Lifestyle and metabolic syndrome in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study

Abstract

Background Childhood cancer survivors (CCS) are at increased risk for the metabolic syndrome (MetSyn), which may be reduced with lifestyle modifications. The purpose of this investigation was to characterize lifestyle habits and associations with the MetSyn among CCS. Methods CCS ≥10 years from diagnosis, older than 18 years of age, and participating in the St. Jude Lifetime Cohort Study completed medical and laboratory tests and a food frequency questionnaire (FFQ). The Third National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) criteria were used to classify participants with MetSyn. Anthropometric, FFQ and self-reported physical activity data were used to characterize lifestyle habits according to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. Those who met ≥4 of 7 recommendations were classified as following guidelines. Sex stratified log-binomial regression models were used to evaluate associations between dietary/lifestyle habits and MetSyn, adjusted for age, age at cancer diagnosis, cranial radiation, education, and household income. Results Among 1598 CCS (49.2% male, median age 32.7 years, range, 18.9–60.0 years), 31.8% met criteria for MetSyn and 27.0 % followed WCRF/AICR guidelines. Females who did not follow WCRF/AICR guidelines were 2.4 (95% CI 1.7–3.3) and males were 2.2 (95% CI 1.6–3.0) times more likely to have MetSyn than those who followed WCRF/AICR guidelines. Conclusion Adherance to a heart healthy lifestyle is associated with lower risk of MetSyn among CCS. There is a need to determine if lifestyle interventions prevent or remediate MetSyn in CCS.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

“…The mean HEI-2010 score identified in this large cohort of childhood cancer survivors is consistent with findings from previous studies in smaller cohorts of survivors that reported diet quality scores ranging from 33% to 56% of the maximum score (5)(6)(7)(8)24). Although dietary assessment methods or indexes to measure diet quality varied between studies, the collective evidence consistently points to poor diet quality in childhood cancer survivors.…”

“…Although the few existing studies provide some evidence that suggests poor adherence to current dietary guidelines (5)(6)(7)(8), this evidence is primarily based on small cohorts of survivors or focused on specific cancer groups, such as pediatric acute lymphoblastic leukemia. We lack a comprehensive evaluation of survivorsÕ intakes of key nutrients and food groups, which is essential for developing targeted nutritional interventions to address the specific nutritional needs in this high-risk population.…”

Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: an L.E.A. study

“…Indeed, adherence to these public health policies are known to be inversely associated with MetS among survivors of childhood cancer. 46 Several other therapeutic interventions can be considered, of which some have already been reported in the literature. A meta-analysis study has examined the effect of physical exercise programs for children with cancer.…”

Energy balance and fitness in adult survivors of childhood acute lymphoblastic leukemia

“…By the age of 50 years, it is estimated that over 40% of ALL survivors will have at least 1 severe, disabling, or life-threatening chronic condition. 3 Risk for adverse energy balance, including obesity, 4 poor fitness, 5 suboptimal dietary intake, 6,7 and physical inactivity, 3 are increased in ALL survivors when compared with peers. This is likely both the result of and a contributor to poor health status.…”