Premature adiposity rebound in children treated for acute lymphoblastic leukemia

The adiposity rebound (AR), when body mass index begins to increase after i ts nadir in childhood, is a critical period for the regulation of energy ba lance and adult obesity risk. The aim of the present study was to test whet her children treated for acute lymphoblastic leukemia (ALL) experience prem ature AR. This might, in part, explain their tendency to develop obesity. T iming of AR was assessed by visual inspection of body mass index plots in 6 8 patients treated for ALL in first remission. This sample comprised all el igible patients treated in Scotland between 1991 and 1998, age 30 months or less at the time of diagnosis. Timing of AR in patients was compared again st a cohort of 889 healthy British children studied during the 1990s using the same method. AR occurred significantly earlier in the patients treated for ALL (chi (2) test, P < 0.001). The AR had occurred in 43% (29 of 68) of the patients and 4% (40 of 889) of the comparison group by age 37 months. At 49 months AR had occurred in 81% (55 of 68) of the patients and 21% (190 of 889) of the comparison group. Treatment of ALL is associated with a sig nificantly advanced AR. This might, in part, explain the extremely high pre valence of obesity in long-term survivors. Clinical management should focus on minimizing excess weight gain during therapy to reduce long-term obesit y risk.