Abstract
Background
Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness.
Objectives
Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors.
Methods
Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique.
Results
Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group.
Conclusion
AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.
Acknowledgement
This work was supported by the Telethon New Children’s Hospital Research Fund (CSC), Princess Margaret Hospital Foundation (SRR), The Perron Family Foundation who supports the Chair of Paediatric Haematology/Oncology (CHC) and the REDiMED Honours Scholarship (TML). We acknowledge the assistance of Miss Kerrie Graham for help with recruitment of study participants and Dr. Mandy Taylor for details regarding radiotherapy treatments of the cancer survivors.
Appendix
Surgery and/or chemotherapy (n = 7) | Radiotherapy (n = 13) | ||||
---|---|---|---|---|---|
Mean | SD | Mean | SD | p-Value | |
Heart rate and blood pressure | |||||
Systolic blood pressure, mm Hg | 121 | 9 | 116 | 20 | 0.571 |
Diastolic blood pressure, mm Hg | 69 | 6 | 69 | 13 | 0.911 |
Mean arterial pressure, mm Hg | 89 | 5 | 87 | 17 | 0.836 |
Heart rate, bpm | 76 | 10 | 75 | 16 | 0.905 |
Endothelial function | |||||
Baseline diameter, cm | 0.34 | 0.07 | 0.31 | 0.07 | 0.461 |
Peak diameter, cm | 0.37 | 0.06 | 0.34 | 0.07 | 0.402 |
Delta diameter, cm | 0.03 | 0.01 | 0.06 | 0.09 | 0.576 |
Delta percent, % | 10.19 | 4.69 | 9.78 | 3.08 | 0.836 |
Time to peak, s | 50.41 | 39.59 | 54.16 | 20.93 | 0.799 |
Anthropometry | |||||
Height, cm | 168.51 | 18.17 | 161.77 | 9.12 | 0.278 |
Body mass, kg | 66.96 | 18.87 | 66.33 | 24.99 | 0.955 |
Body mass index, kg/m2 | 23.1 | 3.5 | 25.2 | 8.3 | 0.542 |
Waist circumference, cm | 75.6 | 10.0 | 81.6 | 17.6 | 0.421 |
Hip circumference, cm | 95.0 | 8.6 | 96.5 | 21.4 | 0.863 |
Waist:hip ratio | 0.79 | 0.07 | 0.85 | 0.07 | 0.133 |
Body composition | |||||
Total fat mass, kg | 20.91 | 8.06 | 25.08 | 15.68 | 0.521 |
Central fat mass, kg | 12.02 | 5.10 | 15.37 | 10.98 | 0.459 |
Peripheral fat mass, kg | 14.24 | 5.45 | 15.81 | 8.90 | 0.677 |
Total percent fat, % | 33.56 | 10.13 | 37.43 | 9.78 | 0.415 |
Central percent fat, % | 35.02 | 10.37 | 38.83 | 9.62 | 0.422 |
Peripheral percent fat, % | 36.95 | 11.44 | 40.24 | 10.36 | 0.522 |
Total lean body mass, kg | 42.96 | 15.54 | 37.57 | 9.30 | 0.341 |
Bone mineral density | |||||
Total bone mineral density, g/cm | 1.14 | 0.09 | 1.13 | 0.12 | 0.875 |
Muscular strength, kg | |||||
Lateral pull downs | 49 | 18 | 38 | 15 | 0.184 |
Bicep curl | 8 | 3 | 7 | 4 | 0.805 |
Muscular endurance (60 s) | |||||
Squats | 34 | 12 | 30 | 17 | 0.612 |
Sit-ups | 25 | 7 | 28 | 10 | 0.500 |
Push-ups | 26 | 11 | 23 | 12 | 0.628 |
Graded exercise test | |||||
Rating perceived exertion | 17 | 1 | 16 | 3 | 0.345 |
Maximal heart rate, bpm | 190 | 3 | 178 | 15 | 0.023a |
Minute ventilation, L/min | 80.63 | 39.55 | 58.41 | 17.75 | 0.200 |
Respiratory exchange ratio | 1.01 | 0.06 | 1.08 | 0.35 | 0.634 |
| 2.96 | 1.51 | 2.06 | 0.56 | 0.209 |
| 43.99 | 13.66 | 31.40 | 11.75 | 0.064 |
| 65.68 | 11.29 | 52.92 | 12.28 | 0.053 |
LBM, lean body mass.
aDenotes statistical significance (p ≤ 0.05).
GHD and TSH deficiency (n = 8) | Normal GH and TSH (n = 12) | FSH deficiency (n = 7) | Normal FSH (n = 13) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | p-Value | Mean | SD | Mean | SD | p-Value | |
Heart rate and blood pressure | ||||||||||
Systolic blood pressure, mm Hg | 112 | 15 | 121 | 18 | 0.247 | 119 | 24 | 116 | 14 | 0.784 |
Diastolic blood pressure, mm Hg | 66 | 6 | 71 | 13 | 0.283 | 71 | 15 | 68 | 9 | 0.534 |
Mean arterial pressure, mm Hg | 84 | 10 | 90 | 16 | 0.329 | 89 | 18 | 87 | 11 | 0.760 |
Heart rate, bpm | 73 | 6 | 77 | 18 | 0.550 | 83 | 18 | 71 | 9 | 0.063 |
Endothelial function | ||||||||||
Baseline diameter, cm | 0.28 | 0.07 | 0.34 | 0.06 | 0.060 | 0.29 | 0.06 | 0.33 | 0.07 | 0.229 |
Peak diameter, cm | 0.30 | 0.07 | 0.37 | 0.06 | 0.053 | 0.31 | 0.07 | 0.36 | 0.07 | 0.235 |
Delta diameter, cm | 0.07 | 0.11 | 0.03 | 0.01 | 0.267 | 0.08 | 0.12 | 0.03 | 0.01 | 0.182 |
Delta percent, % | 11.77 | 3.53 | 9.36 | 3.91 | 0.213 | 11.93 | 1.89 | 9.49 | 4.41 | 0.222 |
Time to peak, s | 50.03 | 14.80 | 55.66 | 32.43 | 0.657 | 55.21 | 27.09 | 51.85 | 25.86 | 0.795 |
Anthropometry | ||||||||||
Height, cm | 155.53 | 12.21 | 169.87 | 10.24 | 0.011a | 159.49 | 9.09 | 166.63 | 14.31 | 0.250 |
Body mass, kg | 55.08 | 20.67 | 74.20 | 21.08 | 0.061 | 67.87 | 33.59 | 65.84 | 15.40 | 0.854 |
Body mass index, kg/m2 | 22.19 | 5.73 | 25.99 | 7.53 | 0.242 | 26.03 | 11.16 | 23.63 | 3.53 | 0.478 |
Waist circumference, cm | 73.57 | 13.80 | 82.78 | 15.49 | 0.212 | 82.50 | 25.70 | 77.95 | 8.01 | 0.559 |
Hip circumference, cm | 85.86 | 10.35 | 101.88 | 18.34 | 0.050a | 96.75 | 28.99 | 95.62 | 10.28 | 0.900 |
Waist: hip ratio | 0.85 | 0.08 | 0.81 | 0.07 | 0.272 | 0.85 | 0.09 | 0.82 | 0.06 | 0.354 |
Body composition | ||||||||||
Total fat mass, kg | 19.91 | 10.19 | 26.09 | 15.10 | 0.326 | 26.67 | 20.23 | 21.98 | 8.48 | 0.470 |
Central fat mass, kg | 11.60 | 7.14 | 15.93 | 10.48 | 0.323 | 16.54 | 14.29 | 12.93 | 5.55 | 0.424 |
Peripheral fat mass, kg | 12.96 | 5.63 | 16.79 | 8.77 | 0.290 | 16.65 | 11.40 | 14.51 | 5.30 | 0.569 |
Total percent fat, % | 36.78 | 7.61 | 35.61 | 11.36 | 0.440 | 37.56 | 10.34 | 35.28 | 9.85 | 0.633 |
Central percent fat, % | 37.63 | 9.03 | 37.41 | 10.66 | 0.953 | 38.31 | 11.46 | 37.06 | 9.25 | 0.793 |
Peripheral percent fat, % | 40.29 | 7.21 | 38.30 | 12.58 | 0.099 | 41.10 | 9.90 | 38.01 | 11.15 | 0.547 |
Total lean body mass, kg | 32.39 | 11.01 | 44.16 | 10.02 | 0.023a | 37.48 | 12.22 | 40.2 | 11.84 | 0.594 |
Bone mineral density | ||||||||||
Total bone mineral density, g/cm | 1.08 | 0.10 | 1.16 | 0.11 | 0.261 | 1.14 | 0.11 | 1.13 | 0.11 | 0.871 |
Muscular strength, kg | ||||||||||
Lateral pull downs | 36 | 17 | 46 | 16 | 0.220 | 37 | 15 | 44 | 17 | 0.371 |
Bicep curl | 7 | 2 | 8 | 3 | 0.215 | 7 | 2 | 8 | 3 | 0.444 |
Muscular endurance (60 s) | ||||||||||
Squats | 27 | 13 | 35 | 16 | 0.255 | 30 | 11 | 33 | 17 | 0.696 |
Sit-ups | 24 | 5 | 29 | 11 | 0.294 | 24 | 5 | 28 | 11 | 0.402 |
Push-ups | 20 | 10 | 28 | 11 | 0.146 | 22 | 9 | 26 | 12 | 0.547 |
Graded exercise test | ||||||||||
Rating perceived exertion | 17 | 3 | 17 | 3 | 0.791 | 16 | 3 | 17 | 2 | 0.606 |
Maximal heart rate, bpm | 179 | 13 | 185 | 14 | 0.362 | 182 | 10 | 182 | 15 | 0.959 |
Minute ventilation, L·min−1 | 53.37 | 14.46 | 76.21 | 33.40 | 0.089 | 62.65 | 7.78 | 68.89 | 36.31 | 0.663 |
Respiratory exchange ratio | 0.99 | 0.12 | 1.10 | 0.35 | 0.406 | 1.18 | 0.43 | 0.98 | 0.09 | 0.120 |
| 1.75 | 0.41 | 2.82 | 1.15 | 0.033a | 1.99 | 0.33 | 2.60 | 1.26 | 0.272 |
| 30.79 | 5.44 | 39.38 | 16.49 | 0.207 | 29.10 | 7.17 | 39.52 | 15.00 | 0.133 |
| 53.40 | 9.13 | 60.24 | 15.22 | 0.307 | 51.16 | 8.25 | 60.84 | 14.40 | 0.154 |
FSH, follicle stimulating hormone; GH, growth hormone; GHD, Growth hormone deficiency; LBM, Lean body mass; TSH, thyroid stimulating hormone.
aDenotes statistical significance (p ≤ 0.05).
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