Evaluating eating behaviour, energy homeostasis and obesity in childhood onset craniopharyngioma: A feasibility study

INTRODUCTION: Craniopharyngiomas are rare brain tumours (incidence 1.1-1.7 cases/million/year). Although non-malignant, craniopharyngioma causes major endocrine and visual morbidities including hypothalamic obesity, yet mechanisms leading to obesity are poorly understood. This study investigated the feasibility and acceptability of eating behaviour measures in patients with craniopharyngioma, to inform the design of future trials.

METHODS: Patients with childhood-onset craniopharyngioma and controls matched for sex, pubertal stage and age were recruited. After an overnight fast, participants received the following measures: body composition, resting metabolic rate, oral-glucose-tolerance-test including MRI (patients only), appetite ratings, eating behaviour and quality of life questionnaires, ad libitum lunch, and an acceptability questionnaire. Data are reported as median ± IQR, with effect size measure (Cliff's delta) and Kendall's Tau for correlations, due to the small sample size.

RESULTS: Eleven patients (median age=14yrs; 5F/6M) and matched controls (median age=12yrs; 5F/6M) were recruited. All patients had received surgery and 9/11 also received radiotherapy. Hypothalamic damage post-surgery was graded (Paris grading): grade 2 n=6; grade 1 n=1; grade 0 n=2. The included measures were deemed highly tolerable by participants and their parent/carers. Preliminary data suggests a difference in hyperphagia between patients and controls (d=0.5), and a relationship between hyperphagia with body mass index (BMISDS) in patients (τ=0.46).

DISCUSSION: These findings demonstrate that eating behaviour research is feasible and acceptable to craniopharyngioma patients and there is an association between BMISDS and hyperphagia in patients. Thus, food approach and avoidance behaviours may be useful targets for interventions to manage obesity in this patient group.