Journal of Clinical Oncology, Vol 21, Issue 7
(April), 2003: 1359-1365
© 2003 American Society for Clinical Oncology
Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study
Kevin C. Oeffinger,
Ann C. Mertens,
Charles A. Sklar,
Yutaka Yasui,
Thomas Fears,
Marilyn Stovall,
Terry A. Vik,
Peter D. Inskip,
Leslie L. Robison
From the Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; Department of Pediatrics, University of Minnesota, Minneapolis, MN; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY; Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Washington, DC; Department of Radiation Physics, University of Texas, M.D. Anderson Cancer Center, Houston, TX; and Riley Children’s Hospital, Indianapolis, IN.
Address reprint requests to Kevin C. Oeffinger, MD, The University of Texas Southwestern Medical Center at Dallas, Department of Family Practice and Community Medicine, 6263 Harry Hines Blvd., Dallas, TX 75390-9067; email: kevin.oeffinger{at}utsouthwestern.edu.
Purpose: To determine whether adult survivors ( 18 years of age) of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity and to assess patient and treatment variables that influence risk.
Patients and Methods: A retrospective cohort of participants of the Childhood Cancer Survivor Study was used to compare 1,765 adult survivors of childhood ALL to 2,565 adult siblings of childhood cancer survivors. Body-mass index (BMI; kilograms per square meter), calculated from self-reported heights and weights, was used to determine the prevalence of being overweight (BMI, 25–29.9) or obese (BMI 30.0). Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for being overweight or obese among ALL survivors relative to the sibling control group.
Results: The age- and race-adjusted OR for being obese in survivors treated with cranial radiation doses 20 Gy in comparison with siblings was 2.59 for females (95% CI, 1.88 to 3.55; P < .001) and 1.86 for males (95% CI, 1.33 to 2.57; P < .001). The OR for obesity was greatest among females diagnosed at 0 to 4 years of age and treated with radiation doses 20 Gy (OR, 3.81; 95% CI, 2.34 to 5.99; P < .001). Obesity was not associated with treatment consisting of chemotherapy only or with cranial radiation doses of 10 to 19 Gy.
Conclusion: Cranial radiotherapy 20 Gy is associated with an increased prevalence of obesity, especially in females treated at a young age. It is imperative that healthcare professionals recognize this risk and develop strategies to enhance weight control and encourage longitudinal follow-up.
Supported by grant 5U01-CA-55727-05 from the Department of Health and Human Services and funding to the University of Minnesota from the Children’s Cancer Research Fund. K.C. Oeffinger received partial support for this work through the American Academy of Family Physicians Advanced Research Training Grant.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
M. van Waas, S. J. C. M. M. Neggers, R. Pieters, and M. M. van den Heuvel-Eibrink
Components of the metabolic syndrome in 500 adult long-term survivors of childhood cancer
Ann. Onc.,
October 22, 2009;
(2009)
mdp414v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Oeffinger, B. Adams-Huet, R. G. Victor, T. S. Church, P. G. Snell, A. L. Dunn, D. A. Eshelman-Kent, R. Ross, P. M. Janiszewski, A. J. Turoff, et al.
Insulin Resistance and Risk Factors for Cardiovascular Disease in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia
J. Clin. Oncol.,
August 1, 2009;
27(22):
3698 - 3704.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. B. Haddy, R. B. Mosher, and G. H. Reaman
Late Effects in Long-Term Survivors After Treatment for Childhood Acute Leukemia
Clinical Pediatrics,
July 1, 2009;
48(6):
601 - 608.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P. C. Nathan, J. S. Ford, T. O. Henderson, M. M. Hudson, K. M. Emmons, J. N. Casillas, E. A. Lown, K. K. Ness, and K. C. Oeffinger
Health Behaviors, Medical Care, and Interventions to Promote Healthy Living in the Childhood Cancer Survivor Study Cohort
J. Clin. Oncol.,
May 10, 2009;
27(14):
2363 - 2373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Hudson, D. A. Mulrooney, D. C. Bowers, C. A. Sklar, D. M. Green, S. S. Donaldson, K. C. Oeffinger, J. P. Neglia, A. T. Meadows, and L. L. Robison
High-Risk Populations Identified in Childhood Cancer Survivor Study Investigations: Implications for Risk-Based Surveillance
J. Clin. Oncol.,
May 10, 2009;
27(14):
2405 - 2414.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. T. Armstrong, Q. Liu, Y. Yasui, J. P. Neglia, W. Leisenring, L. L. Robison, and A. C. Mertens
Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study
J. Clin. Oncol.,
May 10, 2009;
27(14):
2328 - 2338.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Diller, E. J. Chow, J. G. Gurney, M. M. Hudson, N. S. Kadin-Lottick, T. I. Kawashima, W. M. Leisenring, L. R. Meacham, A. C. Mertens, D. A. Mulrooney, et al.
