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Body composition, dietary intake and physical activity of young survivors of childhood cancer
Alexia J. Murphy-Alford a, *, Melinda White b, Liane Lockwood c, Andrew Hallahan c, Peter S.W. Davies a
a Children's Nutrition Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
b Department of Dietetics and Food Services, Lady Cilento Children's Hospital, Brisbane, Australia
c Oncology Service Group, Children's Health Queensland, Lady Cilento Children's Hospital, Brisbane, Australia
Childhood cancer survivors
Aim: To describe the body composition, dietary intake and physical activity and of paediatric, adolescent and young adult childhood cancer survivors (CCS) and examine the factors that impact body composition after treatment.
Methods: This prospective cross-sectional study involved 74 subjects who were at least three years post treatment. Measurements included anthropometry, whole body potassium counting, air displacement plethysmography, and three day physical activity and diet diaries. Results: The CCS had significantly reduced body cell mass index Z-scores compared to controls (p ¼ 0.0001), with 59% considered undernourished. The CCS had a significantly higher percent fat (p ¼ 0.002) than the controls, with 27% classified as obese. The intake of 60% of CCS met estimated 1,2-Distearoyl-sn-glycero-3-PC requirements, but the CCS consumed high amount of energy from fat and low amount of energy from carbohydrates. A high percentage of CCS did not meet their dietary requirements for calcium (61%), magnesium (46%), folate (38%) and iodine (38%). The CCS group had a light active lifestyle with 64% spending more than 2 h daily on screen time. Receiving a bone marrow transplant (r ¼ 0.27; p ¼ 0.02) and physical activity level (r ¼ 0.49; p ¼ 0.0001) were significantly correlated with body cell mass index. Conclusions: This study demonstrates that increased fat mass and decreased body cell mass is a concern for CCS and that CCS have poor health behaviours including light active lifestyles, excessive screentime, high fat intake, and poor intake of essential nutrients. This study has highlighted that CCS are at risk of both obesity and undernutrition and that increasing body cell mass as well as decreasing fat mass should be a focus of energy balance interventions in survivorship. There is a need for parents and children undergoing treatment for cancer to be educated about diet quality and importance of daily physical activity to ensure healthy habits are established and maintained into survivorship. r> © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
The five-year relative survival rate for all children diagnosed with cancer has improved over recent decades and is approxi-mately 80% in developed countries [1e4]. The improvement in survival of cancer patients has placed an increased focus on the long term effects of treatment, with late effects of childhood cancer representing a continuing emotional and physical burden on
Abbreviations: AMDR, Acceptable Macronutrient Distribution Range; BCM, body cell mass; BCMI, body cell mass index; BMT, bone marrow transplant; BMI, body mass index; CCS, childhood cancer survivors; EAR, estimated average requirement; EER, estimated energy requirements; %FM, percent fat mass; FM, fat mass; FMI, fat mass index; FFM, fat free mass; FFMI, fat free mass index; METs, metabolic equivalents; MVPA, moderate to vigorous physical activity; PAL, physical activity level; TBK, total body potassium.
* Corresponding author.
E-mail address: [email protected] (A.J. Murphy-Alford).
children and families. It has recently been reported that 70% of survivors exhibit at least one chronic health condition five years post treatment  and it is recognized that adult survivors of childhood cancer are at increased risk of developing second cancers [5,6], cardiovascular disease [7,8], diabetes [9,10], and obesity [11,12]. The development of obesity in this population is particu-larly alarming because increased fat mass may exacerbate the other chronic health conditions experienced by childhood cancer survi-vors (CCS). Increased fat mass is not the only body composition alteration that is a concern in cancer patients and survivors, as recent studies in adult patients have shown that it may be the reduced lean mass that influences outcomes in cancer [13e16].