{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:45:55Z","timestamp":1787021155617,"version":"build-2736575974"},"reference-count":50,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"21","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2016,7,20]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for low bone mineral density (BMD) and frail health, outcomes potentially modifiable by altering health behaviors and\/or treating endocrine abnormalities. We evaluated associations between lifestyle and hormonal deficits with risk of low BMD and frailty among survivors of ALL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Participants included 862 survivors of ALL (median age, 31.3 years [range, 18.4 to 59.7 years]) enrolled in the St Jude Lifetime Cohort study. Bone density was measured using quantitative computed tomography of L1 through L2 vertebrae; low BMD was defined as an age- and sex-standardized z score &lt; \u22121. The presence of frailty or prefrailty was defined as having at least two of the following: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. Hormonal deficiencies were determined according to medical history, medications, and laboratory findings (insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and testosterone levels). Logistic regression was used to examine associations between lifestyle (smoking, alcohol consumption, and activity levels) and deficiencies in growth hormone (GHD) and\/or sex steroids with low BMD and frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty percent of survivors met criteria for low BMD, and 18.6% for frailty\/prefrailty. After adjusting for body mass index, low BMD was associated with GHD (odds ratio [OR], 1.59; 95% CI, 1.02 to 2.13) and current smoking (OR, 1.71; 95% CI, 1.02 to 2.85) among men; and GHD (OR, 2.18; 95% CI, 1.26 to 3.78) and moderate alcohol consumption (OR, 2.09; 95% CI, 1.14 to 3.83) among women. After adjusting for current age, the odds of frailty\/prefrailty were increased among men with GHD (OR, 2.97; 95% CI, 1.56 to 5.67) and those who smoked (OR, 3.26; 95% CI, 1.65 to 6.43); there were no significant associations among women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that survivors of ALL should receive counseling regarding lifestyle and undergo screening for hormonal deficits to minimize the risk of low BMD and frailty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2015.64.9525","type":"journal-article","created":{"date-parts":[[2016,3,21]],"date-time":"2016-03-21T23:56:37Z","timestamp":1458604597000},"page":"2509-2515","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":40,"title":["Modifiable Factors Associated With Aging Phenotypes Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia"],"prefix":"10.1200","volume":"34","author":[{"given":"Carmen L.","family":"Wilson","sequence":"first","affiliation":[{"name":"Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wassim","family":"Chemaitilly","sequence":"additional","affiliation":[{"name":"Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue C.","family":"Kaste","sequence":"additional","affiliation":[{"name":"Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. Ojha, Yutaka Yasui, Ching-Hon Pui, Leslie L. Robison, Melissa M. Hudson, and Kirsten K. Ness, St Jude Children's Research Hospital; Sue C. Kaste and Ching-Hon Pui, University of Tennessee Health Sciences Center, Memphis, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deo Kumar","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Carmen L. Wilson, Wassim Chemaitilly, Kendra E. Jones, Sue C. Kaste, Deo Kumar Srivastava, Rohit P. 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