Chronic Disease in the Childhood Cancer Survivor Study Cohort: A Review of Published Findings
J. Clin. Oncol.,
May 10, 2009;
27(14):
2339 - 2355.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Robison, G. T. Armstrong, J. D. Boice, E. J. Chow, S. M. Davies, S. S. Donaldson, D. M. Green, S. Hammond, A. T. Meadows, A. C. Mertens, et al.
The Childhood Cancer Survivor Study: A National Cancer Institute-Supported Resource for Outcome and Intervention Research
J. Clin. Oncol.,
May 10, 2009;
27(14):
2308 - 2318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
AMERICAN ACADEMY OF PEDIATRICS Section on Hematolo
Long-term Follow-up Care for Pediatric Cancer Survivors
Pediatrics,
March 1, 2009;
123(3):
906 - 915.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. G. Garmey, Q. Liu, C. A. Sklar, L. R. Meacham, A. C. Mertens, M. A. Stovall, Y. Yasui, L. L. Robison, and K. C. Oeffinger
Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study
J. Clin. Oncol.,
October 1, 2008;
26(28):
4639 - 4645.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Mody, S. Li, D. C. Dover, S. Sallan, W. Leisenring, K. C. Oeffinger, Y. Yasui, L. L. Robison, and J. P. Neglia
Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study
Blood,
June 15, 2008;
111(12):
5515 - 5523.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Varma
Childhood Leukemia Survivors At Risk for Harmful Obesity
AAP Grand Rounds,
January 1, 2008;
19(1):
5 - 5.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. E. Scully, T. L. Miller, and S. E. Lipshultz
Detecting Anthracycline-induced Cardiotoxicity in Survivors of Childhood Cancer
ASCO Educational Book,
January 1, 2008;
2008(1):
454 - 458.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. T. Armstrong, C. A. Sklar, M. M. Hudson, and L. L. Robison
Long-Term Health Status Among Survivors of Childhood Cancer: Does Sex Matter?
J. Clin. Oncol.,
October 1, 2007;
25(28):
4477 - 4489.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Janiszewski, K. C. Oeffinger, T. S. Church, A. L. Dunn, D. A. Eshelman, R. G. Victor, S. Brooks, A. J. Turoff, E. Sinclair, J. C. Murray, et al.
Abdominal Obesity, Liver Fat, and Muscle Composition in Survivors of Childhood Acute Lymphoblastic Leukemia
J. Clin. Endocrinol. Metab.,
October 1, 2007;
92(10):
3816 - 3821.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. Florin, G. E. Fryer, T. Miyoshi, M. Weitzman, A. C. Mertens, M. M. Hudson, C. A. Sklar, K. Emmons, A. Hinkle, J. Whitton, et al.
Physical Inactivity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study
Cancer Epidemiol. Biomarkers Prev.,
July 1, 2007;
16(7):
1356 - 1363.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Oeffinger and L. L. Robison
Childhood Cancer Survivors, Late Effects, and a New Model for Understanding Survivorship
JAMA,
June 27, 2007;
297(24):
2762 - 2764.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. I. Razzouk, S. R. Rose, S. Hongeng, D. Wallace, M. P. Smeltzer, M. Zacher, C.-H. Pui, and M. M. Hudson
Obesity in Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma
J. Clin. Oncol.,
April 1, 2007;
25(10):
1183 - 1189.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Dickerman
The Late Effects of Childhood Cancer Therapy
Pediatrics,
March 1, 2007;
119(3):
554 - 568.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R.-E. W. Kavey, V. Allada, S. R. Daniels, L. L. Hayman, B. W. McCrindle, J. W. Newburger, R. S. Parekh, and J. Steinberger
Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics
Circulation,
December 12, 2006;
114(24):
2710 - 2738.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. B. Crom, V. L. Tyc, S. N. Rai, X. Deng, M. M. Hudson, A. Booth, L. N. Rodrigues, L. Zhang, E. Mccammon, and S. C. Kaste
Retention of survivors of acute lymphoblastic leukemia in a longitudinal study of bone mineral density
J Child Health Care,
December 1, 2006;
10(4):
337 - 350.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. C. Bowers, Y. Liu, W. Leisenring, E. McNeil, M. Stovall, J. G. Gurney, L. L. Robison, R. J. Packer, and K. C. Oeffinger
Late-Occurring Stroke Among Long-Term Survivors of Childhood Leukemia and Brain Tumors: A Report From the Childhood Cancer Survivor Study
J. Clin. Oncol.,
November 20, 2006;
24(33):
5277 - 5282.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Oeffinger, A. C. Mertens, C. A. Sklar, T. Kawashima, M. M. Hudson, A. T. Meadows, D. L. Friedman, N. Marina, W. Hobbie, N. S. Kadan-Lottick, et al.
