human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Despite a widespread belief that glucocorticoid therapy is associated with positive energy balance and excess weight gain there is a dearth of quantitative evidence about its effects and the underlying mechanisms of any effects . The primary aim of the present study was to quantify the effect of dexamethasone and prednisone treatment on energy intake in children treated for childhood acute lymphoblastic leukemia . A secondary aim was to test for differences in excess weight gain between patients treated using the 2 glucocorticoids . We measured energy intake in 26 patients ( mean + /- SD age , 6.3 + /- 2.3 yr ) during a 5-d period " on " steroids and again in the week before steroid treatment .  Changes in body mass index from diagnosis to 1 and 2 yr postdiagnosis were expressed as SD scores . Steroid treatment was associated with a significant increase in energy intake of approximately 20 % ( mean paired difference , 1.7 MJ/d ; SD , 2.8 ; 95 % confidence interval , 0.7 - 2.8 MJ/d ) , with no significant difference between the 2 steroids . The mean change in body mass index SD score was + 0.38 ( SD , 1.10 ; P < 0.05 ) to 1 yr and + 0.68 ( SD , 1.38 ; P < 0.05 ) to 2 yr , with no significant difference between the 2 groups of patients .  Glucocorticoid treatment in childhood acute lymphoblastic leukemia increases energy intake markedly , and this effect contributes to the excess weight gain and obesity characteristic of patients being treated for acute lymphoblastic leukemia Purpose Improved survival of patients with childhood acute lymphoblastic leukemia ( ALL ) has drawn attention to the potential for late consequences of previous treatments among survivors , including metabolic syndrome . In this study , we evaluated changes in 3 parameters , namely , r and om blood glucose , body mass index ( BMI ) , and Z score for BMI ( Z- BMI ) , in children with ALL during chemotherapy and after completion of treatment . Methods Patients newly diagnosed with ALL from January , 2005 to December , 2008 at Saint Mary 's Hospital , The Catholic University of Korea , who completed treatment with chemotherapy only were included ( n=107 ) .  R and om glucose , BMI , and Z- BMI were recorded at 5 intervals : at diagnosis , before maintenance treatment , at completion of maintenance treatment , and 6 and 12 months after completion of maintenance treatment . Similar analyses were conducted on 2 subcohorts based on ALL risk groups . Results For r and om glucose , a paired comparison showed significantly lower levels at 12 months post-treatment compared to those at initial diagnosis ( P<0.001 ) and before maintenance ( P<0.001 ) . The Z- BMI score was significantly higher before maintenance than at diagnosis ( P<0.001 ) , but decreased significantly at the end of treatment ( P<0.001 ) and remained low at 6 months ( P<0.001 ) and 12 months ( P<0.001 ) post-treatment . Similar results were obtained upon analysis of risk group-based subcohorts . Conclusion For a cohort of ALL patients treated without allogeneic transplantation or cranial irradiation , decrease in r and om glucose and Z- BMI after completion of chemotherapy does not indicate future glucose intolerance or obesity Background Obesity is a well-known problem in children with acute lymphoblastic leukemia ( ALL ) , and it might be the result of an excess in energy intake , reduced energy expenditure , or both . The aim of this study is to describe energy intake and physical activity during treatment for ALL with intermittent dexamethasone ( DEXA ) . Methods Body mass index ( BMI ) , energy intake , and physical activity were measured in 16 ALL patients on maintenance treatment and in 17 healthy controls . ALL patients were measured during ( “ on DEXA ” ) and in between ( “ off DEXA ” ) DEXA treatments . Results In patients , the mean increase in BMI z-score was 1.4 ± 1.1 . Energy intake on DEXA was higher ( 2,125.9 ± 476.0 vs 1,775.1 ± 426.1 kcal/24 h , p < 0.05 ) and energy intake off DEXA was lower ( 1,305.0 ± 249.4 vs 