{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:40:44Z","timestamp":1779338444645,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,2,26]],"date-time":"2013-02-26T00:00:00Z","timestamp":1361836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pediatric acute lymphoblastic leukemia (ALL) survivors are at increased risk for the metabolic syndrome (MS). To establish the trajectory of development during active treatment, we followed patients longitudinally over the first year of maintenance therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>In a prospective cohort of 34 pediatric ALL patients, followed over the first 12 months of ALL maintenance, we evaluated changes in body mass index (BMI), blood pressure, fasting insulin and glucose, lipids, Homeostatic Metabolic Assessment (HOMA), leptin, and adiponectin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the study time period, the median BMI z\u2010score increased from 0.29 to 0.66 (<jats:italic>P<\/jats:italic>\u2009=\u20090.001), median fasting insulin levels increased from 2.9 to 3.1\u2009\u00b5U\/ml (<jats:italic>P<\/jats:italic>\u2009=\u20090.023), and the proportion of patients with insulin resistance by HOMA (&gt;3.15) increased from 3% to 24% (<jats:italic>P<\/jats:italic>\u2009=\u20090.016). Median leptin increased from 2.5 to 3.5\u2009ng\/ml (<jats:italic>P<\/jats:italic>\u2009=\u20090.001), with levels correlated with BMI z\u2010score. Median adiponectin level decreased from 18.0 to 14.0\u2009\u00b5g\/ml (<jats:italic>P<\/jats:italic>\u2009=\u20090.009), with levels inversely correlated to BMI z\u2010score. No change in median total cholesterol and LDL levels was observed. Median triglycerides decreased (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and there was a trend to increase in HDL (<jats:italic>P<\/jats:italic>\u2009=\u20090.058). Blood pressure did not significantly change, although overall prevalence of systolic and diastolic hypertension was high (23.5% and 26.4%, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Following patients over the first year of ALL maintenance therapy demonstrated that components of the MS significantly worsen over time. Preventive interventions limiting increases in BMI and insulin resistance during maintenance therapy should be targeted during this time period to avoid long\u2010term morbidity associated with the MS in long\u2010term survivors. Pediatr Blood Cancer 2013;601287\u20101291. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.24489","type":"journal-article","created":{"date-parts":[[2013,2,26]],"date-time":"2013-02-26T16:38:33Z","timestamp":1361896713000},"page":"1287-1291","source":"Crossref","is-referenced-by-count":49,"title":["Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy"],"prefix":"10.1002","volume":"60","author":[{"given":"Adam J.","family":"Esbenshade","sequence":"first","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill H.","family":"Simmons","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuki","family":"Koyama","sequence":"additional","affiliation":[{"name":"Department of Biostatistics at Vanderbilt University Nashville, Tennessee"},{"name":"Vanderbilt\u2010Ingram Cancer Center Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert B.","family":"Lindell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra L.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee"},{"name":"Vanderbilt\u2010Ingram Cancer Center Nashville, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,2,26]]},"reference":[{"key":"e_1_2_5_2_1","volume-title":"Seer cancer statistics review, 1975\u20132006","author":"Horner MJRL","year":"2009"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.16.3527"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-09-0555"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2006.01858.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-2178"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mph.0000181428.63552.e9"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21410"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e318059c249"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23050"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22782"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22237"},{"key":"e_1_2_5_13_1","article-title":"Glucocorticoids and insulin resistance in children with acute lymphoblastic leukemia","author":"Chow EJ","year":"2012","journal-title":"Pediatr Blood Cancer"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22120"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/met.2007.0027"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.1.45"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.114.2.S2.555"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1921"},{"key":"e_1_2_5_19_1","volume-title":"R. 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