Abstract
ObjectiveObesity, represented by high body mass index (BMI), is a major complication after treatment for childhood cancer. However, it has been shown that high total fat percentage and low lean body mass are more reliable predictors of cardiovascular morbidity. In this study longitudinal changes of BMI and body composition, as well as the value of BMI and waist-hip ratio representing obesity, were evaluated in adult childhood cancer survivors.MethodsData from 410 survivors who had visited the late effects clinic twice were analyzed. Median follow-up time was 16 years (interquartile range 11–21) and time between visits was 3.2 years (2.9–3.6). BMI was measured and body composition was assessed by dual X-ray absorptiometry (DXA, Lunar Prodigy; available twice in 182 survivors). Data were compared with healthy Dutch references and calculated as standard deviation scores (SDS). BMI, waist-hip ratio and total fat percentage were evaluated cross-sectionally in 422 survivors, in who at least one DXA scan was assessed.ResultsBMI was significantly higher in women, without significant change over time. In men BMI changed significantly with time (ΔSDS = 0.19, P<0.001). Percentage fat was significantly higher than references in all survivors, with the highest SDS after cranial radiotherapy (CRT) (mean SDS 1.73 in men, 1.48 in women, P<0.001). Only in men, increase in total fat percentage was significantly higher than references (ΔSDS = 0.22, P<0.001). Using total fat percentage as the gold standard, 65% of female and 42% of male survivors were misclassified as non-obese using BMI. Misclassification of obesity using waist-hip ratio was 40% in women and 24% in men.ConclusionsSixteen years after treatment for childhood cancer, the increase in BMI and total fat percentage was significantly greater than expected, especially after CRT. This is important as we could show that obesity was grossly underestimated using BMI and waist-hip ratio.
Highlights
Childhood cancer survival rates have increased enormously over the last few decades [1,2]
Shah and Braverman showed that Body mass index (BMI) misclassified 48% of the female and 25% of the male population using total fat percentage measured by dual X-ray absorptiometry (DXA) as the gold standard
Two leukemia survivors had been treated with cranial radiotherapy (CRT) and total body irradiation (TBI) and were analyzed in the CRT group
Summary
Childhood cancer survival rates have increased enormously over the last few decades [1,2]. It has been shown that a high amount of total body fat, high intra-abdominal fat percentage and low lean body mass are more reliable determinants than high BMI in predicting the development of cardiovascular disease or diabetes mellitus [6,7,8,9,10]. Shah and Braverman showed that BMI misclassified 48% of the female and 25% of the male population using total fat percentage measured by dual X-ray absorptiometry (DXA) as the gold standard. This lead to an underestimation of the prevalence of obesity [10]. Waist circumference, which approximates the amount of intra-abdominal fat, is a more accurate marker than BMI and is one of the criteria used to define metabolic syndrome [11,12]
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