Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review.

Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.

A long-term trajectory of bone mineral density in childhood cancer survivors after discontinuation of treatment: retrospective cohort study.

Low bone mineral density (BMD) was diagnosed in 24% of childhood cancer survivors (CCS), whereas very low BMD was relatively uncommon at 8%. We suggest that low BMD in CCS may become alleviated over time. Stem cell transplantation, radiotherapy, and underweight were the strongest independent predictors of decreased BMD. PURPOSE: Childhood cancer survivors (CCS) are at risk of premature bone loss, although published studies are inconsistent. The objective of this study was to evaluate the prevalence and pattern of low bone mineral density (BMD) in short- and long-term CCS, and to determine clinical factors affecting skeleton after anticancer treatment. METHODS: This retrospective study was conducted in a cohort of 326 children and young adult CCS (147 females) who completed anticancer treatment. BMD was determined by dual-energy X-ray absorptiometry (DXA). Low BMD was defined as a Z-score ≤ - 1.0, and the very low BMD as a Z-score ≤ - 2.0. Additionally, the changes in BMD over time were studied in 123 CCS who had been re-examined by DXA during follow-up. RESULTS: Median age at diagnosis was 7.27 years (range, 4.4-10.6); median time between end of treatment and DXA was 6.12 (range, 4.0-22.0). Low BMD was found in 24% of CCS, while very low BMD was relatively uncommon (8%). Based on multivariate analysis, the following were significantly associated with low BMD at the follow-up: hematopoietic stem cell transplantation (OR 3.13, 95% CI 1.02-9.63), head and neck radiotherapy (OR 2.54, 95% CI 1.32-4.90), and body weight below the standard reference (OR 3.57, 95% CI 1.24-10.23). The time-related trajectory showed an improvement (BMDLS) or stabilization (BMDTB) in Z-scores values. CONCLUSION: These data based on serial DXA measurements, encompassing a long-lasting observation period, show that CCS may not be at risk of premature bone loss in young adulthood. However, it is unknown how the scenario for skeletal mass is until the CCS will achieve older or postmenopausal age.

A 23-year follow-up of a male with Hajdu-Cheney syndrome due to NOTCH2 mutation.

We present a natural history of a 32-year-old man with Hajdu-Cheney syndrome (HJCYS), because of the de novo truncating mutation in the exon 34 of NOTCH2 (c.6424-6427delTCTG, p.Ser2142ArgfsX4), who has been followed up for a period of 23 years (between 9 and 32 years). During follow-up, we observed abnormalities of vision, hearing, voice, and progression of craniofacial features in the form of skeletal dysplasia with affected skull, dentition, spine, limbs, fingers, and toes. Low bone mineral density and history of fragility fractures also suggested primary osteoporosis being a clinical manifestation. According to Stengel-Rutkowski, Schimanek, and Wernheimer (1984; Human Genetics, 6, 272-295), systematic data acquisition has been used for quantitative analysis of anthropological, radiographic, and clinical features at childhood, adolescence, and young adulthood separately. A detailed phenotype description together with the results of reanalysis of 14 reports so far published on patients with HJCYS and NOTCH2 mutation showed similar phenotype evolution with age. The spectrum of observed features may improve diagnostic tools for HJCYS at different periods of the lifespan.

The Association Between Long-Term Acenocoumarol Treatment and Vitamin D Deficiency.

