Metabolic Syndrome in Childhood Cancer Survivors: Does Delta BMI Predict Risk in Lower-middle-income Countries?

Purpose Metabolic syndrome (MetSyn) is an important late effect of childhood cancer. The combination of rising obesity and high prevalence of under-nutrition at diagnosis, make this a unique population to study in LMIC (lower middle-income countries). Methods Children <18 years of age at cancer diagnosis, in a single-centre in a LMIC, who were disease free and had completed treatment at least 2 years prior to study were included. MetSyn was defined using International Federation for Diabetes criteria for Asian Indians. Logistic regression analyses were carried out to evaluate the influence of various risk factors, including delta BMI (increase in body mass index from diagnosis to evaluation), on MetSyn.Results A high prevalence of MetSyn (12.2%), central obesity (33%), and dyslipidemia (61.8%) was found in a cohort of 500 Asian Indian childhood cancer survivors (CCS) at a median follow-up age of 17 years. Multivariable analysis revealed older age at diagnosis >10 years, OR 2.9(1.6-5), longer survival duration >10 years, OR 2.2(1.3-3.8), high BMI at diagnosis OR 3.2(1.5-6.9) and large delta BMI >50, OR 3.15(1.7-5.9) to be independent predictors of MetSyn. Patients who were under-weight or normal at diagnosis with large Delta BMI > 50 had very high odds (OR, 12.5,1.7-92) of developing MetSyn compared to those with lower Delta BMI. Conclusions and implications for cancer survivors: A high prevalence of MetSyn was observed in CCS with early age at onset. Timely screening and early intervention are proven to be beneficial and delta BMI could be a useful screening tool for LMIC.