Background: Adverse changes in metabolic parameters and body composition are frequently reported among childhood cancer survivors treated with cranial or total body irradiation. Data regarding the occurrence of metabolic impairments among survivors following abdominal and pelvic radiation are lacking.
Objective and hypotheses: To define the prevalence of metabolic impairments among survivors of paediatric abdominal and pelvic solid tumours and to assess the contribution of adverse body composition to metabolic impairments.
Method: Participants included 347 10+ year survivors of abdominal or pelvic tumours who were ≥18 years of age at study. All participants underwent evaluation for insulin resistance (HOMO-IR >2.86), diabetes and dyslipidaemia (laboratory values and medication usage). Relative lean mass Z-score (LM) and percent whole body fat (%BF) were determined using dual X-ray absorptiometry. Poisson regression was used to evaluate associations between body composition and metabolic impairments.
Results: The median age at evaluation was 29.9 (range: 18.755.1) years. The prevalence of insulin resistance, diabetes, and dyslipidaemia was 40.6, 7.0, and 50.6%, respectively. Overall, 44% of participants received abdominal/pelvic radiation. Radiation was associated with low LM among males (mean [S.D.]; irradiated, −1.16 [1.38], vs non-irradiated, −0.22 [1.03], P<0.01) and females (irradiated, −1.01 [1.40], vs non-irradiated −0.45 [1.23], P<0.01). After adjusting for chronological age and age at diagnosis, low LM was associated with an increased risk of insulin resistance among both males (relative risk [RR]=1.61, 95%CI=1.391.86) and females (RR =1.64, 95%CI=1.411.91). However, an association between dyslipidaemia and low LM was only observed in females (RR=1.23, 95%CI=1.081.41). In multivariable models, %BF was associated with an increased risk of insulin resistance (males, RR=1.08, 95%CI=1.051.11; females, RR=1.08, 95%CI=1.041.11) and dyslipidaemia (males, RR=1.04, 95%CI=1.021.06; females, RR=1.04, 95%CI=1.021.07) among both males and females.
Conclusion: Body composition influences metabolic health among solid tumour survivors. Interventions targeting LM and %BF may improve metabolic health in this population.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology