Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS)

Vincent Pluimakers,Jenneke Van Atteveld,Sebastian Neggers,Marta Fiocco,Marry Van Den Heuvel-Eibrink,Eline Van Dulmen-Den Broeder,Geert O Janssens,Margriet Van Der Heiden-Van Der Loo,Marloes Louwerens,Andrica De Vries,Cécile Ronckers,Leontien Kremer,Birgitta Versluys,Jacqueline Loonen,Helena Van Der Pal,Dorine Bresters,Monique Hobbelink,Hanneke Van Santen

doi:10.2196/21256

Abstract

BackgroundPotential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available.ObjectiveThe objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer.MethodsThis is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested.ResultsPatient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed.ConclusionsThe Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications.International Registered Report Identifier (IRRID)DERR1-10.2196/21256

Highlights

Due to increasing survival of patients with childhood cancer, late side effects have become more prominent
The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies
Metabolic syndrome is associated with a higher risk of diabetes mellitus, as well as cardio- and cerebrovascular morbidity and mortality later in life [1,2,3]

Summary

Introduction

Due to increasing survival of patients with childhood cancer, late side effects have become more prominent. Studies in childhood cancer survivors have reported a prevalence of metabolic syndrome of over 30% after 25 years follow-up, substantially higher compared to age- and sex-matched controls (odds ratio 1.76) [6,7]. This apparent risk difference for metabolic syndrome further increases the elevated risks for cardiovascular outcomes and endothelial damage from anthracyclines, alkylating agents, and irradiation [8,9]. Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. No national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available

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Conclusion