The prevalence of overweight and obesity in pediatric survivors of cancer

  • Paul C. Nathan
    Correspondence
    Reprint requests: Paul C. Nathan MD, MSc, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Vesna Jovcevska
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Kirsten K. Ness
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Norma Mammone D’Agostino
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Patricia Staneland
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Stacey L. Urbach
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Mary Barron
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Maru Barrera
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Author Footnotes
    1 Dr. Mark Greenberg holds the Paediatric Oncology Group of Ontario Chair in Childhood Cancer Control at The University of Toronto.
    Mark L. Greenberg
    Footnotes
    1 Dr. Mark Greenberg holds the Paediatric Oncology Group of Ontario Chair in Childhood Cancer Control at The University of Toronto.
    Affiliations
    Divisions of Haematology/Oncology and Endocrinology, Department of Paediatrics, Department of Psychology, and Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Minnesota Cancer Center, Minneapolis, MN; and Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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  • Author Footnotes
    1 Dr. Mark Greenberg holds the Paediatric Oncology Group of Ontario Chair in Childhood Cancer Control at The University of Toronto.

      Objective

      To compare the prevalence of overweight in a cohort of pediatric survivors of cancer with that in the general population.

      Study design

      We reviewed the charts of 441 cancer survivors followed at a Canadian tertiary care pediatric hospital and calculated their most recent body mass index. We compared this cohort with population data generated from the Canadian Community Health Survey.

      Results

      At a median age of 14.7 years (range, 3.4 to 19.5 years) and a median time from diagnosis of 9.7 years (range, 3.4 to 19.2 years), 140 of 441 patients (31.7%) were overweight or obese. Only 12 of the 441 patients (2.7%) were underweight. Males age 6 to 11 years (odds ratio [OR] = 2.29; 95% confidence interval [CI] = 1.36 to 3.86; P < .001) and male survivors of acute lymphoblastic leukemia (OR = 1.55; 95% CI = 1.03 to 2.52; P = .04) were more likely to be overweight than the general population. No other age or diagnostic group had an increased risk of overweight.

      Conclusions

      The prevalence of overweight was not increased in this cohort compared with the general population. However, almost 1/3 of these patients are overweight, necessitating a clinical and research focus on preventing and combating overweight in childhood cancer survivors.

      Abbreviations:

      ALL ( Acute lymphoblastic leukemia), BMI ( Body mass index), CCHS ( Canadian Community Health Survey), CCSS ( Childhood Cancer Survivor Study), CDC ( Centers for Disease Control), CI ( Confidence interval), IOTF ( International Obesity Taskforce), OR ( Odds ratio)
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      References

