Recruitment feasibility to a cohort study of endocrine and metabolic health among survivors of childhood brain tumours: a report from the Canadian study of Determinants of Endometabolic Health in ChIlDrEn (CanDECIDE)

Survivors of childhood brain tumors (SCBT) face a higher risk of cardiometabolic disorders and premature mortality compared to the general population. Excess adiposity is a known risk factor for these comorbidities. However, while SCBT have higher adiposity compared to healthy controls, measuring adiposity in clinical practice involves access to specialized equipment and may impact busy clinical services. Tri-ponderal Mass Index (TMI; kg/m3) may be a superior measure of adiposity when compared to Body Mass Index (BMI; kg/m2). However, its use in determining adiposity in SCBT has not been assessed. This study aims to validate TMI as a clinical measure of adiposity in SCBT. This was a cross-sectional study including 44 SCBT (n = 20 female) and 137 (n = 64 female) non-cancer control children, 5–17 years of age. BMI and TMI were calculated from height and weight measurements. Fat mass percentage was assessed using bioelectrical impedance analysis and waist to hip and waist to height ratios were used to assess central adiposity. Regression analyses were adjusted for age, sex, puberty and treatment. TMI demonstrated strong correlations to measures of total and central adiposity and predicted adiposity in SCBT and non-cancer controls, with stronger trends in the latter group. TMI may serve as a reliable clinical measure of adiposity in both SCBT and healthy children.

Section: Methodsmentioning

confidence: 99%

“…Standardized questionnaires were used to collect data on age, sex, puberty, and ethnicity 58 , 59 . Medical records were consulted to verify and collect data regarding tumor type, location, sidedness and treatment modalities for SCBT.…”

Section: Methodsmentioning

confidence: 99%

Tri-ponderal mass index in survivors of childhood brain tumors: A cross-sectional study

Sims

Wang

Fleming

et al. 2018

“…The complete study methodology has been reported previously 76,77 . This is a secondary analysis of cross-sectional data from the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE study) 76,77 . The Hamilton Integrated Research Ethics Board has approved this project.…”

Section: Participantsmentioning

confidence: 99%

Circulating leptin levels are associated with adiposity in survivors of childhood brain tumors

Sims

Jennings

Empringham

et al. 2020

Survivors of Childhood Brain Tumors (SCBT) are at a higher risk of developing cardiovascular disease and type 2 diabetes compared to the general population. Adiposity is an important risk factor for the development of these outcomes, and identifying biomarkers of adiposity may help the stratification of survivors based on their cardiovascular risk or allow for early screening and interventions to improve cardiometabolic outcomes. Leptin is an adipokine that positively correlates with the adipose mass in the general population and is a predictor of adverse cardiometabolic outcomes, yet its association with adiposity in SCBT has not been studied. The aim of this study was to determine if leptin levels are associated with the adipose mass in SCBT, and to define its predictors. This cross-sectional study included 74 SCBT (n = 32 females) with 126 non-cancer controls (n = 59 females). Total adiposity was measured using Bioelectrical Impendence Analysis (BIA) and central adiposity was measured using waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). We used multivariable linear regression analysis to determine if leptin predicts adiposity in SCBT and adjusted for age, sex, puberty, and cancer status. Leptin correlated strongly with total (p < 0.001) and central (WHR p = 0.001; WHtR p < 0.001) adiposity in SCBT and non-cancer controls. In conclusion, leptin is a potential biomarker for adiposity in SCBT, and further investigation is needed to clarify if leptin is a predictor of future cardiometabolic risk in SCBT. Cardiovascular disease is a leading cause of morbidity and mortality, accounting for approximately 17.6 million deaths per annum globally 1,2. While cardiovascular diseases are a significant burden on healthcare systems in the general population 1-4 , specific populations seem to have a higher propensity for these diseases than others, and one such cohort includes the survivors of childhood cancer. Cardiovascular diseases are one of the leading causes of non-cancer related mortality in this population, and accounts for 20% of mortality rates within 15 years of cancer therapy 5-8. Within the cancer survivorship subgroups, the Survivors of Childhood Brain Tumors (SCBT) have a significant risk of premature cardiovascular diseases and one of their major risk factors, type 2 diabetes mellitus 6,9,10. SCBT have a 29-fold higher risk for stroke and a twofold higher risk of type 2 diabetes compared to non-cancer controls 9,11. Cardiometabolic disorders are emerging as an important determinant of longevity and quality of life in SCBT 8 , and there is a critical necessity to identify the risk factors and biomarkers of cardiometabolic risk to personalize preventative and therapeutic strategies to improve outcomes in this population.

“…This secondary data analysis used data that were collected as a part of the CanDECIDE Study. This is a cohort study conducted at McMaster Children’s Hospital in Hamilton, Ontario, Canada 52 , 53 .…”

Section: Methodsmentioning

confidence: 99%

“…The collected data included age, sex, ethnicity, puberty, pregnancy gestation, maternal gestational diabetes and preeclampsia, and reported birth weight using standardized questionnaires 52 , 53 . While reported birth weight correlates with measured birth weight 54 , the reported birth weight was verified from the medical records.…”

Section: Methodsmentioning

confidence: 99%

Birth weight and body mass index z-score in childhood brain tumors: A cross-sectional study

Wang

Fleming

Johnston

et al. 2018

Children with brain tumors (CBT) are at higher risk of cardiovascular disease and type 2 diabetes compared to the general population, in which birth weight is a risk factor for these diseases. However, this is not known in CBT. The primary aim of this study was to explore the association between birth weight and body mass measures in CBT, compared to non-cancer controls. This is a secondary data analysis using cross-sectional data from the CanDECIDE study (n = 78 CBT and n = 133 non-cancer controls). Age, sex, and birth weight (grams) were self-reported, and confirmed through examination of the medical records. Body mass index (BMI) was calculated from height and weight measures and reported as kg/m2. BMI z-scores were obtained for subjects under the age of 20 years. Multivariable linear regression was used to evaluate the relationship between birth weight and BMI and BMI z-score, adjusted for age, sex, puberty, and fat mass percentage. Higher birth weight was associated with higher BMI and BMI z-score among CBT and controls. In conclusion, birth weight is a risk factor for higher body mass during childhood in CBT, and this may help the identification of children at risk of future obesity and cardiometabolic risk.