Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Visceral fat deposition among survivors of pediatric acute lymphoblastic leukemia (146479)

Carmen L Wilson 1 , Sue Kaste 2 , Shalini Bhatia 3 , Diane Storment 2 , Matthew Scoggins 4 , Kunanya Suwannaying 5 , Sedigheh Mirzaei 3 , Ching-Hon Pui 6 , Melissa M Hudson 6 7 , Kirsten K Ness 7 , Hiroto Inaba 6
  1. Australian Research Centre for Cancer Survivorship, Randwick, NSW, Australia
  2. Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
  3. Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
  4. Psychology and Behavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
  5. Hematology-Oncology, Khon Kaen University, Khon Kaen, Thailand
  6. Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
  7. Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA

Background: Obesity is common among pediatric acute lymphoblastic leukemia survivors (ALL); however, the distribution of adipose deposition, particularly visceral adipose tissue (VAT), remains poorly characterized. This study aimed to identify risk factors associated with increased VAT, evaluate associations between baseline VAT with incident cardiometabolic conditions, and examine correlations between VAT and standard obesity metrics.

Methods: Participants included 1,110 survivors of pediatric ALL (median age [range]= 34.1 [18.0-66.6] years) enrolled in the St. Jude Lifetime Cohort. Areal VAT (cm2) was quantified from computed tomography scans at the level of the second lumbar vertebrae (GE CT scanners, QCT Pro BIT, Mindways). Multivariate linear regression models were used to evaluate associations between host- and treatment-factors with VAT. Logistic regression models were used to assess associations between baseline VAT with incident hypertension, diabetes, insulin resistance (IR), high LDL-cholesterol and triglycerides, and low HDL-cholesterol.

Results: Older age (>40 vs. 18-29 years, mean change [±SD] males, 68.8 [±10.5] cm2, p<0.001; females, 40.3 [±8.8] cm2, p<0.001) and exposure to cranial irradiation (males, 40.1 [±8.2] cm2, p<0.001; females, 49.9 [±7.4] cm2, p<0.001) were associated with greater VAT, whereas being physically active (males, -21.7 [±6.5] cm2, p<0.001; females, -23.7 [±5.7] cm2, p<0.001) was associated with lower VAT. VAT was associated with an increased likelihood of  IR (OR=1.22, 95%CI=1.14-1.30), hypertriglyceridemia (OR=1.08, 95%CI=1.01-1.15), diabetes (OR=1.14, 95%CI=1.08-1.21) and hypertension (OR=1.07, 95%CI=1.00-1.13) among females, and with an increased likelihood of IR among males (OR=1.15, 95%CI=1.09-1.21). VAT was strongly correlated with waist-to-height-ratio (males r=0.76, p<0.001, females r=0.84, p<0.001) and moderately correlated with body mass index (males r=0.61, p<0.001, females r=0.72, p<0.001) and percent body fat (males 0.64, p<0.001, females, 0.66 p<0.001).

Conclusion: Increased VAT is associated with higher risk of cardiometabolic complications among pediatric ALL survivors. Findings support the need for interventions targeting visceral adiposity to reduce long-term cardiometabolic risk in this population.