1,775.1 ± 426.1 kcal/24 h , p < 0.05 ) , compared to healthy controls . Physical activity on DEXA was lower compared to healthy controls ( 30.0 ± 3.9 vs 40.0 ± 6.0 kcal kg−1 24 h−1 , p < 0.001 and 7,303.1 ± 4,622.9 vs 13,927.2 ± 3,822.7 steps , p < 0.05 ) . Physical activity off DEXA was not different compared to healthy controls . Conclusion Weight gain in patients on ALL treatment might be owing to increased energy intake and decreased physical activity during treatment with DEXA BACKGROUND Long-term survivors of acute lymphoblastic leukemia ( ALL ) in childhood are at increased risk of late effects of cancer treatment , among which are cardiovascular sequelae . Purpose of this study was to assess blood pressure and body composition in childhood ALL survivors and compare data to reference values from the general population . PROCEDURE This single-center retrospective study included 68 survivors of childhood ALL with a median age of 25 years ( range 16.4 - 39.5 ) and a median follow-up of 16.0 years ( range 5.3 - 30.4 ) .  Data on previous treatment , blood pressure and measurements of weight and height at diagnosis and at long-term follow-up ( from which body mass index ( BMI ) was calculated ) were obtained from medical records . All data were converted to control-referenced st and ard deviation scores . RESULTS Of the ALL survivors 48½% were prehypertensive and 22.1 % were hypertensive . Both the mean systolic ( mean SDS 0.736 , P < 0.001 ) and diastolic blood pressure ( mean SDS 0.409 , P < 0.001 ) of survivors was significantly higher compared to reference control values . Based on BMI values , 38.2 % of the survivors were considered overweight/obese and females , in contrast to males had a significantly higher BMI ( mean SDS 1.355 , P < 0.001 ) compared to reference values . In addition , females who had received cranial radiotherapy ( mean SDS 2.078 ) had a significantly higher BMI than females who had not ( mean SDS 0.512 ) ( P = 0.009 ) . CONCLUSIONS Both diastolic and systolic blood pressure are significantly increased in survivors of childhood ALL . Female survivors treated with cranial radiation therapy have the highest prevalence and greatest risk of overweight/obesity . Therefore , survivors of childhood ALL are likely to be at an increased risk of cardiovascular disease later in life , which stresses the need for follow-up and adequate medical and /or life style interventions INTRODUCTION While it is known that leukemia therapy is associated with obesity in survivorship , limited information is available on its time-related pattern of development and its variation across patient subgroups . The goal of the present study was to examine demographic correlates of body mass index ( BMI ) changes over time from diagnosis through chemotherapy for children with B-precursor acute lymphoblastic leukemia ( ALL ) . METHODS The study cohort consisted of 307 pediatric patients diagnosed with ALL who were treated at four South Texas pediatric oncology centers between 1990 and 2002 . To minimize treatment-related variability , we excluded patients who received cranial irradiation as part of their treatment . Variation in age- and gender-st and ardized BMI z-scores according to age at diagnosis , gender , and ethnicity were assessed . RESULTS The overall study cohort exhibited an increase in age- and gender-adjusted BMI z-scores for the first 24 months of chemotherapy followed by a slight decrease in BMI at 30 months ( end of therapy ) . A repeated measures analysis indicated a statistically significant difference in the time-related pattern of BMI changes for age at diagnosis ( P = 0.001 ) but no significant effect for gender ( P = 0.32 ) or Hispanic versus non-Hispanic ethnicity ( P = 0.89 ) . DISCUSSION In our cohort of ALL patients , BMI was elevated at diagnosis ( mean st and ardized BMI z-score = 0.22 , st and ard deviation = 1.4 ) then increased and remained elevated for the entire duration of chemotherapy .  