Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy.
Nutrition. 2023 Sep;113:112129. doi: 10.1016/j.nut.2023.112129. Epub 2023 Jun 14.
Survival after childhood cancer has significantly improved in recent decades. Nevertheless, an increased incidence of metabolic syndrome and cardiovascular disease among childhood cancer survivors (CCS) has been reported. The aim of this study was to evaluate whether fat-to-lean mass ratio (FLR) is associated with a dysmetabolic profile in CCS.
At least 2 years from completion of therapy, data from CCS aged 10 to 16 years at follow-up and without any concurrent steroid treatment were collected. Body mass index, waist circumference (WC), WC-to-height ratio, laboratory blood tests, and FLR calculated by dual-energy X-ray absorptiometry measurements were considered. Body mass index >85 percentile and >97 percentile, WC >90 percentile, and WC-to-height ratio > 0.5 were chosen as criteria of overweight and obesity, visceral obesity, and increased cardiovascular risk, respectively.
We enrolled 205 CCS previously treated for hematologic cancer or solid or central nervous system tumor. The best cutoff of FLR was 0.6. CCS; those with FLR ≥0.6 (43%) were more frequently overweight and obese (P < 0.001), and presented with higher levels of triglycerides (P = 0.011), homeostatic model assessment for insulin resistance (P = 0.001), alanine transaminase (P = 0.004), and trunk fat (P < 0.001) and lower levels of insulin-like growth factor 1 (P < 0.001) and lean mass (P = 0.009). WC >90 percentile (P = 0.007), insulin-like growth factor 1 (P = 0.002), and trunk fat (P = 0.006) were independent predictors of FLR ≥0.6 in a model including all the previous variables.
An increased FLR is suggestive of altered body composition phenotype, allowing identification of CCS at higher risk of metabolic syndrome. Diet and physical activity are needed from commencement of oncological treatments to preserve overall nutritional status and maintain it over the long term.
近年来，儿童癌症患者的生存率有了显著提高。然而，有报道称儿童癌症幸存者（CCS）中代谢综合征和心血管疾病的发病率有所增加。本研究旨在评估脂肪与瘦肉质量比（FLR）是否与 CCS 的代谢异常谱有关。
至少在完成治疗后 2 年，收集了随访时年龄在 10 至 16 岁且无任何同时进行的类固醇治疗的 CCS 的数据。考虑了体重指数、腰围（WC）、WC 与身高比、实验室血液检查和通过双能 X 射线吸收法测量得出的 FLR。体重指数>第 85 百分位数和>第 97 百分位数、WC>第 90 百分位数和 WC 与身高比>0.5 分别被选为超重和肥胖、内脏肥胖和心血管风险增加的标准。
我们共纳入了 205 例先前接受血液系统癌症或实体瘤或中枢神经系统肿瘤治疗的 CCS。FLR 的最佳截断值为 0.6。CCS;那些 FLR≥0.6（43%）的人更常超重和肥胖（P<0.001），且甘油三酯（P=0.011）、稳态模型评估的胰岛素抵抗（P=0.001）、丙氨酸氨基转移酶（P=0.004）和躯干脂肪（P<0.001）水平更高，而胰岛素样生长因子 1（P<0.001）和瘦体重（P=0.009）水平更低。WC>第 90 百分位数（P=0.007）、胰岛素样生长因子 1（P=0.002）和躯干脂肪（P=0.006）是包含所有上述变量的模型中 FLR≥0.6 的独立预测因素。
FLR 的增加表明身体成分表型发生改变，可识别出代谢综合征风险较高的 CCS。从开始进行肿瘤治疗时就需要饮食和体育活动，以保持整体营养状况并长期维持。
