The Association of the Built Environment with Body Mass Measures in Survivors of Childhood Brain Tumors and Non-Cancer Controls

Abstract

Background: While the obesity epidemic is impacting children, survivors of childhood brain tumors (SCBT) are particularly vulnerable to obesity-driven cardiometabolic comorbidities. SCBT have excess body fat (adiposity) with similar body mass measures when compared to matched non-cancer controls. The effect of the built environment on the risk of obesity has received relatively limited attention in survivors. Aim & Methods: The aim of this project was to determine the impact of the built environment on body mass index (BMI) percentile, body fat percentage (BF%), waist-to-hip ratio (WHR), and waist-to-height-ratio (WHtR) in SCBT and non-cancer controls. The data for this secondary analysis were derived from participants in the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE), a prospective cohort study based at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. The Neighborhood Environment Walkability Scale (NEWS) was used to assess the built environment. Multivariable regression analyses were used to define the predictors of the association. Results: The built environment was not associated with BMI percentile in SCBT and non-cancer controls including residential density (B 0.276, p value 0.436), land use mix diversity (B -0.286, p value 0.301), land use mix access (B 0.004, p value 0.993), street connectivity (B 0.297, p value 0.431), walking/cycling facilities (B 0.185, p value 0.540), neighborhood aesthetics (B 0.270, p value 0.513), safety from traffic (B -0.368, p value 0.418), and safety from crime (B -0.074, p value 0.907). The built environment was also not associated with adiposity measures (BF%: residential density B 0.031, p value 0.851, land use mix diversity B -0.082, p value 0.513, land use mix access B -0.036, p value 0.861, street connectivity B 0.309, p value 0.055, walking/cycling facilities B 0.109, p 0.439, neighborhood aesthetics B 0.127, p value 0.503, safety from traffic B -0.047, p value 0.825, and safety from crime B -0.154, p value 0.601; WHR: residential density B -0.042, p value 0.362, land use mix diversity B 0.043, p value 0.131, land use mix access B -0.028, p value 0.558, street connectivity B -0.044, p value 0.252, walking/cycling facilities B 0.026, p value 0.476, neighborhood aesthetics B 0.062, p value 0.137, safety from traffic B -0.048, p value 0.336, and safety from crime B -0.083, p value 0.239; WHtR: residential density B 0.011, p value 0.865, land use mix diversity B 0.033, p value 0.462, land use mix access B -0.032, p value 0.662, street connectivity B 0.021, p value 0.720, walking/cycling facilities B 0.042, p value 0.493, neighborhood aesthetics B 0.018, p value 0.790, safety from traffic B -0.020, p value 0.789, and safety from crime B -0.086, p value 0.392). Conclusion: The results of this study suggest that the built environment has less of an impact than brain tumors and their treatments on driving body mass and fat mass changes in SCBT. The use of lifestyle interventions may need to be combined with pharmacotherapies in the treatment of obesity in SCBT.