Children who were 2 - 9 years of age at diagnosis began therapy with a substantially lower BMI and remained lower over the course of chemotherapy than patients aged 10 - 18 years at diagnosis . It will be important for future investigations to explore the biological and behavioral factors that may underlie such differential patterns of BMI change over time BACKGROUND Chronicity of muscle weakness from cancer and its treatment may be problematic , particularly in those treated for cancer during childhood . We compared body composition , muscle strength , and mobility between 75 adult survivors of childhood acute lymphoblastic leukemia ( ALL ) and expected values based on population normative data . METHODS Subjects were young adults treated for childhood ALL between 1970 and 1986 , selected r and omly from participants in an ongoing study of cancer survivors .  DeXA scans were performed to evaluate body composition , and myometry used to measure strength . Mobility was evaluated with the  Timed Up and Go ( TUG ) and 2-min walk ( TMW ) . One sample t-tests compared ALL survivors to population norms . RESULTS Males had 4.5 % and females had 2.3 % more body fat than expected ( expected males 21.5 % , females 36.0 % ) . Males were 76.7 Newtons and females were 58.6 Newtons weaker in quadriceps strength than expected ( expected males 569.87 N , females 464.67 N ) . Males walked 100.88 m and females walked 85.38 m less on the TMW ( expected values : males 304.23 m , females 276.26 m ) , and took longer to complete the TUG ( males 5.82 vs. 2.84 sec , females 5.88 vs. 3.00 sec ) than expected . Treatment with cranial radiation and current growth hormone ( GH ) deficiency were associated with lower body weakness among females . CONCLUSIONS Young adult survivors of childhood ALL have strength and mobility deficits . Decreased strength may reduce ability to participate in physical activity , perpetuating fitness deficits in survivors of childhood ALL BACKGROUND The risk factors responsible for an increased prevalence of obesity or overweight in survivors of acute lymphoblastic leukemia ( ALL ) remain controversial . We evaluated changes in body mass index ( BMI ) in a cohort of ALL survivors , all of whom have been followed until completion of linear growth . PROCEDURE BMI ( weight/height(2 ) ) was used as an index of adiposity and was calculated at diagnosis , at the end of treatment , and at attainment of final height in a cohort of 126 ( 59 males ) survivors of ALL .  BMI was adjusted for age and sex by computing a BMI st and ard deviation score ( SDS ) or z score . The spectrum of therapies used included intrathecal chemotherapy given alone ( n = 38 ) or combined with cranial irradiation ( CRT ; 18 Gy , n = 35 ; 24 Gy , n = 53 ) and exposure to prednisone at a low dose ( < 3.5 gm , n = 49 ) , medium dose ( 3.5 - 9.4 gm , n = 46 ) , or high dose ( > 9.4 gm , n = 30 ) . RESULTS Overall , mean + /- SEM BMI -SDS increased significantly between diagnosis ( -0.18 + /- 0.08 ) and the end of therapy ( 0.41 + /- 0.09 , P < 0.01 ) , with no significant change thereafter . For patients without CRT , mean BMI -SDS remained unchanged , whereas , for those so treated , mean BMI -SDS increased significantly between diagnosis and the completion of therapy ( P < 0.001 ) . The change in mean BMI -SDS was greater in the 24 Gy group vs. the 18 Gy CRT sample ( P < 0.005 ) . In a multivariate logistic regression model , CRT was an independent predictor of being overweight ( BMI > /=85 percentile ) at attainment of final height [ odds ratio = 1.6 ( 95 % confidence interval 1.0 - 23 . 