Prevalence and risk factors of metabolic syndrome in survivors of childhood acute leukemia: a systematic review and meta-analysis

Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease and has also been associated with malignancies including leukemia. This systematic review and meta-analysis aimed to assess the prevalence of metabolic syndrome (MetS) and its core components, as well as identify associated risk factors among survivors of childhood acute leukemia (AL) in order to improve their life quality for the long run. We searched PubMed, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang, VIP and CBM databases from inception to October 2024. After screening, the literature quality was assessed, and data were extracted for systematic review and meta-analysis using R software. By October 2024, 19 studies including 3,313 childhood AL survivors were analyzed. The prevalence of MetS among these survivors ranged from 0 to 57.9%, with a pooled estimate of 13% (95% CI: 10–18%). The pooled prevalence of the core components of MetS was as follows: central obesity, 18% (95% CI: 12–29%); high triglycerides (TGs), 15% (95% CI: 4–32%); low high-density lipoprotein cholesterol (HDL-C), 3% (95% CI: 0–9%); hypertension, 19% (95% CI: 13–27%); and high fasting blood glucose (FBG), 23% (95% CI: 10–39%). Five studies evaluated cranial radiation therapy (CRT) as a risk factor for MetS, with three case–control studies showed a borderline non-significant association (OR: 1.79, 95% CI: 1.00–3.20, P = 0.050), while cohort studies identified it as a significant risk factor (RR: 1.72, 95% CI: 1.22–2.41, P = 0.002). Overweight/obesity was consistently reported as a significant risk factor for MetS in multivariate analysis from two studies, while gender and age at diagnosis showed no significant associations. Childhood AL survivors face a substantially elevated burden of MetS. Regular monitoring for MetS is crucial, particularly for survivors who once received CRT or are overweight/obese at follow-up.