Body composition and cardiovascular risk factors in survivors of bone marrow transplantation (BMT) in childhood

N Davis; M Stevens; J Cornish; R Elson; C Stuart; W Woltersdorf; E Crowne

Background: There is emerging evidence that BMT survivors not only suffer long term endocrine sequelae, but also have increased risk of cardiovascular disease and T2DM. We examined body composition and cardiovascular and metabolic risk factors in adolescent and young adult survivors.

Method: We enrolled 36 BMT survivors (20 male). Seven were pre-pubertal, 9 pubertal, and 20 post-pubertal. We measured body composition by DEXA scan and BMI, and fasted lipids and HSCRP. They were compared with 16 (11 male) age-matched non-BMT controls. The controls were being assessed for growth hormone deficiency. All subjects had GH status assessed and 31 BMT survivors and 5 controls were growth hormone deficient. Twenty-three of the survivors and none of the controls were on GH treatment at the time of testing.

Results:


	% Body fat	BMI SDS	T. Chol (mmol/l)	LDL (mmol/l)	HDL (mmol/l)	Total cholesterol/HDL	Triglycerides (mmol/l)	HSCRP
Controls	25.2(12.4)	−0.12(1.67)	3.58(0.67)	1.96(0.46)	1.52(0.68)	2.9 (0.5)	0.80(0.37)	1.5 (3.6)
Survivors	32.1*(12.5)	0.04(1.47)	4.78^†(0.93)	2.53*(0.75)	1.77(0.67)	3.2 (0.9)	1.57*(1.06)	4.6* (8.4)
*P<0.05, ^†P<0.0005, results expressed as mean (S.D.).

BMI is a poor indicator of adiposity in this group due to their short stature and reduced lean mass. The BMT survivors have higher % body fat than controls despite a normal BMISDS. Female survivors have higher body fat than male survivors (40.6 vs 25.3%), and HSCRP is higher, although lipids are similar. Total cholesterol was high or borderline high in 16 survivors. Seven have borderline high LDL and 18 have a total/HDL ratio above the recommended level of 3. Lipid abnormalities did not show any relationship to growth hormone status. Twelve survivors also had OGTTs, of which 5 show impaired glucose tolerance, and 3 show diabetes mellitus.


	% Body fat	BMI SDS	T. Chol (mmol/l)	LDL (mmol/l)	HDL (mmol/l)	Total cholesterol/HDL	Triglycerides (mmol/l)	HSCRP
Controls	25.2(12.4)	−0.12(1.67)	3.58(0.67)	1.96(0.46)	1.52(0.68)	2.9 (0.5)	0.80(0.37)	1.5 (3.6)
Survivors	32.1*(12.5)	0.04(1.47)	4.78^†(0.93)	2.53*(0.75)	1.77(0.67)	3.2 (0.9)	1.57*(1.06)	4.6* (8.4)
*P<0.05, ^†P<0.0005, results expressed as mean (S.D.).

Conclusion: BMT survivors have a high rate of abnormal body composition and lipid profiles. These are more pronounced in females. Future studies should investigate the benefits of early targeted interventions to improve body composition, lipid profiles and metabolic health.

Endocrine Abstracts

P42