Weight gain, becoming overweight or obese, and hypothalamic-pituitary dysfunction (HPD) were found to be common among survivors of childhood brain cancer, according to the results of a study published in the Journal of Clinical Oncology.1

Although previous studies have suggested that obesity is highly prevalent among childhood brain cancer survivors, these cohorts may have overestimated or underestimated obesity or weight gain due to inclusion and exclusion criteria. The aim of this study was to determine the prevalence of weight gain and becoming overweight or obese and the association with HPD in a cohort of noncraniopharyngioma and nonpituitary childhood brain cancer survivors.

The retrospective study evaluated data from 661 children diagnosed with noncraniopharyngioma and nonpituitary brain cancers between 2002 and 2012. The World Health Organization (WHO) definitions of underweight, overweight, and obesity were used for infants aged 0 to 2 years; for older children, the international cutoff points identified by Cole et al were used.2 Weight gain was defined as an increase of at least 2.0 standard deviation score (SDS) in body mass index (BMI).1

Weight gain or being overweight or obese was reported among 33.1% of the cohort during a mean follow-up of 7.3 years.


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The proportion of childhood brain cancer survivors who were overweight or obese was substantially greater than the general population of children of the same age. In the 4-to-20 age group, 28.7% of childhood brain cancer survivors were overweight or obese compared with 13.2% of the general population.

Weight gain was significantly associated with factors including lower BMI SDS at diagnosis (odds ratio [OR], 0.51; 95% CI, 0.40-0.66), whereas becoming overweight or obese was significantly associated with a higher BMI SDS at diagnosis (OR, 2.00; 95% CI, 1.70-2.34).

Presence of central precocious puberty at follow-up was also associated with weight gain (OR, 4.06; 95% CI, 1.58-10.42) and becoming overweight or obese (OR, 3.12; 95% CI, 1.38-7.04). Other risk factors for becoming overweight or obese included a diagnosis of low-grade glioma (OR, 1.68, 95% CI, 1.05-2.67) and diabetes insipidus at follow-up (OR, 6.41; 95% CI, 1.35-30.41).

A diagnosis of HPD was also common in the cohort, with 22.8% of childhood brain cancer survivors diagnosed with one or more HPD disorder at follow-up. Of the 74.3% of childhood brain cancer survivors who underwent endocrine testing, 30.8% were diagnosed with at least 1 HPD with a mean onset of diagnosis of 3 years after brain tumor diagnosis.

The authors concluded that these results demonstrate “a high prevalence of significant weight gain, overweight, and obesity during follow-up.” They added that “these childhood brain cancer survivors should receive endocrine surveillance and early support regarding weight control as they are at serious risk for adverse metabolic health.”

References

  1. van Schaik J, van Roessel IMAA, Schouten-van Meeteren NAYN, et al. High prevalence of weight gain in childhood brain tumor survivors and its association with hypothalamic-pituitary dysfunction. J Clin Oncol. Published online February 23, 2021. doi:10.1200/JCO.20.01765
  2. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335:194. doi:10.1136/bmj.39238.399444.55