OBJECTIVE: Both vitamin D and K2 are involved in a number of metabolic processes, including bone metabolism; however, associations between the vitamins are not fully understood. The aim of the study was to evaluate serum concentrations of 25-hydroxyvitamin D [25(OH)D] in adult patients receiving long-term acenocoumarol (AC) treatment. PARTICIPANTS AND METHODS: In this cross-sectional study, 58 Caucasian patients (31 women, 27 men) with a median age of 65 years receiving long-term AC therapy were evaluated and compared with 35 age- and gender-matched healthy controls. The AC treatment was used due to recurrent venous thromboembolism (34.5%), atrial fibrillation (31%), or mechanical heart valve prostheses (34.5%). Medical records and a questionnaire were used to obtain information about chronic diseases, smoking habits, and the duration of therapy and weekly dose of AC. Anthropometric measurements were performed, and serum concentration of 25(OH)D and total alkaline phosphatase (ALP) activity were measured. RESULTS: Among the 58 patients receiving long-term AC treatment, a high proportion (46.6%) demonstrated significant vitamin D deficiency with concentrations of 25(OH)D lower than 20 ng/mL. The median concentration of 25(OH)D in subjects receiving AC was significantly lower compared to the control group [20.4 (17.4; 26.1) vs. 28.2 (24; 32.7); p < 0.001]. No differences were found between women and men receiving AC therapy. In patients receiving AC, a negative correlation was found between the concentration of 25(OH)D and the weekly dose of AC (r = -0.337, p = 0.01). Patients with concentrations of 25(OH)D < 20 ng/mL were found to have a significantly higher median dose of AC, compared to those with concentrations of 25(OH)D ≥ 20 ng/mL [21 (17; 31) vs. 17 (12; 28); p = 0.045]. CONCLUSION: In conclusion, treatment with AC is associated with low 25-hydroxyvitamin D levels, although the path leading to this phenomenon is not entirely clear. Long-term administration of AC in adults may increase the risk of chronic vitamin D deficiency, thus, effective supplementation of vitamin D in these individuals needs careful consideration.

Cardiovascular Risk Factors after Childhood Cancer Treatment Are Independent of the FTO Gene Polymorphism?

The study objective was to assess the prevalence of cardiovascular disease risk factors in patients treated for childhood cancer (N = 101) and to determine the involvement of clinical (cancer type and therapy) and/or genetic (FTO gene rs9939609 polymorphism) factors. Anthropometric features, laboratory findings, and standardized osteodensitometric indices (fat and lean mass) were considered. Overweight/obesity was found in 17.82% of the patients; however, central adiposity was found in as many as 42.5%. At least one abnormality in lipid metabolism was observed in 35.6%. Densitometry revealed elevated levels of fat mass in 44.55% of the patients. None of the parameters studied were associated with the FTO gene polymorphism. Standardized waist circumference was significantly higher in patients treated for leukemia than those treated for solid tumors (p = 0.04). Our findings indicate a high rate of central adiposity among childhood cancer survivors, especially leukemia patients. The prevalence of risk factors of cardiovascular disease after anticancer therapy is not FTO gene polymorphism-dependent.

Bone mineral density, thyroid function, and gonadal status in young adult survivors of childhood cancer.

INTRODUCTION: During the last years, changes in the diagnosis and treatment have caused a significant increase of the number of young adults who experienced cancer in childhood. This enlarging population is affected by many health problems, including multiple hormone deficiencies and bone mineral deficits. This is the first polish study assessing bone mineral density and endocrine status in young adult cancer survivors. MATERIAL AND METHODS: A total of 76 long-term survivors treated for pediatric cancer were identified. The mean age at the time of study was 24.1 ±3.5 years. Bone mineral density and TSH, fT3, fT4, FSH, LH, estradiol and testosterone level were assessed for each patient. RESULTS: Nine subjects were diagnosed with subclinical hypothyroidism. We found higher level of TSH in the study group, in comparison with control group (p = 0.015). Eighteen patients had increased level of FSH. In the study group higher number of patients with high FSH level was found in comparison with the control group (p = 0.049). A low BMD was observed in 7 patients whereas mild BMD deficits were found in 19 participants. CONCLUSIONS: In conclusion, our data show that young adult cancer survivors might experienced various hormonal problems including low bone mass, thyroid impairment and gonadal dysfunction. Some of the patients required treatment, but they were not diagnosed before this study. There is the lack of proper clinical assessment among adult childhood cancer survivors in Poland. Therefore, we demonstrated the need for a comprehensive plan for longitudinal follow-up for late effects in these population.

