kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.3.93 kjhp-14-93 Original Article Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors SeoJi-Sun 1 ParkHyun-Ah 1 KangJae-Heon 1 KimKyoung-Woo 1 ChoYoung-Gyu 1 HurYang-Im 2 ParkYeo-Rin 1 Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Public Health and Healthcare Management, Inje Institute of Advanced Studies, Seoul, Korea Corresponding author：Hyun-Ah Park, MD, MPH, PhD Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, 100-032 Seoul, Korea Tel: +82-2-2270-0097, Fax: +82-2-2272-0908 E-mail: drparkhyunah@gmail.com 01 2014 20 01 2014 14 3 93 102 27062014 20082014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Obesity not only does increase the incidence of breast cancer, but also affects the course of treatment, recurrence and mortality. This study aims to evaluate on the obesity status of Korean breast cancer survivors and their obesity-related lifestyles.

 Methods

The study included 125 Korean female breast cancer survivors aged over 19 year old enrolled in the 2009–11 Korean National Health and Nutrition Examination Survey. Women who answered ‘yes' to the question ‘have you ever been diagnosed breast cancer by a physician?' was defined as a breast cancer survivors. Height, weight, and waist circumference were measured and Body mass index (BMI) was calculated. Body fat percent was assessed by dual X-ray absorptiometry (DXA). Standardized surveys by trained interviewers were used to investigate survivors' obesity-related lifestyles such as physical activities, sleeping hours and nutrients intake.

 Results

48.4% of Korean breast cancer survivors were obese. 44.7% had abdominal obesity and 89.2% had body fat percent over 30. Their physical activity level was generally low; only 22.5% maintained health-enhancing level of physical activities. Fat intake (14.4 [0.8] %) was as low and carbohydrate intake (74.2 [1.2] %) was high. However, daily dietary fiber intake was low (10.5 [1.1] g). Factors that were found to be significantly related with obesity in Korean breast cancer survivors were low education level (P=0.042), smoking (P<0.001), having chronic diseases (P=0.002) and short sleeping hours (P<0.001).

 Conclusions

It is mandatory for physician to evaluate obesity status of breast cancer survivors as soon as their diagnosis and give proper intervention to maintain healthy weight and healthy obesity related lifestyle.

