Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Risk Factors for Obesity in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
复制标题
DOI：
10.1200/jco.2010.34.4267
复制
发表时间：
2012-01-20
影响因子：
45.3
通讯作者：
Robison, Leslie L.
中科院分区：
文献类型：
--
作者：
Green, Daniel M.;Cox, Cheryl L.;Robison, Leslie L.
许多儿童癌症幸存者研究（CCSS）的参与者肥胖的风险增加。他们肥胖的病因可能是多因素的，但还没有很好地understood.Patients and MethodsWe评估了潜在的贡献人口，生活方式，治疗，和个人因素和自我报告的药物使用肥胖（体重指数>= 30 kg/m2）在9,284成人（> 18岁）CCSS参与者。使用多变量回归模型确定独立的预测因子。使用结构方程模型（SEM）确定相互关系。结果肥胖的独立危险因素包括5至9岁时诊断的癌症（相对风险[RR]，1.12; 95% CI，1.01 - 1.24; P = 0.03），简表-36身体功能异常（RR，1.19; 95% CI，1.06 - 1.33; P < .001），下丘脑/垂体放射剂量为20 - 30戈伊（RR，1.17; 95% CI，1.05至1.30; P = .01），和帕罗西汀使用（RR，1.29; 95% CI，1.08至1.54; P = .01）。符合美国疾病控制和预防中心关于剧烈体力活动（RR，0.90; 95% CI，0.82至0.97; P = 0.01）和中等程度焦虑（RR，0.86; 95% CI，0.75至0.99; P = 0.04）的指南可降低肥胖风险。SEM结果（N = 8，244;比较拟合指数= 0.999; Tucker刘易斯指数= 0.999;近似均方根误差= 0.014;加权均方根残差= 0.749）描述了肥胖的直接预测因子、调节因子和介导因子的分层影响。结论治疗、生活方式和个人因素，以及使用特定的抗抑郁药，可能会导致幸存者肥胖。可能需要多方面的干预，包括替代药物和其他抑郁和焦虑疗法，以降低风险。
PurposeMany 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 MethodsWe 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).ResultsIndependent 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.ConclusionTreatment, 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.