Bone mineral density in pediatric survivors of Hodgkin and non-Hodgkin lymphomas.

PURPOSE: To assess skeletal mass in survivors of childhood Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) 1-5 years after treatment, and to identify potential risk factors influencing bone mineral density (BMD). PATIENTS/METHODS: This cross-sectional study was conducted in a cohort of 43 survivors (HD=31; NHL=12); mean age: 16.21 ± 4.4. Total body bone mineral content (TBMC) and density (TBBMD), and lumbar spine density (LSBMD) were determined using dual-energy X-ray absorptiometry. RESULTS: Three of all 43 patients developed low BMD. No significant differences in height, weight, and/or BMD Z-scores were found between HD and NHL survivors, children who received and did not receive radiotherapy, and the groups with different chemotherapeutic blocks. No differences were noted between the Z-scores of BMC (mean ± SD: 0.31 ± 1.29 vs. -0.089 ± 0.61, p=0.165), TBBMD (mean ± SD: -0.32 ± 1.21 vs. -0.27 ± 0.91, p=0.76), or the LSBMD (mean ± SD: -0.183 ± 1.54 vs. -0.17 ± 0.87, p=0.637) in subgroups, in accordance with time after therapy (subgroup I<2 years and subgroup II>2 years after treatment). In HD survivors, age at diagnosis only affected the TBBMD Z-score (a decrease of 0.127 in total BMD Z-score per each year, R²=0.999, p<0.001). CONCLUSIONS: Childhood lymphoma survivors demonstrate no significant deficits in bone mass and tend to maintain their BMD within the normal range when presenting during one to five years' follow-up. However, this specific group requires longitudinal investigation to assess the pattern of peak bone mass achievement and the risk of future bone loss.

Does Q223R Polymorphism of Leptin Receptor Influence on Anthropometric Parameters and Bone Density in Childhood Cancer Survivors?

Childhood cancer survivors are in augmented risk for developing obesity. For many factors leptin and leptin receptor gene polymorphism play an important role in the development and metabolism not only of fat, but also, bone tissue. The aim of the analysis was to find the relationships between Q223R, leptin levels, and anthropometric parameters. Patients and Methods. In the study 74 cancer survivors participated (ALL n = 64, lymphomas n = 10), and the control group consisted of 51 healthy peers. Leptin blood concentration was determined by ELISA method. To estimate leptin receptor gene polymorphism, RFLP method was used. Bone mineral density (BMD) and content (BMC), fat, and lean tissue measurements were obtained by DXA. Results. We found no correlations between serum leptin concentrations and anthropometric parameters nor BMD. Serum leptin concentrations were significantly lower in the group of cancer survivors compared to controls; however, in those overweight from examined group we found leptin levels higher than those in nonoverweight. Genotype Q223R was not associated with higher leptin levels, BMI, BMD, body fat or lean tissue. Conclusion. To our knowledge, this is the first report describing the relationship between BMD and Q223R polymorphism in childhood cancer survivors. Further analysis, based on a larger group of patients, is needed to confirm these findings.

Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency.

