Obesity and Obesity-Related Lifestyles of Korean Breast Cancer Survivors
- Ji-Sun Seo1, Hyun-Ah Park1,, Jae-Heon Kang1, Kyoung-Woo Kim1, Young-Gyu Cho1, Yang-Im Hur2, Yeo-Rin Park1
- Received June 27, 2014 Accepted August 20, 2014
- 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.
Table 1.
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) |
Table 2.
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) |
Table 3.
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 |
Table 4.
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 |
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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