 Obesity Body mass index Physical activity Metabolic equivalent Nutrient intake References Statistics Korea [Internet] Daejeon Statistics Korea 2014 [Accessed Sep. 24, 2014]. http://www.cancer.go.kr/mbs/can-cer/subview.jsp?id=cancer_040302000000 The Korea Central Cancer Registry, National Cancer Center Annual report of cancer statistics in Korea in 2011. Goyang-si: Ministry of Health and Welfare 2013 [Accessed Sep 19, 2014]. http://ncc.re.kr/manage/manage03_033_view.jsp?bbsnum= 295&hSelSearch=&hTxtKeyword=&current_page=1&cd=null. Protani M Coory M Martin JH Effect of obesity on survival of women with breast cancer: systematic review and metaanalysis Breast Cancer Res Treat 2010123 3 62735 Rock CL Doyle C Demark-Wahnefried W Meyerhardt J Courneya KS Schwartz AL Nutrition and physical activity guidelines for cancer survivors CA Cancer J Clin 201262 4 24374 Pierce JP Natarajan L Caan BJ Parker BA Greenberg ER Flatt SW Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the women's healthy eating and living (WHEL) randomized trial JAMA 2007298 3 28998 Statistics Korea National Health and Nutrition Survey 2009. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV) Reston Ministry of Health and Welfare 2009 [Accessed Sep. 19, 2014]. https://knhanes.cdc.go.kr/knhanes/index.do Deurenberg P Deurenberg-Yap M Guricci S Asians are different from Caucasians and from each other in their body mass in-dex/body fat per cent relationship Obes Rev 20023 3 1416 Oh JY Yang YJ Kim BS Kang JH Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form J Korean Acad Fam Med 200728 7 53241 Chlebowski RT Aiello E McTiernan A Weight loss in breast cancer patient management J Clin Oncol 200220 4 112843 Courneya K Karvinen K Vallance JK Exercise motivation and behavior change Feuerstein M Handbook of Cancer Survivorship New York Springer Science-Business Media LLC 2006 11332 Pinto BM Ciccolo JT Physical activity motivation and cancer survivorship Recent Results Cancer Res 2011186 36787 Schmitz KH Courneya KS Matthews C Demark-Wahnefried W Galvão DA Pinto BM American college of sports medicine roundtable on exercise guidelines for cancer survivors Med Sci Sports Exerc 201042 7 140926 Bae YJ Evaluation of nutrient and food intake status, and dietary quality in Korean female adults according to obesity: based on 2007–2009 Korean National Health and Nutrition Examination Survey Korean J Nutr 201245 2 1409 Kang JH Kim KA Han JS Korean diet and obesity J Korean Soc Study Obes 200413 1 3441 Mosher CE Sloane R Morey MC Snyder DC Cohen HJ Miller PE Associations between lifestyle factors and quality of life among older longterm breast, prostate, and colorectal cancer survivors Cancer 2009115 17 40019 Zhang Q Wang Y Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000 Obes Res 200412 10 162232 Lantz PM House JS Lepkowski JM Williams DR Mero RP Chen J Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults JAMA 1998279 21 17038 Lampert T Smoking, physical inactivity, and obesity: associations with social status Dtsch Arztebl Int 2010107 1–2 17 Na YM Park HA Kang JH Cho YG Kim KW Hur YI Obesity, obesity related disease, and disability Korean J Fam Med 201132 7 41222 Schwartz MW Woods SC Porte D Seeley RJ Baskin DG Central nervous system control of food intake Nature 2000404 6778 66171 Flier JS Maratos-Flier E The stomach speaks-ghrelin and weight regulation N Engl J Med 2002346 21 16623 Park YR Cho YG Kang JH Park HA Kim KW Hur YI Comparison of obesity and overweight prevalence among Korean adults according to community health survey and Korea national health and nutrition examination survey Korean J Obes 201423 1 648 Kim KN Joo NS Relationship between exercise, body fatness and metabolic syndrome Korean J Obes 200918 4 13845 Figures and Tables

Obesity status of 125 Korean breast cancer survivors

Baseline characteristics of 125 Korean breast cancer survivors

Characteristics 　 Percentage (SE) BMIa Mean (SE) Pb
Age, y Mean (SE) 56.9 (1.3)    
  ≤39 4.0 (3.2) 25.01 (1.13) 0.101
  40≤, ≤64 63.8 (6.2) 24.14 (0.36)  
  65≤ 32.2 (5.9) 26.06 (0.83)  
Age at cancer diagnosis, y Mean (SE) 49.2 (1.4)    
Time since diagnosis, y Mean (SE) 7.6 (0.8)    
  ≤2 25.1 (6.0) 24.44 (1.20) 0.631
  3≤, ≤5 25.4 (5.2) 24.39 (0.46)  
  6≤, ≤10 19.5 (4.2) 25.15 (1.00)  
  10< 30.0 (5.6) 25.22 (0.52)  
Education Middle school graduate or less 51.9 (6.3) 25.80 (0.58) 0.012
  High school graduate 27.9 (5.5) 23.70 (0.44)  
  College or graduate degree 20.2 (5.4) 23.72 (0.84)  
Household incomec Low 23.4 (4.6) 25.46 (0.82) 0.432
  Middle low 24.7 (5.0) 23.95 (0.70)  
  Middle high 23.2 (5.5) 24.41 (0.40)  
  High 28.7 (6.3) 25.30 (0.95)  
Marital status Married 72.3 (6.1) 24.53 (0.34) 0.395
  Single 27.7 (6.1) 25.49 (1.07)  
Employed Yes 31.5 (5.7) 25.47 (0.67) 0.244
  No 68.5 (5.7) 24.49 (0.51)  
Smoking Smoker 2.2 (1.5) 31.99 (1.99) 0.001
  Nonsmoker 97.8 (1.5) 24.63 (0.39)  
High risk drinkingd Yes 8.9 (2.7) 24.18 (0.64) 0.385
  No 91.1 (2.7) 24.86 (0.42)  
No. of current comorbid medical conditionse 0 36.3 (5.8) 23.88 (0.41) 0.001
  1 17.6 (4.4) 24.04 (0.92)  
  2 17.6 (4.9) 24.60 (0.62)  
  3 14.1 (3.8) 24.80 (0.82)  
  4 or more 14.4 (5.5) 28.28 (0.91)  
Functional limitation Yes 28.8 (5.1) 24.83 (0.66) 0.954
  No 71.2 (5.1) 24.78 (0.49)  
Perceived health Good 25.0 (5.7) 25.12 (0.72) 0.839
  Moderate 36.2 (6.4) 24.81 (0.79)  
  Bad 38.8 (5.8) 24.58 (0.54)  
Stress level Little 19.7 (5.3) 24.46 (0.92) 0.211
  Moderate 44.1 (6.1) 24.20 (0.39)  
  High 36.2 (6.1) 25.70 (0.76)  
Menopausal status Premenopause 54.2 (6.2) 25.21 (0.61) 0.225
　 Postmenopause 45.8 (6.2) 24.31 (0.43) 　

