Abstract
Childhood brain tumor survivors (CBTS) are at risk for developing obesity, which negatively influences cardiometabolic health. The prevalence of obesity in CBTS may have been overestimated in previous cohorts because of inclusion of children with craniopharyngioma. On the contrary, the degree of weight gain may have been underestimated because of exclusion of CBTS who experienced weight gain, but were neither overweight nor obese. Weight gain may be an indicator of underlying hypothalamic-pituitary (HP) dysfunction. We aimed to study prevalence of and risk factors for significant weight gain, overweight, or obesity, and its association with HP dysfunction in a national cohort of noncraniopharyngioma and nonpituitary CBTS. Prevalence of and risk factors for significant weight gain (body mass index [BMI] change ≥ +2.0 standard deviation score [SDS]), overweight, or obesity at follow-up, and its association with HP dysfunction were studied in a nationwide cohort of CBTS, diagnosed in a 10-year period (2002-2012), excluding all craniopharyngioma and pituitary tumors. Of 661 CBTS, with a median age at follow-up of 7.3 years, 33.1% had significant weight gain, overweight, or obesity. Of the CBTS between 4 and 20 years of age, 28.7% were overweight or obese, compared with 13.2% of the general population between 4 and 20 years of age. BMI SDS at diagnosis, diagnosis of low-grade glioma, diabetes insipidus, and central precocious puberty were associated with weight gain, overweight, or obesity. The prevalence of HP dysfunction was higher in overweight and obese CTBS compared with normal-weight CBTS. Overweight, obesity, and significant weight gain are prevalent in CBTS. An increase in BMI during follow-up may be a reflection of HP dysfunction, necessitating more intense endocrine surveillance.
Highlights
Obesity is a common late effect in childhood brain tumor survivors (CBTS), with reported prevalences up to 55%.1 Obesity during childhood increases the risk for serious morbidity in adulthood, such as diabetes mellitus and cardiovascular disease.[2,3,4,5,6] obesity, and significant weight gain may affect cardiovascular status in adulthood negatively.[7,8]Identifying overweight children early during follow-up may be of great importance for prevention of cardiovascular morbidity
body mass index (BMI) standard deviation score (SDS) at diagnosis, diagnosis of low-grade glioma, diabetes insipidus, and central precocious puberty were associated with weight gain, overweight, or obesity
The prevalence of HP dysfunction was higher in overweight and obese CTBS compared with normal-weight CBTS
Summary
Obesity during childhood increases the risk for serious morbidity in adulthood, such as diabetes mellitus and cardiovascular disease.[2,3,4,5,6] obesity, and significant weight gain may affect cardiovascular status in adulthood negatively.[7,8]. Identifying overweight children early during follow-up may be of great importance for prevention of cardiovascular morbidity. Increasing body mass index (BMI) may be a sign of hypothalamic-pituitary dysfunction (HPD) during follow-up.[9,10,11] Identifying weight gain in CBTS may aid in early diagnosis of HPD.[12] At the other end of the spectrum is underweight, which may be present in CBTS. Underweight survivors may be at risk for adverse health because a proper nutritional state is necessary for motor, cognitive, and social development.[13,14]
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