Central Adiposity and Visceral Fat in Long-Term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence: Exploration of an Underappreciated Risk.

VAT z scores were shifted positively relative to population norms, with 25.7% of survivors at or above the 85th percentile for visceral adipose tissue mass.

• Study examined 70 survivors of pediatric ALL >10 years from diagnosis using DXA scans.
• VAT mass was extracted from dual energy x-ray absorptiometry (DXA) scans.
• 25.7% of survivors had VAT ≥85th percentile relative to population norms.
• VAT z scores were collectively shifted positively relative to population norms across the cohort.

The vast majority of survivors (82.9%) had a waist-to-height ratio above the established 'take action' threshold of 0.5.

• Mean WHtR was 0.55 ± 0.06 across the cohort of 70 survivors.
• 82.9% of survivors exceeded the established 'take action' threshold of WHtR ≥0.5.
• WHtR was calculated from estimated waist circumference extracted from DXA scans.
• This elevation was observed regardless of BMI or visceral fat status.

A WHtR threshold of ≥0.59 demonstrated high sensitivity but moderate specificity for identifying survivors with VAT at or above the 85th percentile.

• WHtR ≥0.59 had a sensitivity of 90.2% (95% CI 82.0–98.4) for identifying VAT ≥85th percentile.
• Specificity at this threshold was 68.4% (95% CI 47.5–89.3).
• Sensitivity and specificity were tested at established WHtR thresholds.
• This threshold performed better than lower established cutoffs for identifying elevated VAT in this population.

ABSI z scores for 94.3% of survivors fell in the highest quintile of population values, indicating near-universally elevated central adiposity relative to population norms.

• Mean ABSI (a body shape index) z score was 1.88 ± 0.85 across the cohort.
• 94.3% of survivors had ABSI z scores in the highest quintile of population values.
• ABSI z scores were higher in women, in those with high-risk ALL, and in those who received cranial radiation (p = 0.01–0.02).
• ABSI z scores were elevated regardless of BMI or visceral fat mass.

ABSI z scores were significantly higher among female survivors, those with high-risk ALL, and those who received cranial radiation.

• Statistically significant differences in ABSI z scores were found across these subgroups (p = 0.01–0.02).
• Subgroups analyzed included sex, ALL risk classification (high vs. non-high risk), and cranial radiation exposure.
• These findings suggest treatment-related and demographic factors may modulate central adiposity in ALL survivors.
• The study cohort consisted of 70 long-term survivors of pediatric ALL.

Elevated visceral fat and central adiposity are underappreciated risks in long-term survivors of childhood ALL that are not adequately captured by BMI alone.

• Elevated central adiposity was observed regardless of BMI or measured visceral fat in individual survivors.
• Authors suggest a broader screening approach considering waist indices may better detect those at increased cardiometabolic risk.
• Elevated visceral fat is associated with poor cardiovascular health, but is described as 'not well characterized in survivors of childhood cancer.'
• Authors call for evaluation and confirmation in a larger prospective cohort.