Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors

Ji-Sun Seo; Hyun-Ah Park; Jae-Heon Kang; Kyoung-Woo Kim; Young-Gyu Cho; Yang-Im Hur; Yeo-Rin Park

doi:10.15384/kjhp.2014.14.3.93

Korean J Health Promot > Volume 14(3); 2014 > Article

Seo, Park, Kang, Kim, Cho, Hur, and Park: Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors

Original Article

Korean Journal of Health Promotion 2014;14(3):93-102.

Published online: January 20, 2014

DOI: https://doi.org/10.15384/kjhp.2014.14.3.93

Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors

Ji-Sun Seo¹, Hyun-Ah Park^1,, Jae-Heon Kang¹, Kyoung-Woo Kim¹, Young-Gyu Cho¹, Yang-Im Hur², Yeo-Rin Park¹

¹Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

²Department 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

Received June 27, 2014 Accepted August 20, 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.

Keywords: Obesity, Body mass index, Physical activity, Metabolic equivalent, Nutrient intake

Figure 1.

Obesity status of 125 Korean breast cancer survivors

Table 1.

Baseline characteristics of 125 Korean breast cancer survivors

Characteristics		Percentage (SE)	BMI^a Mean (SE)	P^b
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 income^c	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 drinking^d	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 conditions^e	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.

^aBMI has the SI units of kg/m

².

^bCalculated by the general linear modeling.

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

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

^eHypertension, 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.

Table 2.

Intensity of physical activity and sleep duration among Korean breast cancer survivors according to BMI tertiles^a

Intensity of physical activity	1^st tertile 17.17–22.63	2^nd tertile 22.64–25.43	3^rd tertile 25.55–34.42	Total	P^c
Intensity of physical activity	BMI^b	BMI^b	BMI^b	Total	P^c
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 level^d
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 duration^d, 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.

^aData are presented as mean (SE) unless otherwise indicated.

^bBMI has the SI units of kg/m

².

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

^dData are presented as percentage (SE).

Table 3.

Nutrients intake among Korean breast cancer survivors according to BMI tertiles^a

Dietary intake	1^st tertile 17.17–22.63	2^nd tertile 22.64–25.43	3^rd tertile 25.55–34.42	Total	P^c
Dietary intake	BMI^b	BMI^b	BMI^b	Total	P^c
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.

^aData are presented as mean (SE) unless otherwise indicated.

^bBMI has the SI units of kg/m².

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

Table 4.

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

Characteristics	OR	95% CI	P^a
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.

^aCalculated 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.

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