Metabolic Syndrome (MS) and Cardiovascular Risk (CV) in Peripubertal and Adolescent Childhood Cancer Survivors (CCS)

Presentation Number: OR42-1
Date of Presentation: April 3rd, 2017

Natascia Di Iorgi*1, Vera Morsellino2, Sanà Dhrari Salem2, Annalisa Gallizia2, Federica Ceroni3, Angela Pistorio2, Riccardo Haupt2 and Mohamad Maghnie1
1Istituto Giannina Gaslini, Università degli Studi di Genova, Genova, Italy, 2Istituto G. Gaslini, Genova, Italy, 3Great Ormond Street Hospital, London, United Kingdom


Introduction and aim: Pediatric CCS have greater CV risk than healthy children that may track into adulthood; however, in this cohort, data about the MS are limited and not well defined. Aim of the study was to evaluate the prevalence of the MS based on the IDF 2007 criteria and of the CV risks included in its definition, i.e. central adiposity based on waist circumference, in a large single center cohort of young CCS.

Methods: two-hundred and six patients (111M, 95F) diagnosed with cancer at a median age of 4.7 years (leukemia/lymphoma n=72, solid tumor n=83, brain tumor n=51) were evaluated at 10-16 years old, with a median off-therapy interval since diagnosis of 8.1 years. All subjects underwent clinical (height-cm, weight-kg,BMI-SDS, waist and hip circumference-WC and HC-cm and ratios, blood pressure, Tanner pubertal staging) biochemical/hormonal (triglicerides-TG, HDL and LDL cholesterol, glicaemia, insulin, fT4) evaluations. The IDF 2007 criteria were applied for the MS definition (CV>90th percentile plus at least 2 of the following: TG>150 mg/dl, HDL<40 mg/dl, blood pressure>130/85 mmHg, baseline glicaemia>100 mg/dl or diabetes mellitus type 2).

Results: in the cohort overall we found a 3.9% prevalence of MS (n=8, 3F, 5M, all>3 Tanner stage) that increased up to 9.9% (n=8/81, 53 males, 28 females) in the obese population (BMI-SDS>2). We found no associations between the MS and type of tumor or previous cancer treatment; however, subjects with brain tumor displayed an overall unfavorable metabolic pattern with increased lipid profile (LDL, TG) and WC/HC ratio (all P values< 0.05) compared to other cancer groups Multiple logistic regression analyses demonstrated that the model with a BMI-SDS >2.24 and a baseline insulin >10.8 µU/mL perfectly predicted the MS; subjects with a WC/height ratio >0.53 (ORadj: 41.6; p <0.0001) and fT4 <9.9 pg/ml (ORadj: 10.6; p=0.007) presented a higher MS risk compared to patients not satisfying these cut-offs. Central adiposity (WC>90thpercentile) was found in 52.4% of the cohort (n=108/206, n=61M, n=47F); BMI-SDS>2.24 (p<0.0001), insulin >10.8 µU/mL (p<0.0001) and prepubertal Tanner stage (p =0.012) were associated to it. A perfect prediction of central adiposity was obtained by a systolic blood pressure value >130 mmHg; furthermore, subjects with a BMI-SDS >2.24 (ORadj: 148.7; p <0.0001) and a follow-up since cancer diagnosis <9.7 years (ORadj: 2.6; p=0.014) presented an increased risk of having a WC>90th percentile.

Conclusions: In our large cohort of CCS 10-16 years of age we found a MS prevalence of 3.9%, 8 years after off-therapy, that increased up to 10% in the obese cohort; however, central adiposity was diagnosed in more than half of the overall population, highlighting an early potential CV morbidity. Specific cut-off for BMI, insulin, fT4 and WC/height ratio could be valuable predictors for developing a MS or CV risk, but they need further validation.


Disclosure: MM: Speaker, Lilly USA, LLC, Speaker, Novo Nordisk, Speaker, Serono, Speaker, Pfizer, Inc., Speaker, Sandoz. Nothing to Disclose: ND, VM, SD, AG, FC, AP, RH