In a Dutch study reported in the Journal of Clinical Oncology, van Schaik et al found that significant weight gain and being overweight and/or obese are common in childhood brain tumor survivors and may be associated with hypothalamic-pituitary dysfunction.
Study Details
The study involved data from a nationwide cohort of 661 survivors diagnosed between 2002 and 2012 who were aged ≤ 18 years at diagnosis and survived for longer than 2 years after diagnosis. The cohort excluded patients with craniopharyngioma and pituitary tumors. The prevalence of and risk factors associated with significant weight gain (body mass index [BMI] change ≥ +2.0 standard deviation score [SDS]), overweight, or obesity at follow-up were assessed, and the association of overweight and obesity and hypothalamic-pituitary dysfunction was analyzed.
“Overweight, obesity, and significant weight gain are prevalent in childhood brain tumor survivors. An increase in BMI during follow-up may be a reflection of hypothalamic-pituitary dysfunction, necessitating more intense endocrine surveillance.”— van Schaik et al
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Key Findings
Among all patients, median age at diagnosis was 7.4 years, mean age at follow-up was 15.1 years, and mean follow-up time was 7.3 years.
Among 602 survivors without underweight at diagnosis, 70 (11.6%) developed significant weight gain at follow-up. Among all 661 survivors, 190 (28.7%) were classified as overweight (n = 134, 20.3%) or obese (n = 56, 8.5%) at follow-up. Overall. 33.1% of the cohort had significant weight gain, overweight, or obesity at follow-up.
Among 578 survivors aged 4 to 20 years at follow-up, 20.3% were classified as overweight and 8.5% as obese vs 10.5% and 2.7% in the general Dutch population in the same age range.
Significant risk factors for overweight or obesity at follow-up were higher BMI SDS at diagnosis (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.70–2.34), low-grade glioma (OR = 1.68, 95% CI = 1.05–2.67 vs other tumors), diabetes insipidus during follow-up (OR = 6.41, 95% CI = 1.35–30.41), and central precocious puberty during follow-up (OR = 3.12, 95% CI = 1.38–7.04).
The prevalence of hypothalamic-pituitary dysfunction was higher in overweight and obese survivors vs normal-weight survivors, including growth hormone deficiency (16.8% vs 12.9%, P = .190), thyroid-stimulating hormone deficiency (18.4% vs 7.7%, P < .001), adrenocorticotropic hormone deficiency (10.5% vs 3.7%, P = .001), gonadotropin-releasing hormone deficiency (7.4% vs 2.9%, P = .009), diabetes insipidus (6.8% vs 1.5%, P < .001), and central precocious puberty (16.3% vs 4.6%, P < .001).
The investigators concluded, “Overweight, obesity, and significant weight gain are prevalent in childhood brain tumor survivors. An increase in BMI during follow-up may be a reflection of hypothalamic-pituitary dysfunction, necessitating more intense endocrine surveillance.”
Jiska van Schaik, MSc, of the Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/Princess Máxima Center, Utrecht, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by Stichting Kinderen Kankervrij (KiKa). For full disclosures of the study authors, visit ascopubs.org.
