Pluimakers Vincent G, van Atteveld Jenneke E, de Winter Demi T C, Bolier Melissa, Fiocco Marta, Nievelstein Rutger Jan A J, Janssens Geert O R, Bresters Dorine, van der Heiden-van der Loo Margriet, de Vries Andrica C H, Louwerens Marloes, van der Pal Heleen J, Pluijm Saskia M F, Ronckers Cecile M, Versluijs Andrica B, Kremer Leontien C M, Loonen Jacqueline J, van Dulmen-den Broeder Eline, Tissing Wim J E, van Santen Hanneke M, van den Heuvel-Eibrink Marry M, Neggers Sebastian J C M M
Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands.
Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden 2333 ZA, The Netherlands.
Eur J Endocrinol. 2023 Nov 8;189(5):495-507. doi: 10.1093/ejendo/lvad139.
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.
The prevalence of overweight and obesity, primarily defined by body mass index (BMI), was assessed in the DCCSS-LATER cohort of adult survivors treated from 1963-2002, with the LifeLines cohort as reference. The 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.
A total of 2338 (mean age 35.5 years, follow-up 28.3 years) survivors participated. The 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 > 50 years, morbid obesity in men > 50 years. 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. Dual-energy X-ray absorptiometry-based classification identified overweight in an additional 30%, particularly after abdominal radiotherapy, total body irradiation, anthracyclines, and platinum.
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.
超重和肥胖是儿童癌症幸存者面临的常见挑战。超重可能被掩盖，因为幸存者的体重可能正常，但双能X线吸收测定法（DXA）显示其脂肪百分比（fat%）较高。我们旨在评估全国队列中超重的患病率，确定其决定因素和生物标志物，并评估哪种方法最能准确检测出超重。
在1963年至2002年接受治疗的成年幸存者DCCSS-LATER队列中，以生命线队列作为对照，评估主要由体重指数（BMI）定义的超重和肥胖的患病率。使用逻辑回归研究风险因素与超重指标之间的关联。其他超重指标包括DXA脂肪百分比、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）和高分子量（HMW）脂联素。
共有2338名幸存者参与（平均年龄35.5岁，随访28.3年）。男性超重患病率为46.3%，女性为44.3%（肥胖率分别为11.2%和15.9%，病态肥胖率分别为2.4%和5.4%），脑肿瘤幸存者中超重率最高。与对照组相比，总体超重率没有增加，但50岁以上女性的超重率较高，50岁以上男性的病态肥胖率较高。癌症诊断时超重（调整后的优势比[aOR]=3.83，95%可信区间2.19-6.69）、颅脑放疗（aOR=3.21，95%可信区间1.99-5.18）和生长激素缺乏（单独模型，aOR=1.61，95%可信区间1.00-2.59）与超重有关。使用BMI、WC、WHR和WHtR时，超重患病率相似。低HMW脂联素仅在4.5%的幸存者中出现，是一种不敏感的超重标志物。基于双能X线吸收测定法的分类额外识别出30%的超重者，尤其是在腹部放疗、全身照射、蒽环类药物和铂类治疗后。
近一半的长期幸存者存在超重问题。与对照组相比，超重的总体发病率没有增加。我们确定了与超重相关的因素，以及DXA能够更可靠地评估超重的幸存者亚组。
