Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study

Melissa Bolier; Demi T.C. de Winter; Vincent G. Pluimakers; Marta Fiocco; Sjoerd A.A. van den Berg; Dorine Bresters; Eline van Dulmen-den Broeder; Margriet van der Heiden-van der Loo; Imo Höfer; Geert O. Janssens; Leontien C.M. Kremer; Jacqueline J. Loonen; Marloes Louwerens; Heleen J. van der Pal; Saskia M.F. Pluijm; Wim J.E. Tissing; Hanneke M. van Santen; Andrica C.H. de Vries; Aart Jan van der Lely; Marry M. van den Heuvel-Eibrink; Sebastian J.C.M.M. Neggers

doi:10.1002/cncr.35681

Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study

Melissa Bolier^*
, Demi T.C. de Winter
, Vincent G. Pluimakers
, Marta Fiocco
, Sjoerd A.A. van den Berg
, Dorine Bresters
, Eline van Dulmen-den Broeder
, Margriet van der Heiden-van der Loo
, Imo Höfer
, Geert O. Janssens
, Leontien C.M. Kremer
, Jacqueline J. Loonen
, Marloes Louwerens
, Heleen J. van der Pal
, Saskia M.F. Pluijm
, Wim J.E. Tissing
, Hanneke M. van Santen
, Andrica C.H. de Vries
, Aart Jan van der Lely
, Marry M. van den Heuvel-Eibrink

Sebastian J.C.M.M. Neggers

^*Corresponding author for this work

Princess Máxima Center for Pediatric Oncology
Leiden University
Vrije Universiteit Amsterdam
Utrecht University
University Medical Centre Utrecht
University of Amsterdam
Radboud University Medical Center
University Medical Centre Groningen

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

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Abstract

Background:

Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor’s excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort.

Methods:

In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat% instead of waist circumference to define abdominal adiposity. Logistic regression models, adjusted for age and sex, were used to investigate the association between the presence of MetS and both cohorts. Demographic, lifestyle, and treatment determinants of MetS were identified through multivariable logistic regression.

Results:

The survivor cohort (median age, 34.7 years, median follow-up time, 27.1 years) showed increased adjusted odds ratio (aOR) for MetS (modified National Cholesterol Education Program Adult Treatment Panel III criteria), as compared to the reference cohort (aOR, 2.07; 95% confidence interval [CI], 1.85–2.32). Compared to these criteria, the alternative method identified 57 additional survivors with MetS (395 of 2070 [19.1%] vs. 452 of 1960 [23.1%], respectively). Age (odds ratio [OR], 1.07; 95% CI, 1.04–1.10, per year increase), smoking (OR, 1.46; 95% CI, 1.04–2.04), low physical activity (OR, 1.48; 95% CI, 1.05–2.09), abdominal radiotherapy (OR, 2.13; 95% CI, 1.01–4.31; >30 Gy), cranial radiotherapy (OR, 2.89; 95% CI, 1.67–4.96; 1–25 Gy; and OR, 2.44; 95% CI, 1.30–4.47; >25 Gy), total body irradiation (OR, 6.17; 95% CI, 3.20–11.76), and underlying central nervous system tumor (OR, 1.78; 95% CI, 1.21–2.60) were associated with MetS.

Conclusion:

The high risk of MetS in CCS, combined with several potential modifiable factors, underscores the need for timely identification and intervention strategies to mitigate the long-term cardiovascular risks in CCS.

Original language	English
Article number	e35681
Journal	Cancer
Volume	131
Issue number	1
DOIs	https://doi.org/10.1002/cncr.35681
Publication status	Published - 1 Jan 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Bolier, M., de Winter, D. T. C., Pluimakers, V. G., Fiocco, M., van den Berg, S. A. A., Bresters, D., van Dulmen-den Broeder, E., van der Heiden-van der Loo, M., Höfer, I., Janssens, G. O., Kremer, L. C. M., Loonen, J. J., Louwerens, M., van der Pal, H. J., Pluijm, S. M. F., Tissing, W. J. E., van Santen, H. M., de Vries, A. C. H., van der Lely, A. J., ... Neggers, S. J. C. M. M. (2025). Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study. Cancer, 131(1), Article e35681. https://doi.org/10.1002/cncr.35681

