The epidemiology of childhood leukemia with a focus on birth weight and diet

Richard L. Tower, Logan G. Spector

Research output: Contribution to journalReview articlepeer-review

65 Scopus citations


Leukemia is the most common childhood cancer and a major source of morbidity and mortality. The etiology of childhood leukemia remains largely unknown. Cytogenetic abnormalities determine disease subtypes, prognosis, clinical presentation, and course and may help in discovering etiological factors. Epidemiologic investigations of leukemia are complicated by many factors, including the rarity of the disease, necessitating careful study design. Two emerging areas of interest in leukemia etiology are birth weight and diet. High birth weight has been associated with increased risk of childhood leukemia. The biological mechanism behind this association may involve insulin-like growth factor I (IGF-I), which is associated with high birth weight. IGF-I may act by increasing the absolute number of stem cells available for transformation, stimulating the growth of cells that are already transformed, or a combination of effects. Diet has been linked with leukemia. Maternal dietary DNA topoisomerase II (DNAt2) inhibitor intake is associated with infant acute myeloid leukemia (AML) with the MLL gene translocation. Increased intake of fruits and vegetables has been associated with decreased leukemia risk and, relatedly, lack of maternal folate supplementation has been associated with increased childhood leukemia risk, possibly by causing DNA hypomethylation and increased DNA strand breaks. Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms modify this risk.

Original languageEnglish (US)
Pages (from-to)203-242
Number of pages40
JournalCritical Reviews in Clinical Laboratory Sciences
Issue number3
StatePublished - May 2007

Bibliographical note

Funding Information:
Costa Rica Finland Canada Hong Kong Sweden Australia, New South Wales Germany Norway USA, SEER∗ (whites) Italy Hungary United Kingdom, England and Wales Czechoslovakia, Slovakia Cuba Kuwait (Kuwaiti) Japan Brazil, Goiania New Zealand (Maori) USA, SEER∗ (blacks) Brazil, Belem Israel (Jews) China, Tianjin India, Bombay Cancer Registry

Funding Information:
New Zealand (Maori) Costa Rica Australia, New South Wales Norway Italy Japan China, Tianjin Germany Sweden Canada United Kingdom, England and Wales USA, SEER∗ (blacks) USA, SEER∗ (whites) Cuba Hungary Finland Brazil, Goiania Israel (Jews) Czechoslovakia, Slovakia India, Bombay Cancer Registry Hong Kong Brazil, Belem Kuwait (Kuwaiti)


  • Acute lymphoblastic leukemia
  • Acute myeloid leukemia
  • Cancer
  • Cytogenetics
  • DNA topoisomerase type II
  • Flavonoids
  • Folate
  • Fruits
  • Incidence
  • Insulin-like growth factors
  • Methods
  • Methylenetetrahydrofolate reductase
  • Pediatrics
  • Prognosis
  • Vegetables


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