Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
J Clin Oncol. 2022 Jul 10;40(20):2213-2223. doi: 10.1200/JCO.21.02973. Epub 2022 Mar 25.
Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.
Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.
Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.
Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.
乳腺癌诊断后体重的不利变化会增加死亡率，但在黑人女性中，影响诊断后体重和体脂变化的个体和社区危险因素尚不清楚，她们的肥胖率和死亡率高于任何其他种族/族裔群体。
在新泽西州的 Women's Circle of Health Follow-Up Study 中，对 785 名于 2012 年至 2018 年间确诊并登记为黑人选区乳腺癌幸存者的人群进行了前瞻性队列研究，评估了诊断后约 10 个月至 24 个月期间的肥胖变化。使用多变量多项逻辑回归和多层次模型来估计体重和脂肪量变化的多层次因素（体重增加或减少的定义为相对差异 3%或更多，并考虑变化是否是有意还是无意的）。
尽管超重或肥胖的基线患病率较高（86%），但仍普遍存在肥胖症：28%和 47%的患者分别体重和体脂增加。脂肪量增加的危险因素包括接受化疗（相对风险比：1.59，95%置信区间，1.08 至 2.33）和居住在快餐店密度较高的社区（与最低三分位相比，最高三分位的相对风险比：2.18，95%置信区间，1.38 至 3.46）；体重增加的结果相似。只有 9%的女性有意减轻体重，多层次的风险因素与无意减重有很大不同。
个体和社区因素均与黑人乳腺癌幸存者的肥胖变化有关。居住环境特征可以为识别有不利体重变化风险较高的癌症幸存者提供有临床意义的信息，并解决诊断后体重管理的障碍。
