Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Cancer Med. 2023 Oct;12(20):20423-20436. doi: 10.1002/cam4.6588. Epub 2023 Oct 9.
After childhood acute lymphoblastic leukemia (ALL), sequelae include overweight and obesity, yet with conflicting evidence. We compared the prevalence of overweight and obesity between ≥5-year ALL survivors from the North American Childhood Cancer Survivor Study (CCSS) and the Swiss Childhood Cancer Survivor Study (SCCSS) and described risk factors.
We included adult childhood ALL survivors diagnosed between 1976 and 1999. We matched CCSS participants (3:1) to SCCSS participants by sex and attained age. We calculated body mass index (BMI) from self-reported height and weight for 1287 CCSS and 429 SCCSS participants; we then compared those with siblings (2034) in North America and Switzerland (678) siblings. We assessed risk factors for overweight (BMI 25-29.9 kg/m ) and obesity (≥30 kg/m ) using multinomial regression.
We found overweight and obesity significantly more common among survivors in North America when compared with survivors in Switzerland [overweight: 30%, 95% confidence interval (CI): 27-32 vs. 24%, 21-29; obesity: 29%, 27-32 vs. 7%, 5-10] and siblings (overweight: 30%, 27-32 vs. 25%, 22-29; obesity: 24%, 22-26 vs. 6%, 4-8). Survivors in North America [odds ratio (OR) = 1.24, 1.01-1.53] and Switzerland (1.27, 0.74-2.21) were slightly more often obese than siblings. Among survivors, risk factors for obesity included residency in North America (5.8, 3.7-9.0); male (1.7, 1.3-2.3); attained age (≥45 years: 5.1, 2.4-10.8); Non-Hispanic Black (3.4, 1.6-7.0); low household income (2.3, 1.4-3.5); young age at diagnosis (1.6, 1.1-2.2). Cranial radiotherapy ≥18 Gray was only a risk factor for overweight (1.4, 1.0-1.8); steroids were not associated with overweight or obesity. Interaction tests found no evidence of difference in risk factors between cohorts.
Although treatment-related risk for overweight and obesity were similar between regions, higher prevalence among survivors in North America identifies important sociodemographic drivers for informing health policy and targeted intervention trials.
儿童急性淋巴细胞白血病（ALL）后，后遗症包括超重和肥胖，但证据相互矛盾。我们比较了北美儿童癌症幸存者研究（CCSS）和瑞士儿童癌症幸存者研究（SCCSS）中≥5 岁 ALL 幸存者中超重和肥胖的患病率，并描述了相关风险因素。
我们纳入了 1976 年至 1999 年间诊断为儿童 ALL 的成年幸存者。我们通过性别和获得年龄将 CCSS 参与者（3：1）与 SCCSS 参与者相匹配。我们根据 1287 名 CCSS 和 429 名 SCCSS 参与者的自我报告身高和体重计算了体重指数（BMI）；然后，我们将这些数据与北美和瑞士的同胞（2034 名）（678 名）进行了比较。我们使用多变量回归评估了超重（BMI 25-29.9kg/m ）和肥胖（≥30kg/m ）的风险因素。
我们发现，与瑞士的幸存者相比，北美的幸存者中超重和肥胖更为常见[超重：30%，95%置信区间（CI）：27-32 与 24%，21-29；肥胖：29%，27-32 与 7%，5-10]，也更常见于同胞[超重：30%，27-32 与 25%，22-29；肥胖：24%，22-26 与 6%，4-8]。北美（比值比（OR）=1.24，1.01-1.53）和瑞士（1.27，0.74-2.21）的幸存者比同胞更容易肥胖。在幸存者中，肥胖的风险因素包括居住在北美（5.8，3.7-9.0）；男性（1.7，1.3-2.3）；获得年龄（≥45 岁：5.1，2.4-10.8）；非西班牙裔黑人（3.4，1.6-7.0）；低家庭收入（2.3，1.4-3.5）；诊断时年龄较小（1.6，1.1-2.2）。颅放疗≥18 格雷仅与超重相关（1.4，1.0-1.8）；类固醇与超重或肥胖无关。交互检验未发现队列间风险因素的差异。
尽管区域间与治疗相关的超重和肥胖风险相似，但北美的幸存者中更高的发病率表明，社会人口统计学驱动因素对于制定卫生政策和有针对性的干预试验非常重要。
