{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:34:30Z","timestamp":1791837270985,"version":"4.3.4"},"reference-count":63,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T00:00:00Z","timestamp":1697241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006244","name":"Children Cancer-free Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006244","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004786","name":"ODAS Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004786","id-type":"DOI","asserted-by":"publisher"}]},{"name":"KiKaRoW Association"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Overweight and obesity are common challenges among childhood cancer survivors. Overweight may be disguised, as survivors can have normal weight but high fat percentage (fat%) on dual-energy X-ray absorptiometry (DXA). We aimed to assess prevalence, identify determinants and biomarkers, and assess which method captures overweight best, in a nationwide cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The prevalence of overweight and obesity, primarily defined by body mass index (BMI), was assessed in the DCCSS-LATER cohort of adult survivors treated from 1963-2002, with the LifeLines cohort as reference. The associations between risk factors and overweight metrics were investigated using logistic regression. Additional overweight metrics included DXA fat%, waist circumference (WC), waist\/hip ratio (WHR), waist\/height ratio (WHtR), and high-molecular-weight (HMW) adiponectin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2338 (mean age 35.5 years, follow-up 28.3 years) survivors participated. The overweight prevalence was 46.3% in men and 44.3% in women (obesity 11.2% and 15.9%, morbid obesity 2.4% and 5.4%), with highest rates among brain tumor survivors. Compared to controls, there was no overall increased overweight rate, but this was higher in women &amp;gt; 50 years, morbid obesity in men &amp;gt; 50 years. Overweight at cancer diagnosis (adjusted odds ratio [aOR] = 3.83, 95% CI 2.19-6.69), cranial radiotherapy (aOR = 3.21, 95% CI 1.99-5.18), and growth hormone deficiency (separate model, aOR = 1.61, 95% CI 1.00-2.59) were associated with overweight. Using BMI, WC, WHR, and WHtR, overweight prevalence was similar. Low HMW adiponectin, present in only 4.5% of survivors, was an insensitive overweight marker. Dual-energy X-ray absorptiometry\u2013based classification identified overweight in an additional 30%, particularly after abdominal radiotherapy, total body irradiation, anthracyclines, and platinum.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Overweight occurs in almost half of long-term survivors. There was no overall increased incidence of overweight compared to controls. We identified factors associated with overweight, as well as subgroups of survivors in whom DXA can more reliably assess overweight.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvad139","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T15:41:08Z","timestamp":1697298068000},"page":"495-507","source":"Crossref","is-referenced-by-count":15,"title":["Prevalence, risk factors, and optimal way to determine overweight, obesity, and morbid obesity in the first Dutch cohort of 2338 long-term survivors of childhood cancer: a DCCSS-LATER study"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3066-3951","authenticated-orcid":false,"given":"Vincent G","family":"Pluimakers","sequence":"first","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenneke E","family":"van Atteveld","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demi T C","family":"de Winter","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Bolier","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Fiocco","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Medical Statistics, Department of Biomedical Data Science, Leiden UMC , Leiden 2333 ZA , The Netherlands"},{"name":"Mathematical Institute Leiden University , Leiden 2333 ZA , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger Jan A J","family":"Nievelstein","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Radiology & Nuclear Medicine, UMC Utrecht , Utrecht 3584 CX , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert O R","family":"Janssens","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Radiation Oncology, UMC Utrecht , Utrecht 3584 CX , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorine","family":"Bresters","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margriet","family":"van der Heiden-van der Loo","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrica C H","family":"de Vries","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Pediatric Oncology\/Hematology, Sophia Children's Hospital\/Erasmus MC , Rotterdam 3015 CN , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marloes","family":"Louwerens","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden UMC , Leiden 2333 ZA , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heleen J","family":"van der Pal","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia M F","family":"Pluijm","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile M","family":"Ronckers","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Health Services Research, Carl von Ossietzky University of Oldenburg , Oldenburg 26129 , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrica B","family":"Versluijs","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital\/UMC Utrecht , Utrecht 3584 EA , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leontien C M","family":"Kremer","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Pediatric Oncology, Emma Children's Hospital\/Amsterdam UMC , Amsterdam 1105 AZ , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline J","family":"Loonen","sequence":"additional","affiliation":[{"name":"Department of Hematology, Radboud UMC , Nijmegen 6525 GA , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline","family":"van Dulmen-den Broeder","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim J E","family":"Tissing","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Pediatric Oncology\/Hematology, University of Groningen, UMC Groningen , Groningen 9713 GZ , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke M","family":"van Santen","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Pediatric Endocrinology, Wilhelmina Children's Hospital\/UMC Utrecht , Utrecht 3584 EA , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marry M","family":"van den Heuvel-Eibrink","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian J C M M","family":"Neggers","sequence":"additional","affiliation":[{"name":"Princess M\u00e1xima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands"},{"name":"Department of Medicine, Section Endocrinology, Erasmus MC , Rotterdam 3015 GD , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,14]]},"reference":[{"key":"2023120101523855000_lvad139-B1","volume-title":"SEER Cancer Statistics Review, 1795-2017","author":"Howlader","year":"2020"},{"issue":"14","key":"2023120101523855000_lvad139-B2","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1200\/JCO.2008.21.1425","article-title":"Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study","volume":"27","author":"Armstrong","year":"2009","journal-title":"J Clin 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