@article{3b61a8d9244c4d28bdb4f8f7eac3387b,

title = "Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study",

abstract = "Background: Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor{\textquoteright}s excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort. Methods:In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat\% instead of waist circumference to define abdominal adiposity. Logistic regression models, adjusted for age and sex, were used to investigate the association between the presence of MetS and both cohorts. Demographic, lifestyle, and treatment determinants of MetS were identified through multivariable logistic regression. Results: The survivor cohort (median age, 34.7 years, median follow-up time, 27.1 years) showed increased adjusted odds ratio (aOR) for MetS (modified National Cholesterol Education Program Adult Treatment Panel III criteria), as compared to the reference cohort (aOR, 2.07; 95\% confidence interval [CI], 1.85–2.32). Compared to these criteria, the alternative method identified 57 additional survivors with MetS (395 of 2070 [19.1\%] vs. 452 of 1960 [23.1\%], respectively). Age (odds ratio [OR], 1.07; 95\% CI, 1.04–1.10, per year increase), smoking (OR, 1.46; 95\% CI, 1.04–2.04), low physical activity (OR, 1.48; 95\% CI, 1.05–2.09), abdominal radiotherapy (OR, 2.13; 95\% CI, 1.01–4.31; >30 Gy), cranial radiotherapy (OR, 2.89; 95\% CI, 1.67–4.96; 1–25 Gy; and OR, 2.44; 95\% CI, 1.30–4.47; >25 Gy), total body irradiation (OR, 6.17; 95\% CI, 3.20–11.76), and underlying central nervous system tumor (OR, 1.78; 95\% CI, 1.21–2.60) were associated with MetS. Conclusion: The high risk of MetS in CCS, combined with several potential modifiable factors, underscores the need for timely identification and intervention strategies to mitigate the long-term cardiovascular risks in CCS.",

author = "Melissa Bolier and \{de Winter\}, \{Demi T.C.\} and Pluimakers, \{Vincent G.\} and Marta Fiocco and \{van den Berg\}, \{Sjoerd A.A.\} and Dorine Bresters and \{van Dulmen-den Broeder\}, Eline and \{van der Heiden-van der Loo\}, Margriet and Imo H{\"o}fer and Janssens, \{Geert O.\} and Kremer, \{Leontien C.M.\} and Loonen, \{Jacqueline J.\} and Marloes Louwerens and \{van der Pal\}, \{Heleen J.\} and Pluijm, \{Saskia M.F.\} and Tissing, \{Wim J.E.\} and \{van Santen\}, \{Hanneke M.\} and \{de Vries\}, \{Andrica C.H.\} and \{van der Lely\}, \{Aart Jan\} and \{van den Heuvel-Eibrink\}, \{Marry M.\} and Neggers, \{Sebastian J.C.M.M.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.",

year = "2025",

month = jan,

day = "1",

doi = "10.1002/cncr.35681",

language = "English",

volume = "131",

journal = "Cancer",

issn = "0008-543X",

publisher = "John Wiley \& Sons Inc.",

number = "1",

}

Bolier, M, de Winter, DTC, Pluimakers, VG, Fiocco, M, van den Berg, SAA, Bresters, D, van Dulmen-den Broeder, E, van der Heiden-van der Loo, M, Höfer, I, Janssens, GO, Kremer, LCM, Loonen, JJ, Louwerens, M, van der Pal, HJ, Pluijm, SMF, Tissing, WJE, van Santen, HM, de Vries, ACH , van der Lely, AJ, van den Heuvel-Eibrink, MM & Neggers, SJCMM 2025, 'Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study', Cancer, vol. 131, no. 1, e35681. https://doi.org/10.1002/cncr.35681

TY - JOUR

T1 - Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors

T2 - A Dutch Childhood Cancer Survivor LATER 2 study

AU - Bolier, Melissa

AU - de Winter, Demi T.C.

AU - Pluimakers, Vincent G.

AU - Fiocco, Marta

AU - van den Berg, Sjoerd A.A.

AU - Bresters, Dorine

AU - van Dulmen-den Broeder, Eline

AU - van der Heiden-van der Loo, Margriet

AU - Höfer, Imo

AU - Janssens, Geert O.

AU - Kremer, Leontien C.M.

AU - Loonen, Jacqueline J.

