Effect of glucocorticoid therapy on energy intake in children treated for acute lymphoblastic leukemia

Despite a widespread belief that glucocorticoid therapy is associated with positive energy balance and excess weight gain there is a dearth of quantit ative evidence about its effects and the underlying mechanisms of any effec ts. The primary aim of the present study was to quantify the effect of dexa methasone and prednisone treatment on energy intake in children treated for childhood acute lymphoblastic leukemia. A secondary aim was to test for di fferences in excess weight gain between patients treated using the 2 glucoc orticoids. We measured energy intake in 26 patients (mean +/- SD age, 6.3 : +/- 2.3 yr) during a 5-d period "on" steroids and again in the week before steroid treatment. Changes in body mass index from diagnosis to I and 2 yr postdiagnosis were expressed as SD scores. Steroid treatment was associated with a significant increase in energy intake of approximately 20% (mean pa ired difference, 1.7 MJ/d; SD, 2.8; 95% confidence interval, 0.7-2.8 MJ/d), with no significant difference between the 2 steroids. The mean change in body mass index SD score was +0.38 (SD, 1.10; P < 0.05) to 1 yr and +0.68 ( SD, 1.38; P < 0.05) to 2 yr, with no significant difference between the 2 g roups of patients. Glucocorticoid treatment in childhood acute lymphoblasti c leukemia increases energy intake markedly, and this effect contributes to the excess weight gain and obesity characteristic of patients being treate d for acute lymphoblastic leukemia.