Characteristics and determinants of adiposity in pediatric cancer survivors

Abstract

Background: Adiposity and the diseases associated with it, including cardiovascular disease, are emerging long-term complications of pediatric cancer survivors. Direct evaluations of adiposity and comparisons to contemporary controls that can differentiate recent trends in obesity from cancer-related treatments and sequelae are limited.

Methods: We evaluated demographic, treatment, lifestyle, and endocrine factors at the time of dual-energy X-ray absorptiometry testing in 170 non-Hispanic white survivors and 71 sibling controls, and compared three measures of adiposity [body mass index (BMI), total body fat, and trunk fat]. For the survivors alone, we determined factors independently associated with BMI and body fat.

Results: Survivors were at 12 years since diagnosis; 58% had leukemia or lymphoma. BMI did not differ between groups. Among males, body fat was greater in survivors than in controls (25.8% versus 20.7%; P = 0.007), as was trunk fat (26.7% versus 21.3%; P = 0.008). Total or trunk fat did not differ among females. Cholesterol, triglycerides, low-density lipoprotein cholesterol, and television viewing hours were higher among male survivors than in controls. Independent factors associated with higher BMI and total and trunk fat included any cranial radiation and television viewing hours, whereas prior treatment with cyclophosphamide was associated with lower BMI and body fat measures.

Conclusions: Compared with siblings, male survivors have greater body fat and metabolic risks. Cranial irradiation and television hours are important risk factors for adiposity in pediatric cancer survivors.

Impact: Pediatric cancer survivors should be carefully monitored for cardiovascular risk factors and sedentary lifestyles.

Figure 1

Comparisons of lipid profiles between female cancer survivors and sibling controls (Figure 1a) and male cancer survivors and sibling controls (Figure 1b). No significant differences were found among females. Male cancer survivors had significantly elevated levels of total and LDL-cholesterol and triglycerides.

Figure 2

Comparisons of adiposity measures (BMI, total body fat and trunk fat) by increasing dosages of cranial irradiation in female cancer survivors (Figure 2a) and male cancer survivors (Figure 2b). Increasing dosages of cranial irradiation did not significantly affect BMI, whereas there were increased levels of total body and trunk fat with cranial irradiation in both females and males.