Nutritional and Behavioral Intervention for Long-Term Childhood Acute Leukemia Survivors With Metabolic Syndrome

Abstract

Purpose: Metabolic syndrome (MetS) is a common complication in survivors of childhood acute lymphoblastic and myeloid leukemia (AL), and a major risk factor for premature cardiovascular disease, type-2-diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD). Lifestyle interventions, including a healthy diet and physical activity, are the cornerstone of the management of MetS. In long-term childhood AL survivors with MetS, the benefits of classical lifestyle interventions remain poorly documented. Methods: We conducted a one-year dietary and behavioral intervention with monthly dietitian coaching in this specific population. We assessed clinical, biological metabolic parameters, noninvasive biomarkers of hepatic steatosis and fibrosis, and eating habits at baseline and after one year of coaching. Results: We enrolled 48 patients from the LEA cohort, diagnosed with MetS. The mean age was 32 years. At baseline, 62.2% of patients had hepatic steatosis and 15% had fibrosis F3–F4 (VCTE > 8 kPa). Daily energy intakes were already limited (average, 1611 Kcal/day). After one year of lifestyle coaching, the body mass index (27.1 vs. 26.5 kg/m2, p = 0.041) and the waist circumference (91.9 vs. 89.5 cm, p = 0.027) had decreased. Daily intakes had significantly decreased (1213 Kcal/day) with a healthier diet. Hepatic and metabolic parameters had not significantly improved in the study population. Liver steatosis was improved only in the subgroup of patients who lost weight and/or waist circumference. Conclusion: Survivors of childhood AL have a high prevalence of MASLD at a young age. Classical lifestyle intervention appears incompletely efficient in improving metabolic and hepatic parameters in this specific population. New therapeutic approaches to reduce MetS and its complications in this unique population need to be studied.