Abbreviation: SE, standard error; BMI, body mass index.

BMI has the SI units of kg/m

.

Calculated by the general linear modeling.

Calculated by the mean monthly household income divided by root of the number of household member.

High risk drinking means consumption of alcohol more than twice a week, each of which should meet more than 5 shots.

Hypertension, diabetes, dyslipidemia, cardiovascular disease, coronary heart disease, arthritis, osteoporosis, tuberculosis, asthma, chronic ob structive pulmonary disease, end-stage renal disease, and thyroid disease were asked.

Intensity of physical activity and sleep duration among Korean breast cancer survivors according to BMI tertilesa

Intensity of physical activity 1st tertile 17.17–22.63 2nd tertile 22.64–25.43 3rd tertile 25.55–34.42 Total Pc
BMIb BMIb BMIb
Walking/light activity          
 Duration, min 72.3 (19.1) 61.8 (10.8) 87.1 (17.2) 75.0 (9.7) 0.452
 Frequency, wk 4.0 (0.6) 3.2 (0.4) 4.3 (0.4) 3.9 (0.3) 0.147
 MET 1,420.9 (462.0) 804.2 (197.7) 1,295.0 (261.1) 1,172.3 (177.2) 0.502
Moderate activity          
 Duration, min 28.9 (7.9) 59.0 (17.6) 17.6 (8.2) 33.9 (7.4) 0.097
 Frequency, wk 1.8 (0.6) 1.2 (0.4) 0.8 (0.4) 1.2 (0.3) 0.346
 MET 442.1 (146.9) 733.3 (354.7) 247.8 (114.8) 455.4 (133.0) 0.314
Vigorous activity          
 Duration, min 27.4 (9.3) 29.3 (11.6) 25.9 (11.1) 27.4 (6.4) 0.978
 Frequency, wk 0.9 (0.0) 1.1 (0.0) 1.1 (0.0) 0.9 (0.2) <0.001
 MET 471.3 (176.7) 972.1 (504.7) 1,030.8 (540.0) 860.8 (279.9) 0.432
Total MET 2,334.3 (484.4) 2,509.6 (852.3) 2,573.7 (768.8) 2,488.5 (432.0) 0.961
Physical activity leveld          
 Inactive 41.5 (9.7) 41.8 (9.0) 52.5 (11.2) 46.1 (6.1) 0.380
 Minimally active 21.9 (6.9) 41.6 (10.3) 29.8 (9.1) 31.4 (5.5)  
 Health enhancing physical activity 36.5 (10.4) 16.7 (6.5) 17.7 (8.4) 22.5 (5.1)  
Daily sleep durationd, h          
 ≤6 35.0 (9.2) 49.3 (9.5) 58.3 (10.5) 49.1 (6.2) 0.365
 6–7 18.6 (8.0) 19.8 (6.9) 21.4 (7.1) 20.1 (4.4)  
 7–8 30.5 (8.9) 25.1 (9.4) 18.5 (8.4) 23.9 (5.2)  
 ≥8 15.9 (8.8) 5.7 (4.6) 1.9 (1.4) 6.9 (3.0)  

Abbreviations: BMI, body mass index; MET, metabolic equivalent.