1 ) ] . The percentage of subjects who were overweight at attainment of final height was 10.5 % , 40 % , and 38 % for subjects treated with no CRT , 18 Gy CRT , or 24 Gy CRT , respectively ( P < 0.01 ) . CONCLUSIONS Children with ALL given CRT develop increases in their BMI -SDS early on and during treatment and remain at significant risk for becoming overweight as young adults , a development that may increase their already heightened risk for various adverse health outcomes PURPOSE We examined the rate of increase in the body mass index ( BMI ; kg/m(2 ) ) after 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Despite a widespread belief that glucocorticoid therapy is associated with positive energy balance and excess weight gain there is a dearth of quantitative evidence about its effects and the underlying mechanisms of any effects . The primary aim of the present study was to quantify the effect of dexamethasone and prednisone treatment on energy intake in children treated for childhood acute lymphoblastic leukemia . A secondary aim was to test for differences in excess weight gain between patients treated using the 2 glucocorticoids . We measured energy intake in 26 patients ( mean + /- SD age , 6.3 + /- 2.3 yr ) during a 5-d period " on " steroids and again in the week before steroid treatment .  Changes in body mass index from diagnosis to 1 and 2 yr postdiagnosis were expressed as SD scores . Steroid treatment was associated with a significant increase in energy intake of approximately 20 % ( mean paired difference , 1.7 MJ/d ; SD , 2.8 ; 95 % confidence interval , 0.7 - 2.8 MJ/d ) , with no significant difference between the 2 steroids . The mean change in body mass index SD score was + 0.38 ( SD , 1.10 ; P < 0.05 ) to 1 yr and + 0.68 ( SD , 1.38 ; P < 0.05 ) to 2 yr , with no significant difference between the 2 groups of patients .  Glucocorticoid treatment in childhood acute lymphoblastic leukemia increases energy intake markedly , and this effect contributes to the excess weight gain and obesity characteristic of patients being treated for acute lymphoblastic leukemia Purpose Improved survival of patients with childhood acute lymphoblastic leukemia ( ALL ) has drawn attention to the potential for late consequences of previous treatments among survivors , including metabolic syndrome . In this study , we evaluated changes in 3 parameters , namely , r and om blood glucose , body mass index ( BMI ) , and Z score for BMI ( Z- BMI ) , in children with ALL during chemotherapy and after completion of treatment . Methods Patients newly diagnosed with ALL from January , 2005 to December , 2008 at Saint Mary 's Hospital , The Catholic University of Korea , who completed treatment with chemotherapy only were included ( n=107 ) .  R and om glucose , BMI , and Z- BMI were recorded at 5 intervals : at diagnosis , before maintenance treatment , at completion of maintenance treatment , and 6 and 12 months after completion of maintenance treatment . Similar analyses were conducted on 2 subcohorts based on ALL risk groups . Results For r and om glucose , a paired comparison showed significantly lower levels at 12 months post-treatment compared to those at initial diagnosis ( P<0.001 ) and before maintenance ( P<0.001 ) . The Z- BMI score was significantly higher before maintenance than at diagnosis ( P<0.001 ) , but decreased significantly at the end of treatment ( P<0.001 ) and remained low at 6 months ( P<0.001 ) and 12 months ( P<0.001 ) post-treatment . Similar results were obtained upon analysis of risk group-based subcohorts . Conclusion For a cohort of ALL patients treated without allogeneic transplantation or cranial irradiation , decrease in r and om glucose and Z- BMI after completion of chemotherapy does not indicate future glucose intolerance or obesity Background Obesity is a well-known problem in children with acute lymphoblastic leukemia ( ALL ) , and it might be the result of an excess in energy intake , reduced energy expenditure , or both . The aim of this study is to describe energy intake and physical activity during treatment for ALL with intermittent dexamethasone ( DEXA ) . Methods Body mass index ( BMI ) , energy intake , and physical activity were measured in 16 ALL patients on maintenance treatment and in 17 healthy controls . ALL patients were measured during ( “ on DEXA ” ) and in between ( “ off DEXA ” ) DEXA treatments . Results In patients , the mean increase in BMI z-score was 1.4 ± 1.1 . Energy intake on DEXA was higher ( 2,125.9 ± 476.0 vs 1,775.1 ± 426.1 kcal/24 h , p < 0.05 ) and energy intake off DEXA was lower ( 1,305.0 ± 249.4 vs 1,775.1 ± 426.1 