Journal of Clinical Endocrinology & Metabolism, Vol 81, 3051-3055, Copyright © 1996 by Endocrine Society

ARTICLES

Long-term survivors of childhood cancer have an increased risk of manifesting the metabolic syndrome

KK Talvensaari, M Lanning, P Tapanainen and M Knip
Department of Pediatrics, University of Oulu, Kajaanintie 50, Finland. ktalvens@cc.oulu.fi

Survivors of childhood cancer have been reported to have a severalfold increased risk of death from cardiovascular disease. A cluster of metabolic abnormalities, including obesity, insulin resistance, hyperinsulinemia, glucose intolerance, hypertension, and dyslipidemia, have been designated as forming a metabolic syndrome that is associated with increased cardiovascular mortality. We studied 50 survivors (23 males) of childhood cancer, aged 10.5-31.2 yr, an average of 12.6 yr (range, 7.9-21.3 yr) after their diagnosis and compared them with 50 age- and sex-matched controls for signs of the metabolic syndrome by examining clinical and anthropometric measures, serum lipid profile, and fasting plasma insulin and glucose concentrations. Spontaneous nocturnal GH secretion was also evaluated in the cancer survivors. The patients had increased relative weight (P = 0.03) and body fat mass (P < 0.001), decreased serum high density lipoprotein (HDL) cholesterol (P < 0.001), and a reduced ratio of HDL to total cholesterol (P = 0.01). Fasting plasma glucose and insulin levels were higher (P < 0.001 and P = 0.003, respectively) in the cancer survivors than in the controls. The patients had an increased risk [odds ratio (OR), 4.5; 95% confidence interval (CI), 1.3-15.8; P = 0.01] of obesity (relative weight, > 120%), fasting hyperinsulinemia ( > 111 pmol/L; OR, 3.0; 95% CI, 1.0-8.6; P = 0.04), and reduced HDL cholesterol ( < 1.07 mmol/L; OR, 7.9; 95% CI, 2.2 to 29.6; P < 0.001). A combination of obesity, hyperinsulinemia, and low HDL cholesterol was seen in eight cancer survivors (16%), but in none of the controls (P = 0.01). This high risk group was characterized by reduced spontaneous GH secretion (P = 0.02). Long term survivors of childhood cancer appear to have an increased risk of manifestations of the metabolic syndrome. Decreased GH secretion may contribute to these metabolic abnormalities.

This article has been cited by other articles:

				S. M. Shankar, N. Marina, M. M. Hudson, D. C. Hodgson, M. J. Adams, W. Landier, S. Bhatia, K. Meeske, M. H. Chen, K. E. Kinahan, et al. Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group Pediatrics, February 1, 2008; 121(2): e387 - e396. [Abstract] [Full Text] [PDF]

				P. M. Janiszewski, K. C. Oeffinger, T. S. Church, A. L. Dunn, D. A. Eshelman, R. G. Victor, S. Brooks, A. J. Turoff, E. Sinclair, J. C. Murray, et al. Abdominal Obesity, Liver Fat, and Muscle Composition in Survivors of Childhood Acute Lymphoblastic Leukemia J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3816 - 3821. [Abstract] [Full Text] [PDF]

				T. A. Florin, G. E. Fryer, T. Miyoshi, M. Weitzman, A. C. Mertens, M. M. Hudson, C. A. Sklar, K. Emmons, A. Hinkle, J. Whitton, et al. Physical Inactivity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study Cancer Epidemiol. Biomarkers Prev., July 1, 2007; 16(7): 1356 - 1363. [Abstract] [Full Text] [PDF]

				K. Scott Baker, K. K. Ness, J. Steinberger, A. Carter, L. Francisco, L. J. Burns, C. Sklar, S. Forman, D. Weisdorf, J. G. Gurney, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study Blood, February 15, 2007; 109(4): 1765 - 1772. [Abstract] [Full Text] [PDF]

				R.-E. W. Kavey, V. Allada, S. R. Daniels, L. L. Hayman, B. W. McCrindle, J. W. Newburger, R. S. Parekh, and J. Steinberger Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics Circulation, December 12, 2006; 114(24): 2710 - 2738. [Abstract] [Full Text] [PDF]

