Prevalence and factors Associated with Obesity Among Children with Acute Lymphoblastic Leukemia/Lymphoma Attending Mulago Hospital and Uganda Cancer Institute.

Abstract

Background Acute lymphoblastic leukemia (ALL) is the most common subtype of leukemia accounting for 80% of cases globally. Acute lymphoblastic lymphoma (LBL) is the second most common type of Non-Hodgkin Lymphoma (NHL) in childhood and adolescence, accounting for 25-35% of all cases. LBL and ALL are treated with similar treatment regimen The cure rate for childhood acute lymphoblastic leukemia (ALL) and LBL now exceeds 80% in many resource countries. In Uganda, current 12-months survival exceeds 85%. Improved survival is associated with treatment related complications such as obesity. In Uganda, outcomes for ALL and LBL have also improved. There is paucity of data on the prevalence and factors associated with obesity among children with ALL/LBL yet obesity during treatment is a strong predictor for obesity after treatment and adulthood. Objective: To determine prevalence and factors associated with obesity among children ages 1- 17 years treated for ALL/LBL at the paediatric Oncology clinic at Mulago National referral hospital and UCI. Methodology: A cross-sectional study carried out at Mulago National Referral Hospital and Uganda Cancer institute between July and August 2022. A total of 127 participants with a confirmed diagnosis of ALL and LBL, age 1-17 years and had completed induction phase of therapy were recruited into the study. Data was cleaned and imported into STATA version 14.0 for analysis. Multivariate logistic regression was performed to determine the factors independently associated with the obesity. A p-value < 0.05 was considered significant. Results: Of the 127 enrolled children, 87 (68.5%) were male. The median (IQR) age was 9 (6-12) years and majority 63 (49.6%) of children were adolescents (10-17) years. The median (IQR) BMI for age z score was -0.372(-1.129,1.038) The prevalence of obesity of among children with ALL/LBL was 11.8%. Family history of obesity aOR (95% CI) 2.212 (1.173 4.17, P=0.014), age at diagnosis between 5 and 9 years aOR (95% CI) 4.729(1.11 20.159, P= 0.036), physical inactivity aOR (95% CI)5.951(4.614 7.677) and duration of treatment less than 12 months aOR (95% CI) 0.243 (0.231 0.256, P=<0.000 were significantly associated with obesity. Conclusion and recommendation: The prevalence of obesity is high among the children with acute lymphoblastic leukemia/lymphoma during treatment. The associated factors were family history of obesity, physical inactivity, age at diagnosis between 5 and 9 years. Children who had been on treatment for less than 12 months were less likely to be obese. x There is need to have a routine nutritional assessment for children with acute lymphoblastic leukemia/lymphoma especially those that have family history of obesity and those aged between 5 and 9 years. Children should be followed up into survivorship since this study has demonstrated that obesity starts during treatment. Children and their caregivers should also be educated and encouraged to do physical activity.