Adiposity in Survivors of Cancer in Childhood: How is it Measured and Why Does it Matter?

Abstract

Survival of cancer in childhood is increasingly common with modern therapeutic protocols but leads frequently to adverse long-term impacts on health, including metabolic and cardiovascular disease. Changes in body composition, especially an increase in fat mass and a decrease in muscle mass, are found early in patients with pediatric cancer, persist long after treatment has been completed and seem to contribute to the development of chronic disease. This review details the effects of such changes in body composition and reviews the underlying pathophysiology of the development of sarcopenic obesity and its adverse metabolic impact. The authors discuss the particular challenges in identifying obesity accurately in survivors of pediatric cancer using available measurement techniques, given that common measures, such as body mass index, do not distinguish between muscle and adipose tissue or assess their distribution. The authors highlight the importance of a harmonized approach to the assessment of body composition in pediatric cancer survivors and early identification of risk using “gold-standard” measurements. This will improve our understanding of the significance of adiposity and sarcopenia in this population, help identify thresholds predictive of metabolic risk, and ultimately prevent or ameliorate the long-term metabolic and cardiovascular impacts on health experienced by survivors of cancer in childhood.

Sarcopenia in long‐term survivors of cancer in childhood and adolescence: A cross‐sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle–bone unit

“…Identification of childhood cancer survivors with sarcopenia and SO is of utmost importance due to their associations with several comorbid conditions, mortality, and poor function and quality of life 16,17,20,22,23,26,56,60–62 . Continued exploration of the optimal means to screen for and diagnose these conditions is warranted, as early detection allows for consideration of options to mitigate or reverse the condition, including changes in lifestyle (sedentary behavior, physical activity) and attention to underlying causes such as adiposity and acute/chronic disease, as described by Donini et al 13 .…”

“…In order to intervene and prevent development or ameliorate these clinical consequences, accurate and accessible techniques for measurement of SMM must be established, with consideration of the availability of reliable and valid, age‐ and sex‐appropriate normative values. There is a considerable array of modalities for measurement, ranging from simple anthropometrics such as arm muscle area (corrected for bone 24 ) and calf circumference 25 to ultrasonography, bioelectrical impedance analysis (BIA), dual‐energy x‐ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI) 26,27 . Much less frequently use has been made of air displacement plethysmography, deuterium dilution, creatinine excretion, total body potassium, and even neutron activation 10 .…”

“…There is a considerable array of modalities for measurement, ranging from simple anthropometrics such as arm muscle area (corrected for bone 24 ) and calf circumference 25 to ultrasonography, bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI). 26,27 Much less frequently use has been made of air displacement plethysmography, deuterium dilution, creatinine excretion, total body potassium, and even neutron activation. 10 As stated by the European Working Group on Sarcopenia in Older People, 1 "CT and MRI are gold standards for estimating muscle mass in research.…”

Detecting Sarcopenic Obesity in Survivors of Pediatric Acute Lymphoblastic Leukemia: An Exploration of Body Mass Index and Triponderal Mass Index as Potential Surrogate Markers

“…[4][5][6][7][8][9] Although the etiology is likely multifactorial, changes in body composition related to treatment likely play a role. 10,11 A particular phenotype found in survivors of ALL is that of sarcopenic obesity 12,13 (SO; increased adiposity with loss of muscle mass), which predisposes those affected both to the negative impacts of increased fat mass and frailty. 14 Fortunately, both conditions can be improved if detected and intervention implemented in a timely manner.…”

“…Unfortunately, detection of SO is difficult, particularly in survivors of pediatric cancer, without resorting to full body composition assessment using invasive and/or expensive techniques such as Dual Energy X-Ray Absorptiometry (DEXA), which is considered to be a clinical gold standard. 13 Given the impracticalities of routine and potentially repeated DEXA scans in all survivors, especially in resource-poor environments such as low-income and middle-income countries, 15 detection of SO using more accessible tests or clinical indices is a worthy goal.…”