AU - Louwerens, Marloes

AU - van der Pal, Heleen J.

AU - Pluijm, Saskia M.F.

AU - Tissing, Wim J.E.

AU - van Santen, Hanneke M.

AU - de Vries, Andrica C.H.

AU - van der Lely, Aart Jan

AU - van den Heuvel-Eibrink, Marry M.

AU - Neggers, Sebastian J.C.M.M.

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background: Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor’s excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort. Methods:In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat% instead of waist circumference to define abdominal adiposity. Logistic regression models, adjusted for age and sex, were used to investigate the association between the presence of MetS and both cohorts. Demographic, lifestyle, and treatment determinants of MetS were identified through multivariable logistic regression. Results: The survivor cohort (median age, 34.7 years, median follow-up time, 27.1 years) showed increased adjusted odds ratio (aOR) for MetS (modified National Cholesterol Education Program Adult Treatment Panel III criteria), as compared to the reference cohort (aOR, 2.07; 95% confidence interval [CI], 1.85–2.32). Compared to these criteria, the alternative method identified 57 additional survivors with MetS (395 of 2070 [19.1%] vs. 452 of 1960 [23.1%], respectively). Age (odds ratio [OR], 1.07; 95% CI, 1.04–1.10, per year increase), smoking (OR, 1.46; 95% CI, 1.04–2.04), low physical activity (OR, 1.48; 95% CI, 1.05–2.09), abdominal radiotherapy (OR, 2.13; 95% CI, 1.01–4.31; >30 Gy), cranial radiotherapy (OR, 2.89; 95% CI, 1.67–4.96; 1–25 Gy; and OR, 2.44; 95% CI, 1.30–4.47; >25 Gy), total body irradiation (OR, 6.17; 95% CI, 3.20–11.76), and underlying central nervous system tumor (OR, 1.78; 95% CI, 1.21–2.60) were associated with MetS. Conclusion: The high risk of MetS in CCS, combined with several potential modifiable factors, underscores the need for timely identification and intervention strategies to mitigate the long-term cardiovascular risks in CCS.

AB - Background: Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor’s excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort. Methods:In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat% instead of waist circumference to define abdominal adiposity. Logistic regression models, adjusted for age and sex, were used to investigate the association between the presence of MetS and both cohorts. Demographic, lifestyle, and treatment determinants of MetS were identified through multivariable logistic regression. Results: The survivor cohort (median age, 34.7 years, median follow-up time, 27.1 years) showed increased adjusted odds ratio (aOR) for MetS (modified National Cholesterol Education Program Adult Treatment Panel III criteria), as compared to the reference cohort (aOR, 2.07; 95% confidence interval [CI], 1.85–2.32). Compared to these criteria, the alternative method identified 57 additional survivors with MetS (395 of 2070 [19.1%] vs. 452 of 1960 [23.1%], respectively). Age (odds ratio [OR], 1.07; 95% CI, 1.04–1.10, per year increase), smoking (OR, 1.46; 95% CI, 1.04–2.04), low physical activity (OR, 1.48; 95% CI, 1.05–2.09), abdominal radiotherapy (OR, 2.13; 95% CI, 1.01–4.31; >30 Gy), cranial radiotherapy (OR, 2.89; 95% CI, 1.67–4.96; 1–25 Gy; and OR, 2.44; 95% CI, 1.30–4.47; >25 Gy), total body irradiation (OR, 6.17; 95% CI, 3.20–11.76), and underlying central nervous system tumor (OR, 1.78; 95% CI, 1.21–2.60) were associated with MetS. Conclusion: The high risk of MetS in CCS, combined with several potential modifiable factors, underscores the need for timely identification and intervention strategies to mitigate the long-term cardiovascular risks in CCS.

UR - https://www.scopus.com/pages/publications/85214110123

U2 - 10.1002/cncr.35681

DO - 10.1002/cncr.35681

M3 - Article

C2 - 39748458

AN - SCOPUS:85214110123

SN - 0008-543X

VL - 131

JO - Cancer

JF - Cancer

IS - 1

M1 - e35681

ER -

Prevalence and determinants of metabolic syndrome in 2338 childhood cancer survivors: A Dutch Childhood Cancer Survivor LATER 2 study

Abstract

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