INTRODUCTION: Adequate Vitamin D intake and its concentration in serum are important for bone health and calcium-phosphate metabolism as well as for optimal function of many organs and tissues. Documented trends in lifestyle, nutritional habits and physical activity appear to be associated with moderate or severe Vitamin D deficits resulting in health problems. Most epidemiological studies suggest that Vitamin D deficiency is prevalent among Central European populations. Concern about this problem led to the organising of a conference focused on overcoming Vitamin D deficiency. METHODS: After reviewing the epidemiological evidence and relevant literature, a Polish multidisciplinary group formulated theses on recommendations for Vitamin D screening and supplementation in the general population. These theses were subsequently sent to Scientific Committee members of the 'Vitamin D - minimum, maximum, optimum' conference for evaluation based on a ten-point scale.With 550 international attendees, the meeting 'Vitamin D - minimum, maximum, optimum' was held on October 19-20, 2012 in Warsaw(Poland). Most recent scientific evidence of both skeletal and non-skeletal effects of Vitamin D as well as the results of panellists' voting were reviewed and discussed during eight plenary sessions and two workshops. RESULTS: Based on many polemical discussions, including post-conference networking, the key opinion leaders established ranges of serum 25-hydroxyVitamin D concentration indicating Vitamin D deficiency [< 20 ng/mL (< 50 nmol/L)], suboptimal status [20-30 ng/mL(50-75 nmol/L)], and target concentration for optimal Vitamin D effects [30-50 ng/mL (75-125 nmol/L)]. General practical guidelines regarding supplementation and updated recommendations for prophylactic Vitamin D intakes in Central European neonates, infants, children and adolescents as well as in adults (including recommendations for pregnant and breastfeeding women and the elderly) were developed. CONCLUSIONS: Improving the Vitamin D status of children, adolescents, adults and the elderly must be included in the priorities of physicians,healthcare professionals and healthcare regulating bodies. The present paper offers elaborated consensus on supplementation guidance and population strategies for Vitamin D in Central Europe.

Little evidence of low bone mass in acute lymphoblastic leukemia survivors.

Childhood acute lymphoblastic leukemia (ALL) survivors represent a specific group at risk for many health problems, including skeletal complications and osteoporosis. The objective of this study was to assess the risk of osteoporosis associated with the prevalence of low bone mass (according to the guidelines of the Pediatric Official Positions of the International Society for Clinical Densitometry 2007) in survivors of childhood ALL. The cross-sectional study was conducted in a cohort of 69 Caucasian children and adolescents (46 boys and 23 girls) aged 12.15 ± 0.5yr diagnosed with ALL and screened up to 5 yr after cessation of the treatment. Total body bone mineral content (TB BMC, g), total body bone mineral density (TB BMD, g/cm(2)), and lumbar spine BMD (LS BMD, g/cm(2)) were determined using dual-energy X-ray absorptiometry. Time interval from the completion of the treatment to the beginning of this study (subgroup I<2 yr or subgroup II>2 yr after treatment), methotrexate (MTX) doses (subgroup I-MTX ranging from 0.5 to 1.0g/m(2); subgroup II-MTX>2.0 g/m(2)), cranial irradiation (subgroup I-without radiotherapy (RTX) and subgroup II receiving RTX of 12-18 Gy), cumulative steroid dose, and impaired endocrine function were considered as potential factors affecting bone metabolism and included in the analysis. No differences were found in bone traits (BMC, TB BMD, LS BMD) in relation to examined risk factors. In multiple regression model that included therapeutical factors, a risk group and central nervous system irradiation were of an important influence on bone mass, and risk group predicted TB BMD in small degree. Risk group and irradiation status lost their significance after the inclusion of anthropometric, age-connected, and time-connected factors. This study suggests that ALL survivors are not at increased risk for low bone mass. However, from the clinical perspective all patients after childhood ALL should be screened for clinical signs, fracture history, and lifestyle risk factors for low bone mass and osteoporosis. They should be referred to bone density evaluation only as often as may be necessary from the clinical evaluation.

Chronic non-cholestatic liver disease is not associated with an increased fracture rate in children.

