Body Composition Analysis Using DEXA-Scan and its Correlation with Arm-Anthropometry in Childhood Acute Lymphoblastic Leukemia Survivors.
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OBJECTIVE: To determine the body composition in childhood acute lymphoblastic leukemia survivors (cALLS) using dual-energy x-ray absorptiometry (DEXA) and correlate the same with mid-upper-arm circumference (MUAC) and triceps-skin-fold thickness (TSFT). METHODS: A cross-sectional study was undertaken to assess body composition in cALLS aged >7 years. Patients who were lost to follow-up after completion of therapy, had relapsed acute lymphoblastic leukemia (ALL), undergone hematopoietic stem cell transplantation and those with neurological disabilities/syndromic diagnosis were excluded. Prevalence of high-adiposity (body fat % > 85th centile), sarcopenia (lean body mass < 5th centile) and sarcopenic obesity (positive fat mass index z-score with negative fat-free mass index z-score); and demographic, therapy-related and endocrine factors were noted. RESULTS: Fifty-nine cALLS survivors with a median (IQR) age of 66 (38, 91) months at diagnosis were analyzed. At a median (IQR) duration of 14 (3, 43) months following completion of therapy, 36 children (61%) had deranged body composition; high adiposity (n = 28; 47%), sarcopenia (n = 20; 34%), sarcopenic obesity (n = 9; 15%). Metabolic syndrome was seen in 7 (12%). Survivors with lower mean-age at diagnosis and at enrolment had high-adiposity levels and sarcopenia. Sarcopenia was seen more commonly in females, pre-pubertal children and survivors with a lower mean-interval from therapy completion. Obesity, sarcopenia and sarcopenic obesity were not significantly associated with the type of ALL, steroid dose and cranial-irradiation. High leptin levels were seen in survivors with obesity and sarcopenic obesity. MUAC and TSFT correlated well with DEXA-generated markers. CONCLUSION: The prevalence of deranged body composition in cALLs from a single centre in Northern India was high, indicating need for early and frequent screening. MUAC and TSFT are reliable surrogate measures for body composition.