kcal/24 h , p < 0.05 ) , compared to healthy controls . Physical activity on DEXA was lower compared to healthy controls ( 30.0 ± 3.9 vs 40.0 ± 6.0 kcal kg−1 24 h−1 , p < 0.001 and 7,303.1 ± 4,622.9 vs 13,927.2 ± 3,822.7 steps , p < 0.05 ) . Physical activity off DEXA was not different compared to healthy controls . Conclusion Weight gain in patients on ALL treatment might be owing to increased energy intake and decreased physical activity during treatment with DEXA BACKGROUND Long-term survivors of acute lymphoblastic leukemia ( ALL ) in childhood are at increased risk of late effects of cancer treatment , among which are cardiovascular sequelae . Purpose of this study was to assess blood pressure and body composition in childhood ALL survivors and compare data to reference values from the general population . PROCEDURE This single-center retrospective study included 68 survivors of childhood ALL with a median age of 25 years ( range 16.4 - 39.5 ) and a median follow-up of 16.0 years ( range 5.3 - 30.4 ) .  Data on previous treatment , blood pressure and measurements of weight and height at diagnosis and at long-term follow-up ( from which body mass index ( BMI ) was calculated ) were obtained from medical records . All data were converted to control-referenced st and ard deviation scores . RESULTS Of the ALL survivors 48½% were prehypertensive and 22.1 % were hypertensive . Both the mean systolic ( mean SDS 0.736 , P < 0.001 ) and diastolic blood pressure ( mean SDS 0.409 , P < 0.001 ) of survivors was significantly higher compared to reference control values . Based on BMI values , 38.2 % of the survivors were considered overweight/obese and females , in contrast to males had a significantly higher BMI ( mean SDS 1.355 , P < 0.001 ) compared to reference values . In addition , females who had received cranial radiotherapy ( mean SDS 2.078 ) had a significantly higher BMI than females who had not ( mean SDS 0.512 ) ( P = 0.009 ) . CONCLUSIONS Both diastolic and systolic blood pressure are significantly increased in survivors of childhood ALL . Female survivors treated with cranial radiation therapy have the highest prevalence and greatest risk of overweight/obesity . Therefore , survivors of childhood ALL are likely to be at an increased risk of cardiovascular disease later in life , which stresses the need for follow-up and adequate medical and /or life style interventions INTRODUCTION While it is known that leukemia therapy is associated with obesity in survivorship , limited information is available on its time-related pattern of development and its variation across patient subgroups . The goal of the present study was to examine demographic correlates of body mass index ( BMI ) changes over time from diagnosis through chemotherapy for children with B-precursor acute lymphoblastic leukemia ( ALL ) . METHODS The study cohort consisted of 307 pediatric patients diagnosed with ALL who were treated at four South Texas pediatric oncology centers between 1990 and 2002 . To minimize treatment-related variability , we excluded patients who received cranial irradiation as part of their treatment . Variation in age- and gender-st and ardized BMI z-scores according to age at diagnosis , gender , and ethnicity were assessed . RESULTS The overall study cohort exhibited an increase in age- and gender-adjusted BMI z-scores for the first 24 months of chemotherapy followed by a slight decrease in BMI at 30 months ( end of therapy ) . A repeated measures analysis indicated a statistically significant difference in the time-related pattern of BMI changes for age at diagnosis ( P = 0.001 ) but no significant effect for gender ( P = 0.32 ) or Hispanic versus non-Hispanic ethnicity ( P = 0.89 ) . DISCUSSION In our cohort of ALL patients , BMI was elevated at diagnosis ( mean st and ardized BMI z-score = 0.22 , st and ard deviation = 1.4 ) then increased and remained elevated for the entire duration of chemotherapy .  