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Metabolic syndrome in childhood cancer survivors: delta BMI a risk factor in lower-middle-income countries

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Abstract

Purpose

Metabolic syndrome (MetSyn) is an important late effect of childhood cancer. The combination of rising obesity and high prevalence of under-nutrition at diagnosis makes this a unique population to study in LMIC (lower middle-income countries).

Methods

Children ≤ 18 years of age at cancer diagnosis, in a single center in a LMIC, who were disease free and had completed treatment at least 2 years prior to study were included. MetSyn was defined using International Federation for Diabetes criteria for Asian Indians. Logistic regression analyses were carried out to evaluate the influence of various risk factors, including delta BMI (increase in body mass index from diagnosis to evaluation), on MetSyn.

Results

A high prevalence of MetSyn (12.2%), central obesity (33%), and dyslipidemia (61.8%) were found in a cohort of 500 Asian Indian childhood cancer survivors (CCS) at a median follow-up age of 17 years. Multivariable analysis revealed older age at diagnosis ≥ 10 years, OR 2.9 (1.6–5); longer survival duration ≥ 10 years, OR 2.2 (1.3–3.8); high BMI at diagnosis, OR 3.2 (1.5–6.9); and large delta BMI ≥ 50, OR 3.15(1.7–5.9) to be independent predictors of MetSyn. Patients who were underweight or normal at diagnosis with large delta BMI ≥ 50 had very high odds (OR, 12.5, 1.7–92) of developing MetSyn compared to those with lower delta BMI.

Conclusions and implications for cancer survivors

A high prevalence of MetSyn was observed in CCS with early age at onset. Timely screening and early intervention are proven to be beneficial and delta BMI could be a useful screening tool for LMIC.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi, 110085, India

    Arushi Agarwal, Gauri Kapoor, Sandeep Jain & Payal Malhotra

  2. Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India

    Anurag Sharma

Authors
  1. Arushi Agarwal
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  2. Gauri Kapoor
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  3. Sandeep Jain
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  4. Payal Malhotra
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  5. Anurag Sharma
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Arushi Agarwal, Gauri Kapoor, and Anurag Sharma. The first draft of the manuscript was written by Arushi Agarwal, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gauri Kapoor.

Ethics declarations

Ethics approval

The study was approved by the Institutional ethics committee.

Consent to participate

Written informed consent was obtained from all individual participants/parents included in the study.

Consent for publication

The participants have consented to the submission of the data in the manuscript to the journal. No images of the participants have been submitted.

Competing interests

The authors declare no competing interests.

Disclosure

Presented at annual national conference PHOCON 2018 held at Bangalore, November 2018 (abstract published): Agarwal A, Kapoor G, Jain S. Risk factors for metabolic syndrome in long-term survivors of childhood cancer: a single centre study. Pediatric Hematology Oncology Journal. 2018; 3(3):S1. https://doi.org/10.1016/j.phoj.2018.11.002.

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Agarwal, A., Kapoor, G., Jain, S. et al. Metabolic syndrome in childhood cancer survivors: delta BMI a risk factor in lower-middle-income countries. Support Care Cancer 30, 5075–5083 (2022). https://doi.org/10.1007/s00520-022-06910-0

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