Chronic liver disease in adults is a risk factor of osteoporosis, but little is known about risk of fractures in children with non-cholestatic liver disease. The aim of this study was to investigate associations among the severity of liver fibrosis, bone mass and low-energy fractures in children. History of fractures, anthropometry, and bone mass and size were examined in 39 Caucasian children (25 boys, 14 girls) aged 7.1-18 years (mean 11.9 ± 3.1) with chronic hepatitis B and liver fibrosis evidenced by liver biopsy. Severity of liver fibrosis was based on histological classification according to the method of Batts and Ludwig (mild, 1-2 scores; advanced, 3 scores) and Ishak (1-3 and 4-5 scores, respectively). Bone mineral content (BMC), density (BMD) and body composition were determined in the total body and lumbar spine using dual energy X-ray absorptiometry. Seven subjects (4 girls, 3 boys; 18% of the sample) had low BMD in the total body and lumbar spine region (Z-scores below -2.0). No associations were found among BMC, BMD, bone size and the severity of liver fibrosis. Nine boys (36% of all boys) and one girl reported repeated fractures (forearm, wrist, tibia, ankle, humerus), showing trends similar to the prevalence in general population. Fractures were neither associated with lower BMD/BMC nor with scores of liver fibrosis. Deficits in BMD in children with chronic hepatitis B are not associated with the severity of liver fibrosis. This study suggests that non-cholestatic liver disease does not increase the risk of low-energy fractures during growth. From the practical perspective, however, children with chronic liver disease should be screened for history and clinical risk factors for fractures rather than referred to bone density testing.

Is the treatment for childhood solid tumors associated with lower bone mass than that for leukemia and Hodgkin disease?

BACKGROUND: Cancer disease and its therapy (e.g., chemotherapeutic agents such as glucocorticoids, methotrexate, antymetabolities, cranial and local irradiation) may severely disturb normal growth, bone mineral acquisition, and skeletal development because most individuals go through the stages of rapid growth when childhood cancer is diagnosed. PROCEDURES: To identify factors associated with reduced bone mineral density (BMD) in survivors of childhood cancer the authors examined 114 patients (70 males) who had been treated for acute lymphoblastic leukemia (ALL; n = 43), Hodgkin disease (HD; n = 35), and solid tumors (ST; n = 36) twice. Median age at diagnosis was 8.4 years; at the consecutive examinations it was 12.8 and 16.3 years, respectively. To assess bone density we used dual-energy x-ray absorptiometry (DXA). RESULTS: In the first examination, patients with a history of steroid therapy had higher total and spine BMD and higher BMI (body mass index) than those who were not given steroids. At the end of the follow-up, no differences were found in BMD between subgroups, although BMI was still higher in both ALL and HD patients than in those with ST. CONCLUSIONS: Patients treated for solid tumors have reduced bone mass. Low BMI and local irradiation seem to be the factors responsible for reduced BMD in children treated for ST. The use of steroids does not disturb bone mass accumulation in patients treated for childhood malignancies. However, a long-term effect of cancer treatment on osteoporosis risk remains to be determined.

Body composition and bone mass in survivors of childhood cancer.

BACKGROUND: The number of survivors of childhood cancer has increased. Several studies in children and adults have shown relationships between lean mass (LM), fat mass (FM), and bone mineral content (BMC). The objective of the study was to examine the association between body composition and bone mass in young survivors of childhood cancer. METHODS: Sixty-eight postpubertal participants (31 females and 37 males) aged between 15.5 and 27 years who were at least 5 years after completion of treatment for leukemia (n = 30), lymphoma (n = 28), or solid tumors (n = 10) were studied. Anthropometry was performed and dual energy X-ray absorptiometry (DXA) was used to assess BMC in the total body (T) and lumbar spine (S), FM, and LM. RESULTS: There were no observed differences in age or time for cessation of treatment. Body mass index (BMI) was a strong determinant of bone mass in both sexes. TBMC correlated positively with LM (males r = 0.9 and females r = 0.76; P < 0.0001, respectively) and with FM (r = 0.54; P < 0.01 in males and r = 0.8; P < 0.00001 in females). SBMC correlated with LM in both sexes (in males r = 0.77 and in females r = 0.64; P < 0.0001, respectively) but only in females, SBMC also correlated positively with FM (r = 44 P = 0.03). There were no differences between patients who received radiation and those who did not. CONCLUSIONS: The associations between bone mass and body composition differ by sex and skeletal site, however, they are similar in survivors of childhood cancer and compared to healthy individuals during growth. Further prospective research is needed in cancer survivors to determine the long-term effect of anti-cancer therapy on body composition and bone mass.

