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Cardiometabolic risk, body composition and bone health in children and adolescents in long-term remission of acute lymphoblastic leukemia - a study protocol

Milena Ivanova Belcheva


Survivors of childhood acute lymphoblastic leukemia (ALL) are at an increased risk of cardiometabolic abnormalities, altered body composition (obesity and sarcopenia) and impaired bone health. These adverse sequelae progress through childhood and adulthood, worsening survivors` quality of life and resulting in cardiovascular conditions, metabolic syndrome (MetS), osteoporosis and related disabilities in the long run. The early identification of an abnormal metabolic profile and altered body composition and the correction of unhealthy behaviors (such as reduced physical activity (PA), a sedentary lifestyle, and unhealthy eating) among survivors have the potential to prevent or delay late morbidity. We present a protocol for a complex evaluation of cardiometabolic risk, body composition, and bone health in children and adolescents in long-term ALL remission. In the context of a case-control study we assessed MetS and traditional cardiovascular disease risk factors, including Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores; we used anthropometric parameters (BMI, waist circumference) and a direct measuring of the fat mass and its distribution (Dual-energy X-ray Absorptiometry, DEXA) to evaluate obesity; DEXA to assess the muscle mass, and appendicular muscle mass and bone mineral density. We analyzed survivors` PA, screen time and mean calorie intake and nutritional model using questionnaires (including the Godin Leisure-Time Physical Activity Questionnaire) and semi-structured interviews. The application of such a complex approach helps the timely identification of survivors at risk and can guide early intervention at an individual level. A broader study conducted in all three national pediatric hematology centers would allow for a more precise understanding of the problems this target group experiences and could help develop a unified approach to their solution.


childhood acute lymphoblastic leukemia survivors, cardiometabolic risk factors, body composition, bone health, physical activity

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