Changes in body composition related to metabolic syndrome are frequent among survivors of haematopoietic stem cell transplantation (HSCT), but insights into predisposing factors are incomplete, and it is unknown to what degree these changes persist at long term. We cross-sectionally investigated body composition by dual-energy X-ray absorptiometry in 98 male survivors of paediatric allogeneic HSCT. Median (range) age at follow-up was 28.1 (18.5–47.0) years and median (range) time from transplant was 18.3 (7.7–34.6) years. Lean Body Mass Index and Skeletal Muscle Mass Index were lower in patients compared to the reference population (mean (SD) standard deviation score (SDS) –1.29 (0.99), p < 0.001 and –1.20 (1.03), p < 0.001). Fat Mass Index was comparable to the reference population, but android/gynoid (AG) fat ratio SDS was higher (mean (SD) 0.46 (1.28), p < 0.001). These changes were found in patients treated with total body irradiation (TBI) as well as non-TBI regimens, although most pronounced in the former. Further, low lean mass was associated with chronic graft-versus-host disease, while high AG ratio was associated with lower testosterone levels. Since the combination of low lean mass and high AG ratio increases the risk of cardio-metabolic disease, these health issues should be monitored at long-term clinical follow-up after paediatric HSCT.
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Mostoufi-Moab S, Ginsberg JP, Bunin N, Zemel BS, Shults J, Thayu M, et al. Body composition abnormalities in long-term survivors of pediatric hematopoietic stem cell transplantation. J Pediatr. 2012;160:122–8.
Inaba H, Yang J, Kaste SC, Hartford CM, Motosue MS, Chemaitilly W, et al. Longitudinal changes in body mass and composition in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem-cell transplantation. J Clin Oncol. 2012;30:3991–7.
Imboden MT, Welch WA, Swartz AM, Montoye AHK, Finch HW, Harber MP, et al. Reference standards for body fat measures using GE dual energy x-ray absorptiometry in Caucasian adults. PLoS ONE. 2017;12:e0175110.
Imboden MT, Swartz AM, Finch HW, Harber MP, Kaminsky LA. Reference standards for lean mass measures using GE dual energy x-ray absorptiometry in Caucasian adults. PLoS ONE. 2017;12:e0176161.
Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2015;21:389–401.e1.
Beaudart C, Zaaria M, Pasleau F, Reginster J-Y, Bruyère O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0169548.
Srikanthan P, Karlamangla AS. Relative muscle mass is inversely associated with insulin resistance and prediabetes. findings from The Third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2011;96:2898–903.
Okosun I, Seale J, Lyn R. Commingling effect of gynoid and android fat patterns on cardiometabolic dysregulation in normal weight American adults. Nutr Diabetes. 2015;5:e155.
Kyle U, Chalandon Y, Miralbell R, Karsegard V, Hans D, Trombetti A, et al. Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients. Bone Marrow Transplant. 2005;35:1171–7.
Glass CK, Olefsky JM. Cell metabolism perspective inflammation and lipid signaling in the etiology of insulin resistance. Cell Metab. 2012;15:635–45.
Tchernof A, Brochu D, Maltais-Payette I, Mansour MF, Marchand GB, Carreau AM, et al. Androgens and the regulation of adiposity and body fat distribution in humans. Compr Physiol. 2018;8:1253–90.
Nysom K, Mølgaard C, Hutchings B, Fleischer Michaelsen K. Body mass index of 0 to 45-y-old Danes: reference values and comparison with published European reference values. Int J Obes. 2001;25:177–84.
This study was financially supported by Rigshospitalet’s Research Funds (Denmark), The Danish Childhood Cancer Foundation, The Danish Cancer Society, The Dagmar Marshall’s Foundation (Denmark), The Hartmann Brothers’ Foundation (Denmark), The Danish Cancer Research Foundation, The Finnish Cancer Society, The Finnish Foundation of Paediatric Research, Helsinki University Research Foundation (Finland), The Swedish Childhood Cancer Foundation and The Swedish Research Council.
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Mejdahl Nielsen, M., Mathiesen, S., Suominen, A. et al. Altered body composition in male long-term survivors of paediatric allogeneic haematopoietic stem cell transplantation: impact of conditioning regimen, chronic graft-versus-host disease and hypogonadism. Bone Marrow Transplant (2020). https://doi.org/10.1038/s41409-020-01038-3