Obesity, Dyslipidemia and Insulin Resistance in Survivors of Childhood Cancer

Abstract

Abstract
 Background: With the increased survival rates following the treatment of childhood cancer, it becomes equally important that the need for evidence based surveillance of long term effects of cancer therapy is addressed. This includes the risk of development of metabolic syndrome features like obesity, altered lipid and sugar profile, which was attempted in the present study.
 Materials and Methods: In this cross sectional case study, 50 survivors of childhood cancer aged between 5 – 18 years were recruited. Positive history of obesity, diabetes mellitus, dyslipidemia, and stroke in family were recorded and their anthropometry was noted with calculation of their Body Mass Index (BMI). Fasting lipid profile, blood sugar, and serum insulin levels were tested; the Homeostatic model assessment of Insulin Resistance (HOMA IR) value and the Fasting Glucose to Insulin Ratio(FGIR) were derived as markers of insulin sensitivity. The data were analyzed using SPSS (version 17.0).
 Results: In these fifty children, the risk factors studied for dyslipidemia and insulin resistance due to chemotherapy were: age at diagnosis, sex, radiation exposure, steroid, and L-asparaginase use during the treatment for cancer. Among the fifty survivors, 7 were found obese, 32 normal, and 11 underweight as per the age specific BMI charts. Their metabolic parameters showed that 12 had raised cholesterol levels, 8 had raised triglyceride levels, and 4 had lowered HDL-C levels. Nine survivors also had raised HOMA-IR levels. However, these metabolic derangements were not found to be statistically significant (p value>0.05) and no correlation was found between the risk factors and obesity, dyslipidemia, or insulin resistance.
 Conclusion: As against the prior evidence, there was no risk of developing obesity, dyslipidemia, and insulin resistance in survivors of childhood cancers.
 Keywords: Dyslipidemias, Insulin Resistance, Obesity, Survivors of childhood cancer

Childhood cancer survivorship and late effects: The landscape in India in 2020

“…A summary of results of 21 studies 8‐28 is tabulated (Supporting Information Table 1) and categorized by organ systems and late effects as used in the Children's Oncology Group Survivorship Guidelines 29 . All except one 8 of these studies have been published in the last decade, highlighting the recent expansion in work in this area in India.…”

“…A median follow‐up was 4.5 years (range, >1‐12 years). Most studies lacked controls, 8‐15,18‐22,24‐28 which is important to quantify the increased risk of the problem as compared with the general population. Importantly, with few exceptions, 10,12,25 most studies had not examined dose‐effect relationship of exposure or the effect of combined modality of treatment.…”

“…Also, the bone mineral density was measured at a single cross‐section of more than two years after the cessation of therapy, and absence of longitudinal data limits our inferences. The prevalence of overweight/obesity varied from 1% to 32% and may reflect the heterogeneity in patient selection, methodology, and study design 11,13,20‐24 . For late effects of the heart the duration of follow‐up was not sufficient to conclude on the magnitude of increased risk.…”