        • Speiser P.W.
        • Rudolf M.C.
        • Anhalt H.
        • Camacho-Hubner C.
        • Chiarelli F.
        • Eliakim A.
        • et al.
        Childhood obesity.
        J Clin Endocrinol Metab. 2005; 90: 1871-1887
        • Visscher T.L.
        • Seidell J.C.
        The public health impact of obesity.
        Annu Rev Public Health. 2001; 22: 355-375
        • Must A.
        • Jacques P.
        • Dallal G.
        Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935.
        N Engl J Med. 1992; 327: 1350-1355
        • Maffeis C.
        • Tato L.
        Long-term effects of childhood obesity on morbidity and mortality.
        Horm Res. 2001; 55: 42-45
        • Grenier M.A.
        • Lipshultz S.E.
        Epidemiology of anthracycline cardiotoxicity in children and adults.
        Semin Oncol. 1998; 25: 72-85
        • Adams M.J.
        • Hardenbergh P.H.
        • Constine L.S.
        • Lipshultz S.E.
        Radiation-associated cardiovascular disease.
        Crit Rev Oncol Hematol. 2003; 45: 55-75
        • Mertens A.C.
        • Yasui Y.
        • Liu Y.
        • Stovall M.
        • Hutchinson R.
        • Ginsberg J.
        • et al.
        Pulmonary complications in survivors of childhood and adolescent cancer: a report from the Childhood Cancer Survivor Study.
        Cancer. 2002; 95: 2431-2441
        • Cohen L.E.
        Endocrine late effects of cancer treatment.
        Curr Opin Pediatr. 2003; 15: 3-9
        • Reilly J.J.
        • Ventham J.C.
        • Newell J.
        • Aitchison T.
        • Wallace W.H.
        • Gibson B.E.
        Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia.
        Int J Obes Relat Metab Disord. 2000; 24: 1537-1541
        • Sklar C.A.
        • Mertens A.C.
        • Walter A.
        • Mitchell D.
        • Nesbit M.E.
        • O’Leary M.
        • et al.
        Changes in body mass index and prevalence of overweight in survivors of childhood acute lymphoblastic leukemia: role of cranial irradiation.
        Med Pediatr Oncol. 2000; 35: 91-95
        • Oeffinger K.C.
        • Mertens A.C.
        • Sklar C.A.
        • Yasui Y.
        • Fears T.
        • Stovall M.
        • et al.
        Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.
        J Clin Oncol. 2003; 21: 1359-1365
        • Gurney J.G.
        • Ness K.K.
        • Stovall M.
        • Wolden S.
        • Punyko J.A.
        • Neglia J.P.
        • et al.
        Final height and body mass index among adult survivors of childhood brain cancer: childhood cancer survivor study.
        J Clin Endocrinol Metab. 2003; 88: 4731-4739
        • Lustig R.H.
        • Post S.R.
        • Srivannaboon K.
        • Rose S.R.
        • Danish R.K.
        • Burghen G.A.
        • et al.
        Risk factors for the development of obesity in children surviving brain tumors.
        J Clin Endocrinol Metab. 2003; 88: 611-616
        • Ross J.A.
        • Oeffinger K.C.
        • Davies S.M.
        • Mertens A.C.
        • Langer E.K.
        • Kiffmeyer W.R.
        • et al.
        Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.
        J Clin Oncol. 2004; 22: 3558-3562
        • Warner J.T.
        • Bell W.
        • Webb D.K.
        • Gregory J.W.
        Daily energy expenditure and physical activity in survivors of childhood malignancy.
        Pediatr Res. 1998; 43: 607-613
        • Bellizzi M.C.
        • Dietz W.H.
        Workshop on childhood obesity: summary of the discussion.
        Am J Clin Nutr. 1999; 70: 173S-175S
        • Cole T.J.
        • Bellizzi M.C.
        • Flegal K.M.
        • Dietz W.H.
        Establishing a standard definition for child overweight and obesity worldwide: international survey.
        BMJ. 2000; 320: 1240-1243
        • Aronne L.J.
        • Flegal K.M.
        • Graubard B.I.
        • Williamson D.F.
        • Gail M.H.
        Classification of obesity and assessment of obesity-related health risks.
        Obes Res. 2002; 10: 105S-115S
        • Kuczmarski R.
        • Ogden C.
        • Grummer-Strawn L.
        CDC growth charts, United States. Department of Health and Human Services, Hyattsville, MD2000
        • Flegal K.M.
        • Graubard B.I.
        • Williamson D.F.
        • Gail M.H.
        Excess deaths associated with underweight, overweight, and obesity.
        JAMA. 2005; 293: 1861-1867
        • Shields M.
        Nutrition: findings from the Canadian Community Health Survey, overweight Canadian children and adolescents. Statistics Canada, Ottawa2005
        • Hosmer D.W.
        • Lemeshow S.
        Fitting the Multiple Logistic Regression Model (Chapters 2, 3).
        in: Applied logistic regression. 2nd ed. Wiley, Hoboken, NJ2000: 33-39
        • National Cancer Policy Board
        Childhood cancer survivorship: improving care and quality of life. National Academies Press, Washington, DC2003
        • Oeffinger K.C.
        • Buchanan G.R.
        • Eshelman D.A.
        • Denke M.A.
        • Andrews T.C.
        • Germak J.A.
        • et al.
        Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia.
