{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:50:50Z","timestamp":1791384650744,"version":"4.3.3"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T00:00:00Z","timestamp":1716336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T00:00:00Z","timestamp":1716336000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA55727"],"award-info":[{"award-number":["CA55727"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA21765"],"award-info":[{"award-number":["CA21765"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007737","name":"St. Jude Children's Research Hospital","doi-asserted-by":"publisher","award":["CA21765"],"award-info":[{"award-number":["CA21765"]}],"id":[{"id":"10.13039\/100007737","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Approximately 1 in 10 adult survivors of childhood cancer is underweight. Although the consequences of being overweight or obese have been well described, outcomes among childhood cancer survivors who are underweight are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether underweight status increases the risk of mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>\n                      Cohort study: Marginal models with generalized estimating equations to evaluate the associations between body mass index (BMI), serious or life\u2010threatening chronic conditions, and death in the setting of long\u2010term follow\u2010up questionnaires and National Death Index search. Participants: Childhood cancer five\u2010year survivors diagnosed during 1970\u20131986 in the Childhood Cancer Survivor Study Exposure: Underweight status, defined as body mass index (BMI) &lt; 18.5 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      compared with ideal body weight. Based on available literature on body weight and mortality from the general population, ideal body weight was defined as BMI 22.0\u201024.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Main outcomes: Overall mortality and cancer\u2010specific mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 9454 survivors (median age 35 years old (range, 17\u201058), an average of 17.5 years from diagnosis), 627 (6.6%) participants were underweight at baseline or follow\u2010up questionnaire. Of 184 deaths, 29 were among underweight survivors. Underweight status was more common among females (9.1%\u00a0vs. 4.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.01) and participants with younger age at diagnosis (8.2% for\u00a0&lt;\u00a05 years vs. 6.1% for\u00a0\u22655 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.01), lower household income (8.9% for\u00a0&lt;\u00a0$20,000\u00a0vs. 6.0% for\u00a0\u2265 $20,000,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.01), or a history of serious chronic condition (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.05). After adjustment for these factors, in addition to prior smoking and a history of radiation therapy, the risk of all\u2010cause mortality within two years of BMI report was increased (OR 2.85; 95% CI: 1.63\u20104.97;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.01) for underweight survivors, compared with ideal\u2010weight survivors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Childhood cancer survivors who are underweight are at increased risk for late mortality that appears unrelated to smoking status, recognized chronic disease, or subsequent malignancy. Whether targeted nutritional interventions would ameliorate this risk is unknown.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.31080","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:07:00Z","timestamp":1716422820000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk of increased mortality in underweight survivors: A brief report from the Childhood Cancer Survivor Study"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-5210","authenticated-orcid":false,"given":"Emily S.","family":"Tonorezos","sequence":"first","affiliation":[{"name":"Division of Cancer Control and Population Sciences National Cancer Institute  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne F.","family":"Chou","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Biostatistics and Pediatrics Memorial Sloan Kettering  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaya S.","family":"Moskowitz","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Biostatistics and Pediatrics Memorial Sloan Kettering  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy M.","family":"Leisenring","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4668-9176","authenticated-orcid":false,"given":"Danielle Novetsky","family":"Friedman","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Biostatistics and Pediatrics Memorial Sloan Kettering  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Sklar","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Biostatistics and Pediatrics Memorial Sloan Kettering  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly J.","family":"Dilley","sequence":"additional","affiliation":[{"name":"Advocate Health Care  Oaklawn Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Hudson","sequence":"additional","affiliation":[{"name":"Departments of Oncology and Epidemiology and Cancer Control St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Mertens","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics Emory University  Atlanta Georgia 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