Prevalence, risk factors, and optimal way to determine overweight, obesity, and morbid obesity in the first Dutch cohort of 2338 long-term survivors of childhood cancer: a DCCSS-LATER study

Abstract

BACKGROUND Overweight and obesity are common challenges among childhood cancer survivors. Overweight may be disguised, as survivors can have normal weight but high fat percentage (fat%) on dual-energy X-ray absorptiometry (DXA). We aimed to assess prevalence, identify determinants and biomarkers and assess which method captures overweight best, in a nationwide cohort. METHODS Prevalence of overweight and obesity, primarily defined by body mass index, was assessed in the DCCSS-LATER cohort of adult survivors treated 1963-2002, with the LifeLines cohort as reference. Associations between risk factors and overweight metrics were investigated using logistic regression. Additional overweight metrics included DXA-fat%, waist circumference (WC), waist/hip-ratio (WHR), waist/height-ratio (WHtR), and high-molecular-weight-(HMW)-adiponectin. RESULTS 2,338 (mean age 35.5y, follow-up 28.3y) survivors participated. Overweight prevalence was 46.3% in men and 44.3% in women (obesity 11.2% and 15.9%, morbid obesity 2.4% and 5.4%), with highest rates among brain tumor survivors. Compared to controls, there was no overall increased overweight rate, but this was higher in women >50y, morbid obesity in men >50y. Overweight at cancer diagnosis (adjusted odds ratio (aOR) = 3.83, 95%CI = 2.19-6.69), cranial radiotherapy (aOR = 3.21, 95%CI = 1.99-5.18) and growth hormone deficiency (separate model, aOR = 1.61, 95%CI = 1.00-2.59) were associated with overweight. Using BMI, WC, WHR and WHtR, overweight prevalence was similar. Low HMW-adiponectin, present in only 4.5% of survivors, was an insensitive overweight marker. DXA-based classification identified overweight in an additional 30%, particularly after abdominal radiotherapy, total body irradiation, anthracyclines and platinum. CONCLUSIONS Overweight occurs in almost half of long-term survivors. There was no overall increased incidence of overweight compared to controls. We identified factors associated with overweight, as well as subgroups of survivors in whom DXA can more reliably assess overweight.

Modifiable Cardiometabolic Risk Factors in Survivors of Childhood Cancer

“… 10 The prevalence of clinically ascertained obesity among survivors of childhood cancer in their 30s ranges from 13.5% in a Dutch cohort compared to 15.1% in the general Dutch population to 36% in a North American cohort compared to 31.6% in the age-, sex-, and race-matched general U.S. population. 11 , 12 Importantly, BMI does not account for the imbalance between lean and fat mass distribution, and a number of studies have highlighted treatment-related changes in body composition among survivors. They observed that 42% to 46% of male and >50% of female survivors were misclassified as nonobese based on BMI compared to body fat percentage (obesity defined as body fat percentage ≥25% for males and ≥30% for females) by dual X-ray absorptiometry (DXA) measurements.…”