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Multicenter Study
. 2026 Feb;123(2):101180.
doi: 10.1016/j.ajcnut.2025.101180. Epub 2025 Dec 30.

Undernutrition or obesity: relationship with long-term survival in children with acute lymphoblastic leukemia in an upper-middle income country: a multicenter cohort study

Elva Jiménez-Hernández  1 , Janet Flores-Lujano  2 , Aurora Medina-Sansón  3 , Elisa María Dorantes-Acosta  3 , Laura Eugenia Espinoza-Hernández  4 , Raquel Amador-Sanchez  5 , José Gabriel Peñaloza-Gonzalez  6 , Betzayda Valdez-Garibay  7 , José Refugio Torres-Nava  8 , Rosa Martha Espinosa-Elizondo  9 , Luz Victoria Flores-Villegas  10 , María Luisa Pérez-Saldivar  2 , Karina Anastacia Solis-Labastida  11 , Haydee Rosas-Vargas  12 , Minerva Mata-Rocha  12 , Jorge Alfonso Martín-Trejo  11 , Silvia Jiménez-Morales  13 , Mariana García-Jiménez  13 , Marta Margarita Zapata-Tarrés  14 , José Arellano-Galindo  15 , Jorge Meléndez-Zajgla  16 , Fernanda Valeria Flores-Pérez  17 , Juan Carlos Núñez-Enríquez  18 , Juan Manuel Mejía-Aranguré  19
Affiliations
Multicenter Study

Undernutrition or obesity: relationship with long-term survival in children with acute lymphoblastic leukemia in an upper-middle income country: a multicenter cohort study

Elva Jiménez-Hernández et al. Am J Clin Nutr. 2026 Feb.

Abstract

Background: Long-term survival rates for children with acute lymphoblastic leukemia (ALL) have not improved in some countries, with undernutrition and obesity identified as potential contributing factors.

Objectives: To evaluate the relationship between undernutrition and obesity in long-term survival in Mexican children with ALL.

Methods: A cohort study included children <18 y, newly diagnosed with ALL between 2010 and 2013, treated at 8 public hospitals in Mexico City. Patients were followed from the diagnosis confirmation. Nutritional status at diagnosis was classified with body mass index (BMI) using the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) criteria. The primary outcome variables were relapse and death >5 y of follow-up. Hazard ratios (HR) with 95% confidence intervals (CI) were reported using a Cox proportional hazards model adjusting for sex, socioeconomic status, immunophenotype, NCI risk classification, and treatment protocol.

Results: A total of 1254 children were diagnosed with ALL. Information was complete for the WHO classification in 1072 patients (85.5%) and for the CDC classification in 997 patients (79.5%). Using WHO criteria, 7% of patients were undernourished, and 13% were overweight or obese; with CDC criteria, the corresponding prevalences were 14.8% and 27.1%. A higher risk of relapse was observed among patients with overweight and obesity (aHR = 1.43; 95% CI: 1.02, 2.00) using the WHO classification. Following the CDC classification, patients with obesity also showed an increased risk of relapse (aHR = 1.33; 95% CI: 0.94; 1.89). Additionally, a higher risk of death was noted among patients with overweight or obesity (aHR = 1.65; 95% CI: 1.25, 2.19) using WHO criteria, whereas under the CDC classification, the increased risk of death was observed in patients with obesity (aHR = 1.65; 95% CI: 1.24, 2.20). No significant associations were found between undernutrition and either relapse or death.

Conclusions: Undernutrition was not associated with long-term survival in pediatric patients with ALL. However, overweight and obesity at diagnosis were associated with relapse and increased mortality, highlighting the importance of addressing these factors through interventions focused on nutritional optimization, especially regarding obesity prevention and management, at or prior to diagnosis, to improve outcomes in Mexican children with ALL.

Keywords: BMI; Mexico; childhood cancer; childhood leukemia; latinos; mortality; obesity; overweight; survival; undernutrition.

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Conflict of interest statement

Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

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