Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

Abstract

Background: An increased risk of becoming overweight has been reported for childhood cancer survivors (CCSs), in particular leukemia survivors, although the evidence is inconclusive. Objective: We assessed the prevalence of overweight in CCSs, with a focus on leukemia survivors, compared it with their peers, and determined potential risk factors. Design: As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire between 2007 and 2013 to all Swiss resident CCSs aged <21 y at diagnosis who had survived ≥5 y. We calculated body mass index (BMI) from medical records at diagnosis and self-reported heights and weights at survey. We calculated BMI z scores by using Swiss references for children and compared overweight prevalence in CCSs, their siblings, and the general population with the use of the Swiss Health Survey (SHS) and assessed risk factors for being overweight by using multivariable logistic regression. Results: The study included 2365 CCSs, 819 siblings, and 9591 SHS participants. At survey, at an average of 15 y after diagnosis, the prevalence of overweight in CCSs overall (26%) and in leukemia survivors (26%) was similar to that in siblings (22%) and the general population (25%). Risk factors for being overweight in CCSs were male sex (OR: 1.8; 95% CI: 1.5, 2.1), both young (OR for ages 5-14 y: 1.6; 95% CI: 1.2, 2.3) and older (range-OR for ages 25-29 y: 1.7; 95% CI: 1.2, 2.4; OR for ages 40-45 y: 4.0; 95% CI: 2.5, 6.5) age at study, lower education (OR: 1.4; 95% CI: 1.1, 1.8), migration background (OR: 1.3; 95% CI: 1.1, 1.7), and no sports participation (OR: 1.4; 95% CI: 1.1, 1.7). Risk factors for overweight were similar in peers. CCSs treated with cranial radiotherapy (≥20 Gy) were more likely to be overweight than their peers (OR: 1.6; 95% CI: 1.2, 2.2). Conclusions:The prevalence of and risk factors for being overweight are similar in long-term CCSs and their peers. This suggests that prevention methods can be the same as in the general population. An important exception is CCSs treated with cranial radiotherapy ≥20 Gy who may need extra attention during follow-up care. This study was registered at clinicaltrials.gov as NCT03297034. Am J Clin Nutr 2018;107:3-11.

No evidence of overweight in long‐term survivors of childhood cancer after glucocorticoid treatment

“…2). 26 First, we assessed whether overweight at the time of the survey was associated with the cumulative glucocorticoid dose received during treatment. 32 For a better comparison between CCS and their peers, we standardized comparison groups for sex, age at the time of the survey, migration background, and language region as described previously.…”

“…32 For a better comparison between CCS and their peers, we standardized comparison groups for sex, age at the time of the survey, migration background, and language region as described previously. 26 First, we assessed whether overweight at the time of the survey was associated with the cumulative glucocorticoid dose received during treatment. We determined these associations using multivariable logistic regression within all CCS, and within patients with the 3 cancer types frequently treated with glucocorticoids.…”

“…A second questionnaire was sent to nonresponders 4 to 6 weeks later. 19,26 Comparison groups Our questionnaire included core questions from the US and UK CCS studies, 22,23 with added questions regarding health behaviors and sociodemographic measures from the Swiss Health Survey (SHS) 24 and the Swiss Census.…”

“…The few protocols (3%) that prescribed glucocorticoids by body weight (in mg/kg) were converted into dose per body surface area (mg/m 2 ) by multiplying the dose in mg/kg by a conversion factor of 30, which represents an average of the factors for individuals weighing 20 and 60 kg. 26 1 Treatment protocols that were included came from the Swiss Pediatric Oncology Group (31%), the Pediatric Oncology Group (29%), the Berlin-Frankfurt-Muenster Study Group (24%), the German Society of Pediatric Oncology and Hematology (7%), and others (9%) (see Supporting Table 1).…”

Dietary intake and diet quality of Swiss adult survivors of childhood cancer compared to the general population

“…For better comparison between CCSs and peers, we standardized comparison groups for sex, age at survey, and language region when applicable as previously described (40)(41)(42). The first step in our analyses was to evaluate whether CCS and their peers met the dietary recommendations for Germany (D), Austria (A), and Switzerland (CH) (DACH) (43).…”