Children who were 2 - 9 years of age at diagnosis began therapy with a substantially lower BMI and remained lower over the course of chemotherapy than patients aged 10 - 18 years at diagnosis . It will be important for future investigations to explore the biological and behavioral factors that may underlie such differential patterns of BMI change over time BACKGROUND Chronicity of muscle weakness from cancer and its treatment may be problematic , particularly in those treated for cancer during childhood . We compared body composition , muscle strength , and mobility between 75 adult survivors of childhood acute lymphoblastic leukemia ( ALL ) and expected values based on population normative data . METHODS Subjects were young adults treated for childhood ALL between 1970 and 1986 , selected r and omly from participants in an ongoing study of cancer survivors .  DeXA scans were performed to evaluate body composition , and myometry used to measure strength . Mobility was evaluated with the  Timed Up and Go ( TUG ) and 2-min walk ( TMW ) . One sample t-tests compared ALL survivors to population norms . RESULTS Males had 4.5 % and females had 2.3 % more body fat than expected ( expected males 21.5 % , females 36.0 % ) . Males were 76.7 Newtons and females were 58.6 Newtons weaker in quadriceps strength than expected ( expected males 569.87 N , females 464.67 N ) . Males walked 100.88 m and females walked 85.38 m less on the TMW ( expected values : males 304.23 m , females 276.26 m ) , and took longer to complete the TUG ( males 5.82 vs. 2.84 sec , females 5.88 vs. 3.00 sec ) than expected . Treatment with cranial radiation and current growth hormone ( GH ) deficiency were associated with lower body weakness among females . CONCLUSIONS Young adult survivors of childhood ALL have strength and mobility deficits . Decreased strength may reduce ability to participate in physical activity , perpetuating fitness deficits in survivors of childhood ALL BACKGROUND The risk factors responsible for an increased prevalence of obesity or overweight in survivors of acute lymphoblastic leukemia ( ALL ) remain controversial . We evaluated changes in body mass index ( BMI ) in a cohort of ALL survivors , all of whom have been followed until completion of linear growth . PROCEDURE BMI ( weight/height(2 ) ) was used as an index of adiposity and was calculated at diagnosis , at the end of treatment , and at attainment of final height in a cohort of 126 ( 59 males ) survivors of ALL .  BMI was adjusted for age and sex by computing a BMI st and ard deviation score ( SDS ) or z score . The spectrum of therapies used included intrathecal chemotherapy given alone ( n = 38 ) or combined with cranial irradiation ( CRT ; 18 Gy , n = 35 ; 24 Gy , n = 53 ) and exposure to prednisone at a low dose ( < 3.5 gm , n = 49 ) , medium dose ( 3.5 - 9.4 gm , n = 46 ) , or high dose ( > 9.4 gm , n = 30 ) . RESULTS Overall , mean + /- SEM BMI -SDS increased significantly between diagnosis ( -0.18 + /- 0.08 ) and the end of therapy ( 0.41 + /- 0.09 , P < 0.01 ) , with no significant change thereafter . For patients without CRT , mean BMI -SDS remained unchanged , whereas , for those so treated , mean BMI -SDS increased significantly between diagnosis and the completion of therapy ( P < 0.001 ) . The change in mean BMI -SDS was greater in the 24 Gy group vs. the 18 Gy CRT sample ( P < 0.005 ) . In a multivariate logistic regression model , CRT was an independent predictor of being overweight ( BMI > /=85 percentile ) at attainment of final height [ odds ratio = 1.6 ( 95 % confidence interval 1.0 - 23 . 1 ) ] . The percentage of subjects who were overweight at attainment of final height was 10.5 % , 40 % , and 38 % for subjects treated with no CRT , 18 Gy CRT , or 24 Gy CRT , respectively ( P < 0.01 ) . CONCLUSIONS Children with ALL given CRT develop increases in their BMI -SDS early on and during treatment and remain at significant risk for becoming overweight as young adults , a development that may increase their already heightened risk for various adverse health outcomes PURPOSE We examined the rate of increase in the body mass index ( BMI ; kg/m(2 ) ) after 
    Output:
    