[Accretion of bone mass in patients treated for childhood acute lymphoblastic leukemia]. / Przyrost masy kostnej u chorych leczonych w dziecinstwie z powodu ostrej bialaczki limfoblastycznej.

UNLABELLED: Chemotherapeutic agents such as glucocorticoids, methotrexate, antymetabolities, cranial and local irradiation) may severely disturb normal growth, bone mineral acquisition and skeletal development because the most individuals go through the stages of rapid growth when childhood acute lymphoblastic leukemia (ALL) is diagnosed. AIM OF THE STUDY: Analysis of the bone density accretion in children and adolescents in various time after tretament for acute lymphoblastic leukemia. MATERIALS AND METHODS: We examined 107 patients (70 males) who had been treated for ALL according to the protocol of the Polish Pediatric Leukemia, Lymphoma Study Group. Mean age at diagnosis was 7.3 years (range 1-19 years). They received chemotherapy with different doses of methotrexate: 46 patients - 5 g/m2; 24 - 2 g/m2 and 37 children received in doses of 0,5-1 g/m2. Cranial irradiation was performed in 22 patients in doses of 12 Gy, in 39 patients in doses of 18 Gy, 46 children did not receive cranial irradiation. The examinations were performed three times. First: immediately after end of maintenance therapy; second: 1,5 years after therapy and third: longer than 5 years after therapy. History of fractures, bone mineral density (BMD) measurements of lumbar spine (L2-L4) and total body were performed using dual-energy x-ray absorptiometry (GE Medical Systems Lunar DPX-L), expressed as g/cm2 and compared to reference values obtained from the 473 age - and gender-matched healthy children from the same region of Poland. RESULTS: at all points we did not find any differences between studied group and age- and gender-matched peers: BMI Z-score 0.77 vs 1.57 vs 0.72); BMD-total Z-score (-0.11 vs 0.012 vs 0.21); BMD-spine Z-score (0.03 vs 0.10 vs 0.08). BMD SDS > - 2 in first study was observed in 11.5% patients, in second - in 10% and in last - in 7.1% patients. In consecutive examinations we observed accretion of bone mass, similar as in healthy populationi. Age at diagnosis, gender, cumulative doses of steroids, using CNS radtiotherapy, high doses of methotrexate did not relate to examined (after treatment) parameters. Patients with history of fractures had lower BMD-total in second assessment and lower BMD-spine in all examiantions, however, statistical significant was not reach. CONCLUSIONS: The disease itself and its complex treatment did not disturb the bone density accretion in examined patients. The patients with history of fractures (before and after tretament) tended to have lower mean values of bone density, (especially in region of spine) than patients without fractures. Small number of patients in last examination did not allowed to conclude about peak bone mass in our patients.

[Bone mineral density in children before and after completion of cancer treatment]. / Gestosc mineralna kosci u dzieci przed leczeniem choroby nowotworowej i po jego zakonczeniu.

This study was performed to determine the degree of osteopenia in children with malignancy before and after completion of treatment. Twenty six subjects (17 male, 9 female) treated for acute lymphoblastic leukemia (n=15), lymphogranulomatosis maligna (n=7) or solid tumor (n=4) at a mean age 9.34 (range 3-17.41 years) before and 15.85 (range 9.66-23) after treatment participated in this longitudinal study. Mean follow up period after discontinuation of therapy was 5.5 years (range 2.6-8.3 years). Interview (estimation of physical activity, other chronic disease, and fractures), anthropometric measurements of body mass and height, body mass index (BMI), bone mineral density total (BMD Total) and spine (BMD Spine) were obtained from every child. Gained findings were compared to the same parameters in the group of 473 healthy children, comparable in age and gender with examined group and showed as SD score. There were no differences in BMI and BMD Total and Spine between patients and controls. No correlation was found between the BMD values and the diagnosis, age at diagnosis, gender and cranial irradiation and duration of follow-up. BMD Spine SD score was significantly increased in a subgroup of patients in pubertal stage at diagnosis as compared to patients in prepubertal stage. Further studies are needed to evaluate the long-term effect on BMD in patients with cancer and how to prevent a decrease of BMD.

