Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

被引:65
|
作者
Green, Daniel M. [1 ]
Cox, Cheryl L.
Zhu, Liang
Krull, Kevin R.
Srivastava, Deo Kumar
Stovall, Marilyn [2 ]
Nolan, Vikki G.
Ness, Kirsten K.
Donaldson, Sarah S. [3 ]
Oeffinger, Kevin C. [4 ]
Meacham, Lillian R. [5 ]
Sklar, Charles A. [4 ]
Armstrong, Gregory T.
Robison, Leslie L.
机构
[1] St Jude Childrens Res Hosp, Dept Epidemiol & Canc Control, Memphis, TN 38105 USA
[2] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[3] Stanford Univ, Med Ctr, Stanford, CA 94305 USA
[4] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[5] Emory Univ, Atlanta, GA 30322 USA
基金
美国国家卫生研究院;
关键词
LONG-TERM SURVIVORS; INDUCED WEIGHT-GAIN; BODY-MASS-INDEX; MULTICENTER COMPARATIVE TRIAL; ACUTE LYMPHOBLASTIC-LEUKEMIA; HEALTH SURVEY SF-36; DOUBLE-BLIND; SCHIZOAFFECTIVE DISORDER; ACUTE EXACERBATION; SODIUM VALPROATE;
D O I
10.1200/JCO.2010.34.4267
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. Patients and Methods We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index >= 30 kg/m(2)) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). Results Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. Conclusion Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
引用
收藏
页码:246 / 255
页数:10
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