Risk factors for overweight and obesity after childhood acute lymphoblastic leukemia in North America and Switzerland: A comparison of two cohort studies

• Type of Material: Article
• Authors: Fabiën N. Belle, University of Bern; Christina Schindera, University of Bern; Marc Ansari, University of Geneva; Gregory T. Armstrong, St. Jude Children's Research Hospital; Maja Beck-Popovic, University Hospital, Lausanne; Rebecca Howell, University of Texas, Houston; Wendy M. Leisenring, Fred Hutchinson Cancer Center; Lillian R Meacham, Emory University; Jochen Rössler, University of Bern; Ben D. Spycher, University of Bern; Emily Tonorezos, National Cancer Institute; Nicolas X. von der Weid, University of Basel; Yutaka Yasui, St. Jude Children's Research Hospital; Kevin C. Oeffinger, Duke University; Claudia E. Kuehni, University of Bern
• Language: English
• Date: 2023-10-09
• Publisher: John Wiley and Sons
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1002/cam4.6588
• Title of Journal or Parent Work: Cancer Medicine
• Volume: 12
• Issue: 20
• Start Page: 20423
• End Page: 20436
• Grant/Funding Information: CCSS is supported by the National Cancer Institute (CA55727, G.T. Armstrong, Principal Investigator). Support to St. Jude Children's Research Hospital also provided by the American Lebanese Syrian Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and Associated Charities (ALSAC). SCCSS is supported by the Swiss Cancer League (KLS‐3886‐02‐2016; KLS‐3644‐02‐2015), Cancer Research Switzerland (KFS‐5027‐02‐2020; KFS‐4722‐02‐2019), CS is supported by the “Stiftung für krebskranke Kinder, Regio Basiliensis” and the University of Basel Research Fund for Excellent Junior Researchers. Finally, we would like to thank Kristin Bivens for editorial assistance.
• Keywords: late effect; acute lymphoblastic leukemia; cardiometabolic; adiposity; childhood cancer survivors
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology; Health Sciences, Public Health

Abstract

Background After childhood acute lymphoblastic leukemia (ALL), sequelae include overweight and obesity, yet with conflicting evidence. We compared the prevalence of overweight and obesity between ≥5‐year ALL survivors from the North American Childhood Cancer Survivor Study (CCSS) and the Swiss Childhood Cancer Survivor Study (SCCSS) and described risk factors. Methods We included adult childhood ALL survivors diagnosed between 1976 and 1999. We matched CCSS participants (3:1) to SCCSS participants by sex and attained age. We calculated body mass index (BMI) from self‐reported height and weight for 1287 CCSS and 429 SCCSS participants; we then compared those with siblings (2034) in North America and Switzerland (678) siblings. We assessed risk factors for overweight (BMI 25–29.9 kg/m2) and obesity (≥30 kg/m2) using multinomial regression. Results We found overweight and obesity significantly more common among survivors in North America when compared with survivors in Switzerland [overweight: 30%, 95% confidence interval (CI): 27–32 vs. 24%, 21–29; obesity: 29%, 27–32 vs. 7%, 5–10] and siblings (overweight: 30%, 27–32 vs. 25%, 22–29; obesity: 24%, 22–26 vs. 6%, 4–8). Survivors in North America [odds ratio (OR) = 1.24, 1.01–1.53] and Switzerland (1.27, 0.74–2.21) were slightly more often obese than siblings. Among survivors, risk factors for obesity included residency in North America (5.8, 3.7–9.0); male (1.7, 1.3–2.3); attained age (≥45 years: 5.1, 2.4–10.8); Non‐Hispanic Black (3.4, 1.6–7.0); low household income (2.3, 1.4–3.5); young age at diagnosis (1.6, 1.1–2.2). Cranial radiotherapy ≥18 Gray was only a risk factor for overweight (1.4, 1.0–1.8); steroids were not associated with overweight or obesity. Interaction tests found no evidence of difference in risk factors between cohorts. Conclusions Although treatment‐related risk for overweight and obesity were similar between regions, higher prevalence among survivors in North America identifies important sociodemographic drivers for informing health policy and targeted intervention trials.