Body mass index and annual increase of body mass index in long-term childhood cancer survivors; relationship to treatment

Abstract

PurposeEvaluation of body mass index (BMI) at final height (FH) and annual BMI increase in adult childhood cancer survivors (CCS) after treatment with anthracyclines, platinum, and/or radiotherapy.MethodsBMI (weight/height²) was calculated retrospectively from diagnosis until FH. The prevalence of underweight (BMI < 18.5 kg/m2) and overweight (BMI ≥ 25 kg/m2)/obesity (BMI ≥ 30 kg/m2) at FH was compared with age-matched controls. The association between underweight/overweight at FH and treatment was assessed by multivariate logistic regression. Annual BMI increase after treatment was assessed by multilevel analysis. Analyses were adjusted for age and underweight/overweight at diagnosis, and age at FH.ResultsAt FH the prevalence of overweight had not increased, while CCS experienced more underweight as compared to controls (14% vs. 4%, P < 0.001). Overweight at FH was associated with cranial/craniospinal radiotherapy (CRT; OR, 2.23; 95% CI, 1.17–4.26) and underweight at FH with anthracyclines > 300 mg/m2 (OR, 2.84; 95% CI, 1.33–6.06). Annual BMI increase was +0.47 (0.34–0.60) kg/m2/year. In CCS, the annual BMI increase was greater in those with CRT ≥ 30 Gy as compared with those with less or no CRT (+0.15 kg/m2/year [0.04–0.25 kg/m2/year], P = 0.008) and smaller in those with a higher cumulative anthracycline dose (−0.03 kg/m2/year [−0.05 to −0.0005 kg/m2/year] per 100 mg/m2, P = 0.046).ConclusionsAfter treatment with anthracyclines, platinum, and/or radiotherapy, CRT-treated survivors have more overweight at FH, and a greater annual BMI increase, while anthracycline-treated survivors have more underweight at FH and a lower annual BMI increase.

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

“…Seventeen studies ( n = 2032 participants) reported prevalence of overweight and obesity among patients with various types of brain tumours ; The study characteristics and results are described in Table . The age at diagnosis ranged from at birth to 24.8 year old.…”

“…The evidence of excess overweight and obesity in SCBT compared to non‐cancer controls has been inconsistent, with some studies reporting an increase , while others finding no significant differences . The small sample size of some studies and the inclusion of different comparison groups including the general population or siblings may have contributed to these conclusions.…”

Treatment, Behavioral, and Psychosocial Components of Cardiovascular Disease Risk Among Survivors of Childhood and Young Adult Cancer

“…This association was not seen among those treated with anthracyclines or platinum. 35 Similarly, in separate studies of survivors of childhood brain tumors and childhood ALL, cranial irradiation was associated with greater risks of overweight/obesity. 36–37 Finally, Oeffinger et al found significantly increased body mass index among young adult survivors of childhood ALL treated with cranial irradiation compared to those treated with chemotherapy alone ( P =0.039).…”

Cranial Irradiation Induces Hypothalamic Injury and Late-Onset Metabolic Disturbances in Juvenile Female Rats

“…Recent clinical studies have shown that cranial radiotherapy results in metabolic sequelae, including overweight/obesity, insulin resistance, hyperlipidemia, and leptin resistance [11, 14, 17]. The incidence of obesity in childhood tumor patients who have received cranial irradiation is 40% [14].…”

“…The incidence of obesity in childhood tumor patients who have received cranial irradiation is 40% [14]. These sequelae are associated with long-term health problems, including hypertension, type 2 diabetes, depression, and cancer [17-19]. There are also sex-specific deleterious effects of cranial irradiation on metabolic function, and female tumor survivors treated with cranial irradiation have a significantly greater increase in metabolic index than male tumor survivors [14, 20-23].…”