title: Metabolic Health in Childhood Cancer Survivors: A Longitudinal Study in a Long-Term Follow-Up Clinic.
abstract: OBJECTIVE
  Childhood cancer survivors (CCS) are at increased risk of metabolic dysfunction as a late effect of cancer treatment. However, pediatric metabolic syndrome (MetS) lacks a unified definition, limiting the diagnosis of MetS in CCS. This study evaluated individual metabolic health risk factors and potential areas for intervention in this at-risk population.
  
  
  METHODS
  This single center, retrospective observational longitudinal study evaluated the metabolic health of all CCS attending an oncology long-term follow-up clinic at a university hospital in Sydney, Australia (January 2012-August 2014). Participants were 276 CCS (52.2% male; mean age 18.0 years; range 6.8-37.9 years), at least 5 years disease free with a broad spectrum of oncological diagnoses. Primary metabolic health risk factors included raised body mass index, hypertension, and hypertransaminasemia. Participants treated with cranial radiotherapy (n = 47; 17.0% of cohort) had additional biochemical variables analyzed: fasting glucose/insulin, HDL/LDL cholesterol, and triglycerides.
  
  
  RESULTS
  Hypertension was common (19.0%), with male sex (p < 0.01) and being aged 18 years or above (p < 0.01) identified as risk factors. Cranial irradiation was a risk factor for overweight/obesity (47.8% in cranial radiotherapy-treated participants vs. 30.4%; p = 0.02). Hypertransaminasemia was more prevalent among participants treated with radiotherapy (15.6% vs. 7.3%; p = 0.03), and overweight/obese participants (17.6% vs. 8.2%; p = 0.04).
  
  
  CONCLUSIONS
  Metabolic health risk factors comprising MetS are common in CCS, placing this population at risk of premature adverse cardiovascular consequences. Proactive surveillance and targeted interventions are required to minimize these metabolic complications, and a unified definition for pediatric MetS would improve identification and monitoring.
authors.affiliation: 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Westmead, Australia .|2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia .
authors.forename: Harriet M
authors.initials: HM
authors.lastname: Gunn
authors.affiliation: 3 The Faculty of Medicine and Health Sciences, Linköping University , Linköping, Sweden .
authors.forename: Hanna
authors.initials: H
authors.lastname: Emilsson
authors.affiliation: 4 Long-Term Follow-Up Clinic, Department of Oncology, The Children's Hospital at Westmead , Westmead, Australia .
authors.forename: Melissa
authors.initials: M
authors.lastname: Gabriel
authors.affiliation: 2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia .|5 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead , Westmead, Australia .
authors.forename: Ann M
authors.initials: AM
authors.lastname: Maguire
authors.affiliation: 1 Academic Department of Adolescent Medicine, The Children's Hospital at Westmead , Westmead, Australia .|2 Discipline of Paediatrics and Child Health, The University of Sydney , Sydney, Australia .
authors.forename: Katharine S
authors.initials: KS
authors.lastname: Steinbeck
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000209:etiology*; D009369:Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: hypertension; metabolic; non-alcoholic fatty liver disease; obesity; overweight