Weight Gain in Pediatric Leukemia Survivors

Participant's weight Z score is a statistical value that indicates how the participant's weight for their age and sex compares to the average weight for that population which is obtained from Center for Disease Control (CDC) growth Charts

Participant's weight Z score is a statistical value that indicates how the participant's weight for their age and sex compares to the average weight for that population which is obtained from CDC growth Charts. Changes in weight Z score from start to end of the study will be analyzed by changes in summary statistics (mean, median, and standard deviation) across timepoints.

Participant's BMI Z score is a statistical value that indicates how the participant's BMI for their age and sex compares to the average BMI for that population which is obtained from CDC growth Charts

Participant's BMI Z score is a statistical value that indicates how the participant's BMI for their age and sex compares to the average BMI for that population which is obtained from CDC growth Charts. Changes in BMI Z score from start to end of the study will be analyzed by changes summary statistics (mean, median, and standard deviation) across timepoints.

Changes in cholesterol (total, LDL, and HDL levels) will be analyzed via summary statistics (means, medians, and standard deviation) at each of the endpoints.

Changes in HbA1c will be analyzed via summary statistics (means, medians, and standard deviation) at each of the endpoints.

Changes in albumin will be analyzed via summary statistics (means, medians, and standard deviation) at each of the endpoints.

The Freedson age-adjusted equation is used to estimate maximum heart rate based on age and then is used to classify activity intensity by the heart rate of the activity.

Activity levels will be assessed by participants' changes in scores across different timepoints on Physical Activity Questionnaire for Older Children (PAQ-C). The PAQ-C is a self-administered, 7 day recall questionnaire designed to assess physical activity of children by proving a summary score of moderate to vigorous physical activity (MVPA). The mean PAQ-C score is interpreted as follows: 1.0-1.9 low physical activity, 2.0-2.9 moderate-low activity, 3.0-3.9 moderate activity, and 4.0-5.0 high activity. A higher score indicates a higher activity level.

Activity levels will be assessed by participants' changes in scores across different timepoints on Physical Activity Questionnaire for Adolescents (PAQ-A). The PAQ-A is a self-administered, 7 day recall questionnaire designed to assess physical activity of adolescents by proving a summary score of moderate to vigorous physical activity (MVPA). The mean PAQ-A score is interpreted as follows: 1.0-1.9 low physical activity, 2.0-2.9 moderate-low activity, 3.0-3.9 moderate activity, and 4.0-5.0 high activity. A higher score indicates a higher activity level.

The health behaviors survey assesses average daily activity level, screen time, sweetened beverage consumption, and fruit and vegetables consumption to determine if patients are compliant with American Academy of Pediatrics Recommendation. 44% of childhood cancer survivors are active more than 60 minutes a day, 40% engage in less than 1 hour of screen time, 34% consume sweetened beverages and 4% consume more than one serving of fruits and vegetables.

Patient and caregiver feeding habits will be assessed by their responses to a 24 hour dietary recall through the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). ASA24 is a web-based, automated dietary recall tool that uses images and prompts. The ASA24 produces automated nutrient and food group data on participant's diet, a Respondent Nutrition Report (RNR). The RNR data will be used to generate a Healthy Eating Index score ranging from 0-100 with higher scores indicating closer alignment to the Dietary Guidelines for Americans. Between group differences between Arm A and Arm B will be compared via various statistical methods.

Changes in health behaviors will be assessed by caregivers' responses to the Child Feeding Questionnaire (CFQ and CFQ-teen) across different timepoints. The Child Feeding Questionnaire is a 31-item questionnaire using a 5-point Likert scale to assesses parents/caregivers' beliefs, attitudes, and practices surrounding feeding and their perceptions of their child's weight and eating behavior. The CFQ includes seven subscales. Subscales are scored from 1-5 with general guidelines for interpreting subscale scores as follows: 1.0-1.9 very low use of that feeding practice/low perception, 2.0-2.9 below average/mild expression, 3.0-3.9 moderate/typical parental level, and 4.0-5.0 high use or strong perception/belief.

Changes in answers to the Health Habits Survey will be assessed by caregivers and patients' responses to the survey at different timepoints. The Health Habits Survey is an assessment consisting of four questions evaluating health behaviors using 4-point Likert scales. These behaviors include daily activity level (not very often, <30 min a day, 30-60 min a day, and ≥ 60 min a day), screen time ( ≥2 hr a day, 1-2 hr a day, 30-60 min a day, and not very often), sweetened beverage consumption ( ≥3 a day, two a day, one a day, and not very often), and fruit and vegetable consumption (0-1, 1-2, 3-4, or >4 times a day.). The investigators will consider percentage of children whose health habits align with American Academy of Pediatric recommendations - 5 fruits and vegetables per day, 2 hours or less of screen time, 1 hour of physical activity, 0 sweetened beverages consumed.