Data are presented as mean (SE) unless otherwise indicated.

BMI has the SI units of kg/m

.

Calculated by the chi-square test of independence test or general linear modeling.

Data are presented as percentage (SE).

Nutrients intake among Korean breast cancer survivors according to BMI tertilesa

Dietary intake 1st tertile 17.17–22.63 2nd tertile 22.64–25.43 3rd tertile 25.55–34.42 Total Pc
BMIb BMIb BMIb
Energy, kcal 1,663.0 (116.3) 1,831.0 (99.2) 1,725.6 (113.5) 1,742.4 (65.7) <0.001
Carbohydrate, g 301.7 (17.5) 339.5 (22.0) 316.4 (22.8) 319.8 (12.8) 0.388
 % Energy from carbohydrate 71.4 (1.5) 73.2 (2.4) 72.0 (2.0) 72.3 (1.2) 0.855
Protein, g 67.9 (1.0) 63.4 (5.6) 57.5 (4.0) 62.2 (3.7) 0.509
 % Energy from protein 15.3 (1.2) 13.4 (0.8) 12.9 (1.5) 13.7 (0.5) 0.146
Fat, g 26.3 (2.9) 28.7 (3.1) 31.2 (4.0) 29.1 (2.1) 0.610
 % Energy from fat 13.3 (0.8) 13.4 (1.1) 15.1 (1.6) 14.0 (0.8) 0.594
Fiber, g 10.1 (2.0) 12.9 (2.5) 8.9 (1.2) 10.5 (1.1) 0.326
 Fiber density, g/1,000 kcal 6.1 (1.2) 7.2 (1.3) 5.1 (0.5) 6.0 (0.6) 0.237
Sodium, mg/day 4,462.4 (687.0) 5,447.4 (738.4) 3,832.0 (409.8) 4,518.4 (366.0) 0.154
 Sodium density, mg/1,000 kcal 2,702.9 (254.9) 3,014.1 (353.2) 2,253.5 (221.4) 2,617.9 (173.8) 0.144

Abbreviation: BMI, body mass index.

Data are presented as mean (SE) unless otherwise indicated.

BMI has the SI units of kg/m2.

Calculated by the chi-square test of independence test or general linear modeling.

Estimated effects on body mass index (kg/m2) of obesity related factors in Korean breast cancer survivors

Characteristics OR 95% CI Pa
Age, y      
 65≤ Reference    
 40≤, ≤64 0.33 –1.20–1.85 0.674
 ≤39 3.06 –0.98–7.10 0.138
Education      
 College or graduate degree Reference    
 High school graduate 0.92 –0.65–2.49 0.250
 Middle school graduate or less 1.76 0.06–3.45 0.042
Smoking      
 Nonsmoker Reference    
 Smoker 5.34 2.38–8.30 <0.001
Exercise limitation      
 No Reference    
 Yes 0 –1.41–1.42 0.996
No. of current comorbid medical conditions      
 0 Reference    
 1 1.07 –0.75–2.88 0.249
 2 0.99 –0.51–2.49 0.194
 3 0.92 –1.22–3.05 0.401
 4 or more 3.31 1.25–5.37 0.002
Physical activity level      
 Health enhancing physical activity Reference    
 Minimally active 1.03 –0.69–2.75 0.240
 Inactive 1.39 –0.22–3.01 0.091
Daliy sleep duration, h      
 >8 Reference    
 7–8 2.97 1.22–4.73 0.001
 6–7 2.37 0.77–3.96 0.004
 <6 2.76 1.29–4.22 <0.001
Energy intake per 1,000 kcal 0.03 0.00–0.00 0.948

Abbreviations: OR, odds ratio; CI, confidence interval.

Calculated by multivariate logistic regression analysis adjusted for age (<39 y, 40–64 y, and >65 y), highest education achieved (middle school graduate or less, high school graduate, and college or graduate degree), current smoking status (smoker, and nonsmoker), exercise limitation (yes, and no), number of current comorbid medical conditions (0, 1, 2, 3, and 4 or more), physical activity level (health enhancing physical activity, minimally active, and inactive), sleep duration (>8 h, 7–8 h, 6–7 h, and <6 h), energy intake per 1,000 kcal.