[Leptin, body composition and bone mineralization in children after treatment for Wilms tumor]. / Leptyna, skladowe masy ciala oraz mineralizacja ukladu kostnego u dzieci po zakonczonym leczeniu guza Wilmsa.

UNLABELLED: Advances in diagnosis and improved methods of treatment have resulted in increasing number of long-term survivors in children with Wilms tumor. Growth and puberty are important for accumulation of bone mass; chemotherapy nad radiotherapy used in treatment for Wilms tumor can influence bone structure and physical development. Leptin plays an important role in metabolism of adipose tissue and bone mineralization. Considering that neoplasm and its treatment can affect normal development in childhood, we analysed the influence of antineoplastic treatment on bone mineralization and the correlations between serum leptin levels, body composition and bone mineral density in survivors of Wilms tumor. Twenty subjects (12 boys) treated for Wilms tumor at the mean age of 10.9 (range 3-20 years) participated in this study. Mean follow up period after discontinuation of therapy was 5.6 years (range 2 months - 13.5 years). Mean age of diagnosis was 3.9 years (range 1 month - 12.6 years). 18 patients received chemotherapy, 7 - additionally radiotherapy and 2 infants had only surgery treatment. We measured fat mass - FM, fat free mass - FFM, bone mineral density - BMD total and BMD spine using dual energy x-ray absorptiometry (DXA) and compared to the results obtained for healthy references (SD score). Leptin levels were measured with RIA method. RESULTS: 1. No difference was found in leptin levels, body mass index, FM, FFM, BMD total and spine in relation to sex. 2. Means of SDS BMI, FM, FFM, BMD and leptin were in the normal range for the age and sex matched controls. 3. We found the correlation between leptin level and BMI, FM, FFM and BMD total and spine, no correlation was found between SDS values. 4. We observed a positive correlation between SDS BMD and SDS BMI, FM, FFM, BMD spine. 5. BMI, FM and leptin levels were higher in children treated with radiotherapy and chemotherapy than in children treated with only chemotherapy. However, the SDS values were comparable with the healthy controls. 6. SDS BMD total was decreased in 5/20 subjects (25% of all studied patients) compared with healthy controls. CONCLUSIONS: The results demonstrated the risk of osteopenia in the group of children treated for Wilms tumor and the necessity for long-term monitoring of bone mineralization.

[Effect of anticancer treatment on leptin level, fat body mass (FM) and lean body mass (LBM)]. / Wplyw leczenia przeciwnowotworowego na wartosci leptyny w surowicy, wskaznik masy ciala oraz zawartosc masy tluszczowej i beztluszczowej.

