Obesity and Pediatric Leukemia: ‘What Kids Eat Does Make a Difference’

Childhood Cancer Awareness Month

American children are getting fatter every year. Poor eating habits, lack of exercise, insufficient sleep and too much time sitting in front of electronic devices have snowballed into a health crisis with no end in sight. Just 25 years ago, 10% of kids between ages 2-19 were overweight or obese. Today that number is 18.5% and climbing. 

Even before they become adults, obese kids often contend with a host of medical problems: high blood pressure, high cholesterol, type 2 diabetes, asthma, sleep apnea, joint problems, fatty liver disease, acid reflux, anxiety and depression. 

Research is beginning to show that obesity can also affect a child’s chances of surviving pediatric leukemia or developing related health problems over the long term. Here are some of the things we know so far:

  • Children with Hodgkin lymphoma who are obese at the time of diagnosis may have a higher risk that the disease will return after treatment. That’s the conclusion of a study by researchers at Roswell Park and Columbia University Medical Center, led by Kara Kelly, MD, Chair of Pediatric Oncology and the Waldemar J. Kaminski Chair of Pediatrics at Roswell Park.

  • “There’s even more evidence that children with acute lymphoblastic leukemia (ALL) who are obese — or who become overweight or obese over the course of treatment — are at higher risk of relapse,” adds Dr. Kelly. In addition, ALL survivors may become overweight or obese early in treatment, due partly to the effects of treatment, not feeling well enough to exercise regularly and not maintaining a healthy diet. That weight gain can lead to cardiometabolic conditions — increased risk of diabetes, heart disease or stroke — but good nutrition can help lower the risk. And while treatment can lead to reduced bone mass, there’s evidence that improved nutrition can reduce that side effect as well. That’s why Kelly and her colleagues refer young patients to Roswell Park’s Clinical Nutrition team soon after diagnosis, so their families can learn how to improve their eating habits.

  • Obese pediatric patients who have acute myeloid leukemia (AML) have a greater risk of dying during treatment and poorer survival overall compared with AML pediatric patients of normal weight.

In addition, the weight of the child’s mother appears to have an impact on a child’s risk of developing leukemia in the first place:

  • Heavy women tend to have heavier babies — and a birth weight of more than 8.8 pounds has been linked to a higher risk of developing pediatric ALL and AML.

  • Children of very obese mothers have a 57% increased risk of developing leukemia before they reach the age of five, according to a July 2019 study out of the University of Pittsburgh. The higher the mother’s Body Mass Index (BMI), the greater the risk. Authors of the study believe the increased risk is due to one of two things: 1) During pregnancy, insulin levels in the mother’s body impact the fetus during critical stages of growth and development, or 2) changes in the mother’s DNA expression are passed along to the baby.

“In children with leukemia, those classified as obese at diagnosis have a 35% increased risk of mortality compared with those who are not obese.”

“Dietary Intake and Childhood Leukemia: The Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) Cohort Study.” Nutrition, March 2016

We still have much to learn about the effects of overweight and obesity on long-term survival in children with leukemia. Clinical research at Roswell Park hopes to answer questions that could help prevent obesity in both pediatric patients and survivors, to improve their survival and quality of life. Denise Rokitka, MD, MPH, Director of Pediatric and Adolescent Cancer Survivorship at Roswell Park, serves as Principal Investigator of a clinical trial that’s studying the long-term effects of regular physical activity in pediatric and adolescent ALL patients who have completed treatment. 

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Dr. Kelly heads another clinical trial that’s investigating whether a low glycemic diet, with plenty of fruits and vegetables, can reduce nutrition-related obesity, bone-related problems and conditions leading to cardiovascular disease in pediatric and adolescent ALL patients who are in treatment. She says she sympathizes with parents of pediatric patients who want to offer their children their favorite junk foods to encourage them to eat during cancer treatment, thinking that the type of food doesn’t matter as long as they’re getting enough calories. “But we need to change that,” she says, “because what kids eat does make a difference.”

Adults in the family play the most important role in providing healthy meals and snacks for children, encouraging them to exercise regularly, limiting the time spent on electronic devices, ensuring they get a good night’s sleep and setting a good example themselves. For children who have been diagnosed with leukemia, a healthier lifestyle has the potential to improve survival and prevent other serious health conditions down the road.