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    2020-08-18


    with the Australian Health Survey where 50% of 4e18 year olds were not consuming recommended intakes of calcium and 34% of 4e19 year olds were not consuming recommended intakes of magnesium [46]. However, the low intakes of iodine and folate of the CCS were not observed in the Australian Health Survey [46]. Calcium, magnesium, folate and iodine are essential for healthy brain, muscle and bone growth and functioning. Reduced intake of these nutrients during the rapid growth periods of childhood and adolescents can lead to poor muscle and bone development and exacerbate the chronic health conditions commonly experienced in CCS.
    The majority of survivors in this study met the recommenda-tions for daily physical activity and were more active than children in the Taranabant [32] and previous studies into CCS [48]. However, they spent a longer daily amount of time in sedentary screenebased activities than the Australian population and were less likely to meet the screen based entertainment recommenda-tions, which was consistent with previous research into CCS [48]. Although the CCS in this study did not have activity patterns different to Australian children, due to their increased FM and decreased BCMI, it is vital that the CCS population has active life-styles with minimal screen time to improve body composition and reduce risk of associated late effects.
    The survivors had a sedentary/light active lifestyle classified by PAL of 1.45, which was below the PAL of 1.75 for adolescents and adults that is considered to be compatible with a healthy lifestyle [49]. In this study, PAL was significantly reduced in the CCS group who were classified as under nourished and the CCS group classi-fied as obese. When the relationship between physical activity and body composition was examined, PAL was significantly related to BCMI and FFMI. These findings indicate that increasing the physical activity level of CCS is an important component for interventions which aim to improve body composition in CCS.
    This study demonstrates that young CCS are at risk of both undernutrition and obesity, with BMT and current PAL important contributing factors to reduced BCM in this group. The CCS in this study had poor dietary and physical activity habits, with low car-bohydrate and high fat contribution to energy intake, poor intake of essential nutrients, light active lifestyle and excessive screen time. Limitations of the study are the small subject numbers and that the control group did not have physical activity and dietary results so CCS results could only be compared to population values; future studies should explore these findings in a larger caseecontrol study. There is a need for parents and children undergoing treat-ment for cancer to be educated about diet quality and importance of daily physical activity to ensure healthy habits are developed, which may lead to improving body composition and reducing risk of developing nutrition related late effects. Future research should focus on investigating intervention programs that target both increasing BCM and decreasing FM for CCS through physical activity and good dietary habits.
    Conflict of interest
    None.
    Acknowledgments
    All authors contributed to the study design. AJMA was respon-sible for coordinating the study, analysis of the data and prepara-tion of the manuscript. All authors contributed to the final version of the manuscript. All authors read and approved the final sub-mitted manuscript. The authors would like to acknowledge Sarah Elliott and Paula Brown who conducted the data collection and thank the After Cancer Clinic nurses and co-ordinators, parents and 
    participants for their part in the study. This work was supported by the Children's Health Queensland Early Career Fellowship funded by the Children's Hospital Foundation and The Cressbrook Com-mittee (AJMA).
    References
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    [5] Friedman DL, Whitton J, Leisenring W, Mertens AC, Hammond S, Stovall M, et al. Subsequent neoplasms in 5-year survivors of childhood cancer: the childhood cancer survivor study. J Natl Cancer Inst 2010;102(14):1083e95.
    [9] Meacham LR, Sklar CA, Li S, Liu Q, Gimpel N, Yasui Y, et al. Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with ra-diation therapy: a report for the childhood cancer survivor study. Arch Intern Med 2009;169(15):1381e8.