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More overweight seven years after pediatric cancer diagnosis

Research shows that survivors after a brain tumor or leukemia are more often overweight. Attention to nutrition and exercise remains important, according to the researchers.

Cancer treatment affects a child's nutritional status. Some children lose a lot of weight during treatment and run the risk of malnutrition, while others gain a lot of weight. But how do children fare after treatment ends? Does their nutritional status recover or are changes that occur during treatment, such as obesity, permanent? These questions were answered in a recently published study.

Nutritional status

Nurse researcher Aeltsje Brinksma and Wim Tissing, pediatric oncologist and head of supportive care, conducted their study among children originally treated at the UMCG. This was a group of children aged 0 to 18 years with a hematological disease, a brain or solid tumor. Aeltsje Brinksma explains: ‘We collected data on nutritional status at diagnosis and one year and seven years after diagnosis. The children were measured at these times, they completed questionnaires themselves or together with their parents and kept a nutritional diary. Other data were collected from the patient records. So we got accurate data on weight, height, BMI, fat and fat-free mass and factors such as age, sex, type of cancer, dietary intake and physical activity.'

Extra weight and fat mass

The data were analyzed and the researchers found striking differences. In children with hematologic cancer and brain tumor, BMI continued to rise after treatment ended. As a result, the percentage of overweight survivors quadrupled seven years after diagnosis. Aeltsje: ‘We calculated that 27.3% of children were overweight after completion of treatment. That is higher than 15.5% and 18.6%, respectively, among children and adolescents in the Netherlands. In the survivors, the acquired extra pounds of weight and fat mass during treatment, did not disappear after completing treatment.’

Risk of being underweight and overweight

An important conclusion from this study: children who gain weight and develop extra fat mass during treatment did not lose it after treatment. Factors that influence weight or fat mass gain are the type of cancer (hematological and brain tumor), lower BMI at diagnosis and higher BMI of the mother. Aeltsje Brinksma: ‘It is important that during treatment attention is paid not only to the risk of malnutrition, but also to the risk of developing obesity. Although we didn’t find a direct relationship between dietary intake (eating a lot or unhealthy food) and weight gain, attention to a healthy diet and sufficient exercise during treatment is important. For children and parents, this is quite a difficult message. Because children sometimes have periods of no appetite and eat little, they may eat tasty ‘unhealthy’ food more often, which is quite logical. It is clearly an art to keep eating 'healthy' when the food tastes different or to keep exercising when you feel tired and miserable.’

Follow-up research

Follow-up research is currently being conducted at the Princess Máxima Center, mapping children's metabolism in addition to dietary intake and physical activity. It is possible that this study will provide even better insight into how obesity occurs and how it can be prevented.