ESPE2023 Rapid Free Communications Fat, metabolism and obesity 2 (6 abstracts)
Acute rise of leptin after five days of dexamethasone and its association with hunger, fat mass, sleep and fatigue, in children with acute lymphoblastic leukemia
Annelienke van Hulst 1 , Emm Verwaaijen 1 , Sjoerd van den Berg 2 , Raphaele van Litsenburg 1 , Martha Grootenhuis 1 , Marta Fiocco 1,3,4 , Sebastian Neggers 2 , Marry van den Heuvel-Eibrink 1,5 & Erica van den Akker 6
1Princess Maxima Center for pediatric oncology, Utrecht, Netherlands. 2Divison of Endocrinolgy, Erasmus Medical Center, Rotterdam, Netherlands. 3Leiden University Mathematical Institute, Leiden, Netherlands. 4Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands. 5Child Health, UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands. 6Pediatric Endocrinology, Erasmus MC- Sophia Children’s Hospital, Rotterdam, Netherlands
Background & Aims: Children with acute lymphoblastic leukemia (ALL) frequently receive high doses dexamethasone during treatment, which may induce acute side effects. The aims of the current study were to determine the influence of a five-day dexamethasone course on changes in leptin, fat mass, body mass index (BMI), hunger, sleep and fatigue and to explore the associations between these changes.
Methods: Pediatric ALL patients were included during maintenance treatment. Data was collected before (T1) and after (T2) a five-day dexamethasone course (6mg/m2/day). BMI, fat mass (bioelectrical impedance analysis) and leptin were assessed on both timepoints, as well as parent-reported questionnaires regarding hunger, fatigue and sleep problems. Changes after five days of dexamethasone (T2 versus T1) were assessed using paired tests. Correlation coefficients were calculated to assess associations between the changes during a dexamethasone course (Delta scores: T2-T1). Univariable regression analyses were used to explore possible contributing factors for high leptin on T1 (defined by a Z-score >1,5).
Results: We included 105 children with a median age of 5.4 years (range 3.0-18.8). Leptin and fat mass, as well as hunger scores, fatigue and sleep deteriorated significantly after five days of dexamethasone (P<0.001), in contrast to BMI (P=0.12). No significant correlations between delta leptin and delta fat mass, BMI, hunger, fatigue or sleep were found. Elevated leptin on T1 was associated with older age (odds ratio (OR) 1.51, 95%-confidence interval (95%-CI) 1.28-1.77), higher fat mass (OR 1.19, 95%-CI 1.07-1.33) and earlier maintenance week (OR 0.96, 95%-CI 0.92-0.99).
Conclusions: Five days of high dose dexamethasone treatment lead to direct and significant changes in leptin, hunger scores and fat mass, which may suggest a dexamethasone-induced state of acute leptin resistance. Since children with ALL are at increased risk for metabolic adverse events, it is important to understand the underlying mechanisms, and leptin resistance might play a role.
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