UNLABELLED: Leptin plays an important role in the metabolism of adipose tissue. Considering that malignancy and its treatment cans affect normal development in childhood. We analysed the correlations between serum leptin levels and body composition after anticancer treatment. We studied 33 survivors (24 boys and 9 girls) who before our study, have been treated for acute lymphoblastic leukaemia (ALL) (n=23) and Hodgkin disease (n=10) after 7.15+/-3.5 years. Sixteen patients with ALL received cranial irradiation (12Gy). We measured body mass index (BM1) fat mass (FM) and lean body mass (LBM) using dual energy x-ray absorptiometry (DXA). We compared these results to the results obtained from reference values (SD score). Leptin levels were measured with the RIA method. RESULTS: 1. Mean leptin levels were higher in girls after puberty (10.93 ng/mL+/-8.9) than in boys (3.73 ng/mL+/-3. 7). In boys no differences were found in leptin levels between T2-4 and T5 stages. In girls the leptin values increased after puberty. Leptin SD score levels were higher in boys during (1.55 +/-1.0) and after puberty (1.46+/-0.75) and in girls - after puberty (1.19 +/-1.51). We did not find any influence of cranial irradiation (12Gy) or various methotrexate doses (5 g/m(2) vs. 19/m(2)) leptin values. 2. No difference in BMI SD score was found within the whole study group. 3. FM did not change ill boys during and after puberty, although FM SD score were higher during puberty (2.98 +/-4.8). In girls FM and FM SD score were higher after puberty. In boys and girls LBM augmented with pubertal development but LBM SD score in boys were lower after puberty (-1.67 +/-1.7) in comparison to puberty (0.2 +/-1.7). No differences were found between LBM SD score in girls during and after puberty. 4. We found a correlation between leptin levels and BMI (r=0.59 p=0.001) and FM (r=0.77 p=0.0001). 5. Relation of FM to LBM in boys remained unchanged, however in girls it increased within pubertal development. CONCLUSION: l. Anticancer treatment during childhood shows no influence on body mass index although the tendency to higher fat mass in pubertal boys and in post pubertal girls is observed. 2. Leptin values depend on fat mass and do not relate directly to the pubertal stage.

[Vertebral compression fractures--the first manifestations of acute lymphoblastic leukemia of childhood]. / Zlamania kompresyjne kregów -- objaw wstepny ostrej bialaczki limfoblastycznej u dzieci.

We report 6 children, aged 4.5- 16 years, with acute lymphoblastic leukaemia with back pain, exacerbated by walking as the first symptom of disease. Collapse of the vertebral bodies at multiple levels was shown on imaging. The presented group had good prognosis. In densitometric examination of BMD (bone mineral density) was observed loss in the thoracic and lumbar vertebrae in 5 out of 6 children. Chemotherapy resulted in decrease of pain and spontaneous remodelling of the vertebrae.

[Bone mineral density and markers of bone turnover in patients treated for malignant disease in childhood]. / Ocena gestosci kosci i wybranych wskazników kosciotworzenia i resorpcji u pacjentów leczonych w dziecinstwie z powodu choroby nowotworowej.

UNLABELLED: Development in diagnostic and therapeutic methods has led to increased survival rates in children with malignancies. The treatment with corticosteroids, methotrexate and irradiation may all cause reduction in bone mass. We assessed bone mineral density (BMD) and several parameters involved in bone formation in long-term survivors with a malignancy at completion of therapy. Total body and lumbar spine bone mineral densities (gram per cm2) were measured by dual energy x-ray absorptiometry in 40 patients (age 12-27 yr; median 17.5 yr; 21 with acute lymphoblastic leukemias, 19 with other malignancies) from 3 to 13.9 years (median 7 yr) after discontinuation of therapy. These results were compared with those from 473 healthy controls and expressed as a percentage of the age and sex-matched control values (mean and standard deviation). Serum levels of osteocalcin, bone specific alkaline phosphatase, parathormone, 1.25 dihydroxyvitamin D, urinary concentrations of deoxypyridinoline were determined as well as several specific markers of bone turnover. RESULTS: The total BMD and in the lumbar spine were not significantly reduced in survivors of childhood malignancies compared to the control population. No correlation was found between the BMD values and the cumulative doses and time of corticosteroids, administered Mtx, irradiation, duration of treatment, age at diagnosis. Duration of follow-up showed correlation with lumbar spine BMD. Serum markers of bone formation and resorption were in the normal range (expressed as standard deviation score relative to the age and sex-matched healthy population), bone turnover was not disturbed at the time of the study. CONCLUSION: We found no difference in bone mineralisation between our patients and the healthy population.