        J Pediatr Hematol Oncol. 2001; 23: 424-430
        • Jago R.
        • Baranowski T.
        • Baranowski J.C.
        • Thompson D.
        • Greaves K.A.
        BMI from 3-6 y of age is predicted by TV viewing and physical activity, not diet.
        Int J Obes (Lond). 2005; 29: 557-564
        • Eiser C.
        • Richard Eiser J.
        • Greco V.
        Parenting a child with cancer: promotion and prevention-focused parenting.
        Pediatr Rehabil. 2002; 5: 215-221
        • Van Dongen-Melman J.E.
        • Hokken-Koelega A.C.
        • Hahlen K.
        • De Groot A.
        • Tromp C.G.
        • Egeler R.M.
        Obesity after successful treatment of acute lymphoblastic leukemia in childhood.
        Pediatr Res. 1995; 38: 86-90
        • Mayer E.I.
        • Reuter M.
        • Dopfer R.E.
        • Ranke M.B.
        Energy expenditure, energy intake and prevalence of obesity after therapy for acute lymphoblastic leukemia during childhood.
        Horm Res. 2000; 53: 193-199
        • Reilly J.J.
        • Brougham M.
        • Montgomery C.
        • Richardson F.
        • Kelly A.
        • Gibson B.E.
        Effect of glucocorticoid therapy on energy intake in children treated for acute lymphoblastic leukemia.
        J Clin Endocrinol Metab. 2001; 86: 3742-3745
        • Reilly J.J.
        • Ventham J.C.
        • Ralston J.M.
        • Donaldson M.
        • Gibson B.
        Reduced energy expenditure in preobese children treated for acute lymphoblastic leukemia.
        Pediatr Res. 1998; 44: 557-562
        • Tillmann V.
        • Darlington A.S.
        • Eiser C.
        • Bishop N.J.
        • Davies H.A.
        Male sex and low physical activity are associated with reduced spine bone mineral density in survivors of childhood acute lymphoblastic leukemia.
        J Bone Miner Res. 2002; 17: 1073-1080
        • Zametkin A.J.
        • Zoon C.K.
        • Klein H.W.
        • Munson S.
        Psychiatric aspects of child and adolescent obesity: a review of the past 10 years.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 134-150
        • Lobstein T.
        • Baur L.
        • Uauy R.
        Obesity in children and young people: a crisis in public health.
        Obes Rev. 2004; 5: 4-104
        • Hill J.M.
        • Kornblith A.B.
        • Jones D.
        • Freeman A.
        • Holland J.F.
        • Glicksman A.S.
        • et al.
        A comparative study of the long-term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation.
        Cancer. 1998; 82: 208-218
        • Seitzman R.L.
        • Glover D.A.
        • Meadows A.T.
        • Mills J.L.
        • Nicholson H.S.
        • Robison L.L.
        • et al.
        Self-concept in adult survivors of childhood acute lymphoblastic leukemia: a cooperative Children’s Cancer Group and National Institutes of Health study.
        Pediatr Blood Cancer. 2004; 42: 230-240
        • Noll R.B.
        • Bukowski W.M.
        • Rogosch F.A.
        • LeRoy S.
        • Kulkarni R.
        Social interactions between children with cancer and their peers: teacher ratings.
        J Pediatr Psychol. 1990; 15: 43-56
        • Meacham L.R.
        • Gurney J.G.
        • Mertens A.C.
        • Ness K.K.
        • Sklar C.A.
        • Robison L.L.
        • et al.
        Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study.
        Cancer. 2005; 103: 1730-1739
        • Mauer A.M.
        • Burgess J.B.
        • Donaldson S.S.
        • Rickard K.A.
        • Stallings V.A.
        • van Eys J.
        • et al.
        Special nutritional needs of children with malignancies: a review.
        JPEN J Parenter Enteral Nutr. 1990; 14: 315-324
        • Rickard K.A.
        • Godshall B.J.
        • Loghmani E.S.
        • Coates T.D.
        • Grosfeld J.L.
        • Weetman R.M.
        • et al.
        Integration of nutrition support into oncologic treatment protocols for high and low nutritional risk children with Wilms’ tumor: a prospective randomized study.
        Cancer. 1989; 64: 491-509
        • Rickard K.A.
        • Grosfeld J.L.
        • Coates T.D.
        • Weetman R.
        • Baehner R.L.
        Advances in nutrition care of children with neoplastic diseases: a review of treatment, research, and application.
        J Am Diet Assoc. 1986; 86: 1666-1676
        • von Eyben F.E.
        • Mouritsen E.
        • Holm J.
        • Montvilas P.
        • Dimcevski G.
        • Suciu G.
        • et al.
        Intra-abdominal obesity and metabolic risk factors: a study of young adults.
        Int J Obes Relat Metab Disord. 2003; 27: 941-949
        • Field A.E.
        • Laird N.
        • Steinberg E.
        • Fallon E.
        • Semega-Janneh M.
        • Yanovski J.A.
        Which metric of relative weight best captures body fatness in children?.
        Obes Res. 2003; 11: 1345-1352
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Bautista L.
        • Franzosi M.G.
        • Commerford P.
        • et al.
        Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.
        Lancet. 2005; 366: 1640-1649