Chronic Health Conditions in Adult Survivors of Childhood Cancer.
N. Engl. J. Med.,
October 12, 2006;
355(15):
1572 - 1582.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Hjern
Chapter 7: Children's and young people's health
Scand J Public Health,
June 1, 2006;
34(67_suppl):
165 - 183.
[PDF]
|
|
|
|
|
|
|
A. J Murphy, J. C. Wells, J. E Williams, M. S Fewtrell, P. S. Davies, and D. K Webb
Body composition in children in remission from acute lymphoblastic leukemia
Am. J. Clinical Nutrition,
January 1, 2006;
83(1):
70 - 74.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. Ladas, N. Sacks, L. Meacham, D. Henry, L. Enriquez, G. Lowry, R. Hawkes, G. Dadd, and P. Rogers
A Multidisciplinary Review of Nutrition Considerations in the Pediatric Oncology Population: A Perspective From Children's Oncology Group
Nutr Clin Pract,
August 1, 2005;
20(4):
377 - 393.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Jarfelt, B Lannering, I Bosaeus, G Johannsson, and R Bjarnason
Body composition in young adult survivors of childhood acute lymphoblastic leukaemia
Eur. J. Endocrinol.,
July 1, 2005;
153(1):
81 - 89.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Greving and S. J. Santacroce
Cardiovascular Late Effects
Journal of Pediatric Oncology Nursing,
January 1, 2005;
22(1):
38 - 47.
[Abstract]
[PDF]
|
|
|
|
|
|
|
K. Link, C. Moell, S. Garwicz, E. Cavallin-Stahl, J. Bjork, U. Thilen, B. Ahren, and E. M. Erfurth
Growth Hormone Deficiency Predicts Cardiovascular Risk in Young Adults Treated for Acute Lymphoblastic Leukemia in Childhood
J. Clin. Endocrinol. Metab.,
October 1, 2004;
89(10):
5003 - 5012.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Ross, K. C. Oeffinger, S. M. Davies, A. C. Mertens, E. K. Langer, W. R. Kiffmeyer, C. A. Sklar, M. Stovall, Y. Yasui, and L. L. Robison
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.,
September 1, 2004;
22(17):
3558 - 3562.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Oeffinger and M. M. Hudson
Long-term Complications Following Childhood and Adolescent Cancer: Foundations for Providing Risk-based Health Care for Survivors
CA Cancer J Clin,
July 1, 2004;
54(4):
208 - 236.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Smith and M. L. Hare
An Overview of Progress in Childhood Cancer Survival
Journal of Pediatric Oncology Nursing,
May 1, 2004;
21(3):
160 - 164.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Castellino, S. Lensing, C. Riely, S. N. Rai, R. Davila, R. T. Hayden, J. Fleckenstein, M. Levstik, S. Taylor, P. J. Dean, et al.
The epidemiology of chronic hepatitis C infection in survivors of childhood cancer: an update of the St Jude Children's Research Hospital hepatitis C seropositive cohort
Blood,
April 1, 2004;
103(7):
2460 - 2466.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Oeffinger, A. C. Mertens, M. M. Hudson, J. G. Gurney, J. Casillas, H. Chen, J. Whitton, M. Yeazel, Y. Yasui, and L. L. Robison
Health Care of Young Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study
Ann. Fam. Med,
January 1, 2004;
2(1):
61 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. K. Dalton, M. Rue, L. B. Silverman, R. D. Gelber, B. L. Asselin, R. D. Barr, L. A. Clavell, C. A. Hurwitz, A. Moghrabi, Y. Samson, et al.
Height and Weight in Children Treated for Acute Lymphoblastic Leukemia: Relationship to CNS Treatment
J. Clin. Oncol.,
August 1, 2003;
21(15):
2953 - 2960.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
