Leptin Increase During Dexamethasone and Its Association With Hunger and Fat in Pediatric Acute Lymphoblastic Leukemia.
Level 3 - non-randomized controlled study
Prospective pre-post observational cohort study without an untreated control group.
PubMed 37878899 · doi:10.1210/clinem/dgad621
What was done
A prospective pre-post study evaluated 105 pediatric acute lymphoblastic leukemia (ALL) patients (median age 5.4 years, range 3.0–18.8) during maintenance therapy. Measurements were collected before (T1) and after (T2) a 5-day course of dexamethasone (6 mg/m²/day). Evaluated outcomes included BMI, fat mass measured by bioelectrical impedance analysis, serum leptin, and parent-reported questionnaires assessing hunger, fatigue, and sleep problems. Paired tests assessed changes (Delta: T2-T1), and regression models examined covariates of elevated leptin.
What was found
Leptin levels, fat mass, hunger scores, fatigue, and sleep disturbances significantly worsened after 5 days of dexamethasone (P < .001 for all), while BMI did not change significantly (P = .12). The abstract did not report absolute numerical baseline or post-treatment values for these measures. Delta leptin did not correlate with changes in fat mass, BMI, hunger, fatigue, or sleep. Elevated leptin at T1 was associated with older age (OR 1.51; 95% CI, 1.28–1.77), higher fat mass (OR 1.19; 95% CI, 1.07–1.33), and earlier maintenance week (OR 0.96; 95% CI, 0.92–0.99).
Why it matters
High-dose dexamethasone pulses in pediatric ALL cause rapid metabolic changes, and the simultaneous rise in both leptin and hunger points toward acute dexamethasone-induced leptin resistance. Understanding this mechanism may help identify strategies to mitigate severe glucocorticoid-related metabolic side effects.
Limits
The study lacked an unexposed control group. Behavioral outcomes (hunger, fatigue, sleep) relied entirely on parent-reported questionnaires rather than objective measurements (such as actigraphy or caloric intake logs), and absolute values for pre- and post-treatment measurements were not provided in the abstract.
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