Longitudinal changes in childhood cancer survivor body mass index during early survivorship: associations with caregiver health-related parenting behaviors and survivor health behaviors.
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PURPOSE: Childhood cancer survivors (CCS) are at risk for obesity and related late effects following treatment. This study examined (1) changes in age- and sex-adjusted standardized BMI (zBMI) over 12 months during early survivorship, (2) associations between CCS dietary behaviors and physical activity with longitudinal changes in zBMI, and (3) the association between health-related parenting behaviors (HRPB) and CCS dietary and physical activity behaviors and zBMI. METHODS: Caregivers of CCS completed baseline measures of children's diet, physical activity, and HRPB at the transition off active cancer treatment. zBMI was extracted from medical records at baseline and 12 months post-baseline assessment and categorized by weight status based on World Health Organization guidelines. Linear probability models assessed associations between CCS health behaviors, caregiver HRPB, and zBMI outcomes. RESULTS: About 47% of CCS maintained a healthy zBMI and 39% maintained an overweight/obese zBMI from baseline to follow-up. Greater fruit and vegetable intake was associated with maintaining a healthy zBMI (B = 0.107, p = 0.018) and inversely associated with overweight/obese zBMI (B = -0.108, p = 0.012). Caregiver efficacy to support dietary behavior was positively associated with CCS fruit and vegetable intake (B = 0.246, p = 0.026). CONCLUSIONS: Most survivors maintained their BMI status from the end of treatment through the first year of survivorship. IMPLICATIONS FOR CANCER SURVIVORS: Strategies focused on increasing fruit and vegetable intake and caregiver efficacy to promote healthy diet should be considered to maintain healthy weight at the end of cancer-directed therapy.