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Age of diagnosis, rate of BMI increase associated with mortality rate for hypothalamic obesity in children
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An increase in BMI following 6 months of therapy for a hypothalamic tumor in children is a risk factor for mortality caused by hypothalamic obesity, with the risk rising in children diagnosed at age 6 years or younger, according to research in Pediatric Obesity.
“[Hypothalamic obesity] is the most frightening [neuroendocrine] problem following surgical intervention in children with brain tumors,” Belma Haliloglu, MD, of the department of pediatric endocrinology at Marmara University Medical School in Istanbul, Turkey, and colleagues wrote. “Although not precisely known, patients with [hypothalamic obesity] probably have a higher mortality rate than patients with other types of obesity; therefore, its diagnosis and identification of the associated risk factors for mortality are important.”
Haliloglu and colleagues analyzed data from 20 children with hypothalamic primary brain tumors and hypothalamic obesity followed for 3 years or more between 2000 and 2013 at Marmara University Hospital and 21 children with hypothalamic primary brain tumors without obesity. The cohort had a mean diagnosis age of 6.36 years; all received supraphysiologic glucocorticoid treatment for 1 month or less.
Researchers calculated BMI and BMI standard deviation of samples (SDS) using growth charts specific for Turkish children; researchers used a t-test to compare mean BMI SDS according to participant age or hormone replacement status. Relative risk was calculated using chi-square contingency tables.
After 6 months, mean BMI SDS increased from 0.77 to 2.66, but slowed from months 6 to 12, according to researchers. The change in BMI SDS in the first 6 months was significantly higher in children aged 6 years or younger at diagnosis vs. children diagnosed at age 6 years or older (3.71 vs. 0.83; P < .001); maximum BMI SDS was also significantly higher in children diagnosed at age 6 years or younger (3.88 vs. 2.79; P < .05).
Four patients in the cohort died; two of the deaths were obesity related. The mortality rate was significantly higher in children with a further BMI SDS increase after 6 months of therapy (RR = 8.4; P < .05). Children diagnosed at age 6 years or younger had a 4.5-fold higher overall mortality rate (37.5% vs. 8.3%) and 7.2-fold higher obesity-related mortality rate. Children with a maximum BMI SDS of 3 or greater at any time during the first 3 years after treatment had a 3.7-fold higher mortality rate (33.3% vs. 9%), according to researchers.
“These findings indicate that the first 6 months after tumor therapy is extremely critical for the prevention of severe [hypothalamic obesity],” the researchers wrote. “Additionally, overall mortality risk was significantly higher in the present study’s subjects that continued to gain weight beyond 6 months posttreatment.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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