4] Columbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USA
[5] Columbia Univ, Med Ctr, Herbert Irving Comprehens Canc Ctr, New York, NY USA
[6] Columbia Univ, Coll Phys & Surg, Med Ctr, Inst Human Nutr, New York, NY USA
[7] Columbia Univ, Med Ctr, Div Pediat Hematol Oncol Stem Cell Transplant, New York, NY USA
[8] Hosp Sick Kids, Div Haemotol Oncol, Toronto, ON, Canada
[9] Univ S Florida, H Lee Moffitt Canc Ctr, Blood & Marrow Transplantat, Tampa, FL 33682 USA
关键词
obesity; pediatric leukemia; relapse; survival; nutritional status; ACUTE MYELOID-LEUKEMIA; ACUTE LYMPHOBLASTIC-LEUKEMIA; INCOME COUNTRIES; EVENT BIAS; CHILDREN; OBESITY; OVERWEIGHT; CHILDHOOD; MORTALITY; CANCER;
D O I
10.3945/ajcn.115.124586
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background: Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemia related mortality; whether a similar effect exists in childhood leukemia remains controversial. Objective: We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR). Design: We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese (>= 95%) or overweight/obese (>= 85%), was compared with lower BMI [non-overweight/obese (<85%)] Summary risk estimates for EFS, OS, and CM (ALL only) were calculated with random- or fixed-effects models according to tests for between-study heterogeneity. Results: Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95%. CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI. Conclusion: Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.
引用
收藏
页码:808 / 817
页数:10
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