Bone mineral density and nutrition in long-term survivors of childhood brain tumors. (August 2022)

• Record Type: Journal Article
• Authors: Kvammen, Janne Anita; Stensvold, Einar; Godang, Kristin; Bollerslev, Jens; Myklebust, Tor Åge; Brandal, Petter; Henriksen, Christine; Bechensteen, Anne Grete
• Is Part Of: Clinical nutrition ESPEN. Volume 50(2022)
• Page Start: 162
• Page End: 169
• Publication Date: 2022-08
• Subjects: Bone -- Brain tumors -- Childhood cancer survivors -- Nutrition -- Physical activity; BMD bone mineral density (g/cm2) -- BMDz bone mineral density Z-score -- BMI body mass index, kg/m2 -- BMR basal metabolic rate -- CSI craniospinal irradiation -- CNS central nervous system -- CNS-PNET central nervous system supratentorial primitive neuroectodermal tumor -- DXA dual-energy x-ray absorptiometry -- Htz height Z-score -- LMI lean mass index, kg/m2 -- MB medulloblastoma -- OUH Oslo University Hospital -- RI recommended intake, referring to Nordic Nutrition Recommendations 2012 -- UiO University of Oslo; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2022.05.025
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background and aims: Childhood cancer survivors are at risk of unwanted late effects. The primary aim of this study was to assess bone mineral density Z-scores (BMDz) in long-term survivors of childhood medulloblastoma (MB) or central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET). Secondary aims were to describe nutrient intake, vitamin D status, physical activity and explore potential risk factors for decreased BMDz. Methods: All MB and CNS-PNET survivors treated at Oslo University Hospital from 1974 to 2013 were invited to participate in a cross-sectional study. Dual-energy x-ray absorptiometry (Lunar Prodigy) assessed BMDz lumbar spine, BMDz total body, and lean body mass. Decreased BMDz was defined as a combination of low BMDz −1 to −1.99 and very low BMDz ≤−2. Lean body mass index (LMI) was calculated by dividing lean body mass by the squared height. Nutrient intake was assessed by a 3-day food record. Serum 25(OH)D was analyzed. Physical activity was reported by a questionnaire. Descriptive statistics and multivariable Cox regression analyses were applied. Results: Fifty survivors with a median age of 25.5 years (5.5–51.9) and a median follow-up time of 19.5 years (3.2–40.5) were included. Mean BMDz lumbar spine was −0.8 (SD 1.1, 95% CI: −1.1 to −0.4), and BMDz total body was −0.6 (SD 1.1, 95% CI: −0.9 to −0.3). Decreased BMDz was detected in 48% of the lumbar spine and 34% of the total body measurements. In all, 62% had low calcium, and 69% had low vitamin D intake. 26% of participants had serum 25(OH)D < 50 nmol/L, and 62% reported an inactive lifestyle. Male sex, higher age at diagnosis, and lower LMI were potential risk factors for decreased BMDz. Conclusions: Long-term survivors of childhood MB and CNS-PNET had decreased BMDz, and risk factors were male sex, higher age at diagnosis, and lower LMI. Inadequate calcium and vitamin D intake, an inactive lifestyle, and a high prevalence of 25(OH)D ≤ 50 nmol/L were detected.