				K. A. Neville, R. J. Cohn, K. S. Steinbeck, K. Johnston, and J. L. Walker Hyperinsulinemia, Impaired Glucose Tolerance, and Diabetes Mellitus in Survivors of Childhood Cancer: Prevalence and Risk Factors J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4401 - 4407. [Abstract] [Full Text] [PDF]

				P. Mansky, T. Sannes, D. Wallerstedt, A. Ge, M. Ryan, L. L. Johnson, M. Chesney, and L. Gerber Tai chi chuan: mind-body practice or exercise intervention? Studying the benefit for cancer survivors. Integr Cancer Ther, September 1, 2006; 5(3): 192 - 201. [Abstract] [PDF]

				K. H. Darzy and S. M. Shalet Absence of Adrenocorticotropin (ACTH) Neurosecretory Dysfunction but Increased Cortisol Concentrations and Production Rates in ACTH-Replete Adult Cancer Survivors after Cranial Irradiation for Nonpituitary Brain Tumors J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5217 - 5225. [Abstract] [Full Text] [PDF]

				D. M. Greving and S. J. Santacroce Cardiovascular Late Effects Journal of Pediatric Oncology Nursing, January 1, 2005; 22(1): 38 - 47. [Abstract] [PDF]

				K. Link, C. Moell, S. Garwicz, E. Cavallin-Stahl, J. Bjork, U. Thilen, B. Ahren, and E. M. Erfurth Growth Hormone Deficiency Predicts Cardiovascular Risk in Young Adults Treated for Acute Lymphoblastic Leukemia in Childhood J. Clin. Endocrinol. Metab., October 1, 2004; 89(10): 5003 - 5012. [Abstract] [Full Text] [PDF]

				K. C. Oeffinger and M. M. Hudson Long-term Complications Following Childhood and Adolescent Cancer: Foundations for Providing Risk-based Health Care for Survivors CA Cancer J Clin, July 1, 2004; 54(4): 208 - 236. [Abstract] [Full Text] [PDF]

				K. C. Oeffinger, A. C. Mertens, M. M. Hudson, J. G. Gurney, J. Casillas, H. Chen, J. Whitton, M. Yeazel, Y. Yasui, and L. L. Robison Health Care of Young Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study Ann. Fam. Med, January 1, 2004; 2(1): 61 - 70. [Abstract] [Full Text] [PDF]

				K. C. Oeffinger, A. C. Mertens, C. A. Sklar, Y. Yasui, T. Fears, M. Stovall, T. A. Vik, P. D. Inskip, and L. L. Robison Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study J. Clin. Oncol., April 1, 2003; 21(7): 1359 - 1365. [Abstract] [Full Text] [PDF]

				N. M. Aziz Cancer Survivorship Research: Challenge and Opportunity J. Nutr., November 1, 2002; 132(11): 3494S - 3503. [Abstract] [Full Text] [PDF]

				R. D. Murray, K. H. Darzy, H. K. Gleeson, and S. M. Shalet GH-Deficient Survivors of Childhood Cancer: GH Replacement during Adult Life J. Clin. Endocrinol. Metab., January 1, 2002; 87(1): 129 - 135. [Abstract] [Full Text] [PDF]

				J. J. Reilly, A. Kelly, P. Ness, A. R. Dorosty, W. H. B. Wallace, B. E. S. Gibson, and P. M. Emmett Premature Adiposity Rebound in Children Treated for Acute Lymphoblastic Leukemia J. Clin. Endocrinol. Metab., June 1, 2001; 86(6): 2775 - 2778. [Abstract] [Full Text] [PDF]

				Discontinuation of Growth Hormone (GH) Treatment: Metabolic Effects in GH-Deficient and GH-Sufficient Adolescent Patients Compared with Control Subjects J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4516 - 4524. [Abstract] [Full Text]

				S. K. Parsons, S. X. Skapek, E. J. Neufeld, C. Kuhlman, M. L. Young, M. Donnelly, J. D. Brunzell, J. D. Otvos, S. E. Sallan, and N. Rifai Asparaginase-Associated Lipid Abnormalities in Children With Acute Lymphoblastic Leukemia Blood, March 15, 1997; 89(6): 1886 - 1895. [Abstract] [Full Text] [PDF]