Endocrine Abstracts

Background: Multiple studies demonstrated increased incidence of obesity, as well as associated morbidity, such as the metabolic syndrome and cardiovascular disease, in childhood cancer survivors (CCS). Still, data regarding the rates and the timeline of obesity as well as of specific risk factors are inconsistent.

Aim: To evaluate the rate of overweight and obesity in CCS, to characterize longitudinal changes in weight status, and to identify predictors of obesity in this population.

Methods: A retrospective cohort study, comprising of all patients followed at the endocrine late effects of childhood cancer clinic between 1.1.2000 –31.12.2020, diagnosed between the ages of 0-18 years, with follow-up of at least one year following completion of anti-cancer treatment. Pertinent data were abstracted from the patients’ medical charts.

Results: The final study cohort included 820 CCS (males:473, 57.7%). The mean age at the time of oncological diagnosis was 7.1±5.1 years, with a median follow-up of 5.5 years from diagnosis. At their last clinic visit, 15.6% of survivors were overweight and 11.1% of them were obese. Compared to the general population, we observed higher rates of overweight and obesity in CCS males aged 2-6 years (33% vs 14%, P<0.001), in males aged 6-12 years (38% vs 19%, P<0.001) and in females aged 6-12 years (35% vs 21%, P<0.001). Multivariate analysis identified weight status at the time of diagnosis (P<0.001), and endocrine dysfunctions (OR=1.46, 95%CI 1.08-1.98, P=0.01), as independent predictors of overweight and obesity. The highest rates of overweight and obesity were observed 3-5 years after diagnosis (OR=1.3, 95% CI 1.11-1.53, P=0.001). Diagnosis between the ages 10-14 years, was associated with lower odds of overweight and obesity at the end of follow up compared to diagnosis at an age younger than three years (OR 0.51, 95% CI 0.32-0.83, P<0.01). There was no association between weight status at the last visit and gender or type of oncological disease. There was a significant increase in BMI-SDS up to 5 years after diagnosis (0.067±0.033, P=0.04), followed by a decrease in BMI-SDS with a later follow up of 5-10 years (-0.11±0.037, P=0.002), and more than 10 years after diagnosis (-0.25±0.055, P<0.001).

Conclusion: Weight status at diagnosis, endocrine deficiencies, and length of follow-up were identified as predictors of overweight and obesity in CCS. Our results may help in identifying at-risk patients and in designing appropriate targeted interventions that might decrease obesity and related morbidity in CCS.