ALL-227 Metabolic Dysfunction-Associated Steatotic Liver Disease in Children With Acute Lymphoblastic Leukemia

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; p. S264
• Main Authors: Ibrahim, Haya E., Makkeyah, Sara M., Ebeid, Fatma S.E., Farag, Kerolos B.A., Ismail, Eman A., Okba, Ahmed A., El-Sayed, Manal H.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2024
• Subjects: ALL; childhood acute lymphoblastic leukemia; metabolic dysfunction-associated steatotic liver disease; ALL; metabolic dysfunction-associated steatotic liver disease; childhood acute lymphoblastic leukemia
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01098-X

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a major health concern. Few studies examined the frequency of MASLD in childhood acute lymphoblastic leukemia (ALL).
To identify the frequency and associated characteristics of MASLD in children with ALL at various phases of treatment.
A cross-sectional phase included 60 children with ALL (20 newly diagnosed, 20 in continuation phase, and 20 early postcompletion of therapy). Newly diagnosed patients were followed up and reevaluated at the end of induction. All patients were treated according to the St Jude Total Therapy Study XV protocol. All patients were assessed using 24-hour dietary recall, body composition analysis, and laboratory investigations including liver function tests and lipid profile in addition to abdominal ultrasound.
The mean age of the patients was 8.9 years with a male-to-female ratio of 2:1. The frequency of MASLD increased from 7 (35%) patients at diagnosis to 56% at the end of induction, while 10% of patients during the continuation phase and 25% at postcompletion of therapy had MASLD. Among the groups, MASLD patients had higher median total daily caloric consumption (3272 vs 1834 kcal/d; P=.021), higher median fat intake (87 vs 49 g/d; P=.046), higher median carbohydrate intake (486 vs 274 g/d; P=.016), and higher median fructose-containing beverages (2 vs 0 per month; P=.041). Additionally, the MASLD group showed higher median triceps skin fold thickness z-score of 0.09 versus –0.51 in the non-MASLD group; P=.002. However, body composition parameters were comparable between both groups. In all treatment phases, MASLD+ and non-MASLD patients had comparable results of median serum ALT (P=.588) and AST levels (P=.612). The most important factors associated with MASLD+ were hepatomegaly (OR [95% CI], 16.559 [2.581-106.240]; P=.003), followed by fat intake >68.12 g/d (OR [95% CI], 12.759 [1.741-93.487]; P=.012], followed by abnormal LDL (OR [95% CI], 9.703 [1.395-67.470]; P=.022].
MASLD is relatively common in childhood ALL, especially in the post-induction phase, and is associated with higher caloric intake, especially of fat. These findings necessitate early implementation of nutritional programs during ALL treatment.