{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T15:47:09Z","timestamp":1770997629492,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Obesity"],"published-print":{"date-parts":[[2018,11,1]]},"abstract":"<jats:p>High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight\/obesity (BMI \u2265 85<jats:sup>th<\/jats:sup>percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients \u226510 years showed a trend towards increased risk of relapse for overweight\/obese patients (HR = 2.89, 95% CI = 0.89\u20139.36,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.08<\/mml:mn><\/mml:mrow><\/mml:math>) that was not evident among children&lt;10 years (HR = 0.52, 95% CI = 0.08\u20133.54,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.49<\/mml:mn><\/mml:mrow><\/mml:math>). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15\u20135.60,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.021<\/mml:mn><\/mml:mrow><\/mml:math>; complete set: HR = 2.72, 95% CI = 1.26\u20135.91,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.011<\/mml:mn><\/mml:mrow><\/mml:math>) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight\/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16\u20131.46) and AML (HR = 1.64, 95% CI = 1.32\u20132.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight\/obese patients. The findings of our study suggest an association of obesity status with relapse in children \u226510 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.<\/jats:p>","DOI":"10.1155\/2018\/7048078","type":"journal-article","created":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T23:54:31Z","timestamp":1541116471000},"page":"1-8","source":"Crossref","is-referenced-by-count":22,"title":["Body Mass Index at Pediatric Leukemia Diagnosis and the Risks of Relapse and Mortality: Findings from a Single Institution and Meta-analysis"],"prefix":"10.1155","volume":"2018","author":[{"given":"Ashleigh M.","family":"Saenz","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacie","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA"},{"name":"Cancer and Blood Disorders Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel G.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA"},{"name":"Office of Medical Education, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg A.","family":"Hale","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA"},{"name":"Cancer and Blood Disorders Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL, USA"},{"name":"Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil A.","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA"},{"name":"Cancer and Blood Disorders Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL, USA"},{"name":"Clinical and Translational Research Organization, All Children\u2019s Research Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Skai","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7054-9400","authenticated-orcid":true,"given":"Ernest K.","family":"Amankwah","sequence":"additional","affiliation":[{"name":"Cancer and Blood Disorders Institute, Johns Hopkins All Children\u2019s 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