Obesity at diagnosis predicts poorer survival for children with cancer
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Key takeaways:
- Children with obesity at cancer diagnosis had poorer survival.
- Researchers observed the strongest associations for children with acute lymphoblastic leukemia and central nervous system tumors.
Obesity at cancer diagnosis appeared linked to significantly poorer survival among children and adolescents, according to results of a retrospective study.
The association between obesity and mortality risk appeared strongest among those with acute lymphoblastic leukemia or central nervous system tumors.
“Our study highlights the negative impact of obesity among all types of childhood cancers,” Thai Hoa Tran, MD, FRCPC, pediatric hematologist-oncologist and clinical adjunct professor at Centre Hospitalier Universitaire Sainte-Justine in Montreal, said in a press release. “It provides the rationale to evaluate different strategies to mitigate the adverse risk of obesity on cancer outcomes in future trials. It also reinforces the urgent need to reduce the epidemic of childhood obesity as it can result in significant health consequences.”
Background and methods
Nearly 20% of children and young adults aged 2 to 19 years in the U.S. have obesity, according to the CDC.
Childhood obesity can cause adverse events such as type 2 diabetes, hypertension, dyslipidemia, depression and sleep apnea, according to study background.
Prior research showed adults with obesity have increased risk for multiple malignancies, including breast, colorectal, uterine, prostate and pancreatic cancers.
Other studies showed children with obesity diagnosed with cancer have a higher likelihood of adverse events. However, that research has been “inconsistent,” Tran and colleagues wrote.
Researchers used the Cancer in Young People in Canada database to investigate obesity’s impact on survival.
The analysis included 11,291 children (median age, 7.6 years; interquartile range, 4.2-12.5 years; 55% boys; 56.2% white) diagnosed with cancer between 2001 and 2020, all of whom had height and weight measurements within 30 days of diagnosis.
The cohort included multiple cancer types, including leukemia (37.1%; 82.5% of leukemia diagnoses being ALL), lymphoma (14.5%), central nervous system tumors (21.8%) and non-central nervous system malignancies (26.6%).
Investigators defined obesity as BMI greater than or equal to the 95th percentile for age and sex.
Five-year EFS and OS rates served as the primary endpoints.
Results and next steps
Researchers determined 10.5% of the cohort had obesity. Obesity rates peaked 2 years following diagnosis.
Patients with obesity at diagnosis were older than those who did not have obesity (median age, 8.6 years vs. 7.5 years).
A lower percentage of patients with obesity than without achieved 5-year EFS (77.5% vs. 79.6%; adjusted HR = 1.16; 95% CI, 1.02-1.32) or 5-year OS (83% vs. 85.9%; adjusted HR = 1.29; 95% CI, 1.11-1.49).
This trend appeared particularly strong for patients with ALL, with those who had obesity being significantly less likely than those without obesity to achieve 5-year EFS (84.5% vs. 89.8%; adjusted HR = 1.55; 95% CI, 1.17-2.04) or 5-year OS (89.8% vs. 94.4%; adjusted HR = 1.75; 95% CI, 1.23-2.49).
Researchers observed the link for B-cell ALL but not for T-lineage ALL.
Analyses of children and adolescents diagnosed with central nervous system tumors also revealed associations between obesity and poorer 5-year EFS (68.1% vs. 74.2%; adjusted HR = 1.38; 95% CI, 1.09-1.76) and OS (73.1% vs. 79.3%; adjusted HR = 1.47; 95% CI, 1.13-1.91).
Tran and colleagues did not observe associations between obesity and outcomes for patients with lymphoma or non-central nervous system tumors.
Researchers acknowledged study limitations, including use of BMI to determine obesity — which they described as a “crude and imperfect” measurement — and lack of data on chemotherapy dose calculations.
“Further studies are needed to better characterize the pathophysiologic mechanisms linking obesity and survival in pediatric oncology,” Tran and colleagues wrote. “Furthermore, it is crucial to determine whether normalization of weight during treatment positively affects cancer outcomes to inform future trial designs and supportive care interventions.”
References:
- CDC. Childhood obesity facts. Available at: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html. Published April 2, 2024. Accessed Jan. 10, 2025.
- Does obesity affect children’s likelihood of survival after being diagnosed with cancer? (press release). Published Jan. 13, 2025. Accessed Jan. 13, 2025.
- Sassine S, et al. Cancer. 2025;doi:10.1002/cncr.35673.
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