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Obesity and cancer

Understanding the link between obesity and cancer

TOS Annual Meeting at ObesityWeek provides the latest research on obesity and cancer
TOS Annual Meeting at ObesityWeek provides the latest research on obesity and cancer

In 2012, about 28,000 new cases of cancer in men (3.5%) and 72,000 in women (9.5%) were due to overweight or obesity in the US alone. There is an urgent need for research that focuses on the cancer-promoting effects of obesity as it’s the leading preventable cause of cancer for women and the second for men. Obesity may influence the development of cancer and cancer survivorship in part through metabolic dysregulation and chronic inflammation, though more research is warranted. By understanding the obesity-cancer link, we can identify and develop effective strategies to reduce the impact of obesity throughout the cancer continuum.

Top researchers, clinicians and surgeons from around the world gathered for the fifth annual ObesityWeek conference at The Gaylord National Resort & Convention Center in National Harbor, Maryland this week. Two papers presented at the meeting focused on the link between obesity and cancer.

The first paper, ‘Improved Body Composition With Ketogenic Diet in Ovarian/Endometrial Cancer Patients’, reported that women with ovarian or endometrial cancer, a ketogenic diet may reduce total and visceral fat mass, perhaps by reducing insulin concentration.

It is known that the glycolytic nature of cancer cells presents a potential treatment target that may be addressed by a low-carbohydrate, high-fat (i.e., ketogenic) diet. The researchers from University of Alabama at Birmingham, AL, tested the hypothesis that a ketogenic diet would improve body composition and lower insulin and IGF-I in women with ovarian or endometrial cancer.

They recruited 45 women with ovarian or endometrial cancer who were randomised to either a ketogenic diet (KD, n=25; 70:25:5% energy from fat, protein, carbohydrate) or the American Cancer Society diet (ACS, n=20; high-fiber, low-fat). Body composition (DXA), and fasting serum insulin and IGF-I, were obtained at baseline and 12 weeks. Between-groups changes were assessed with ANCOVA, controlling for baseline values and weight loss; predictors of change in body composition were determined by regression analysis.

They found that in comparison to participants in the ACS group, those in the KD group had greater reductions in total body fat (-5.2 kg v. -2.9 kg, p<0.05) and android fat (-592 g vs. -320 g, p<0.05) at 12 weeks.

The percent change in visceral fat mass was also greater in the KD group than in the ACS group (-21.2% vs. -4.6%, p<0.05). The change in total lean mass did not differ significantly between groups. In addition, the KD group demonstrated larger decreases in fasting concentrations of insulin (-3.88uU/mL vs. -2.1uU/mL, p<0.05) and IGF-I (-28.4ng/mL vs. +2.1ng/mL, p<0.05), independent of weight loss. In regression analysis, both diet group and the change in fasting insulin concentration were significant predictors of the percent change in visceral adipose tissue (p<0.05).

“In women with ovarian or endometrial cancer, a ketogenic diet may reduce total and visceral fat mass, perhaps by reducing insulin concentration,” the researchers concluded. “A metabolic environment characterized by low insulin and IGF-I may impair the ability of cancer cells to multiply.”

The authors of this paper were Drs Caroline W Cohen, Kevin Fontaine, Rebecca C Arend, Ronald D Alvarez, Charles A Leath and Barbara A Gower.

In a second paper, ‘Bariatric Surgery and the Risk of Cancer in a Multisite Cohort of 88,625 Adults With Severe Obesity’, researchers from the University of Cincinnati sought to determine whether bariatric surgery is associated with a lower risk of cancer.

They conducted a retrospective cohort study of patients undergoing bariatric surgery between 2005 and 2012 with follow-up through 2014 using data from a large integrated health insurance and care delivery systems with five study sites. The study included 22,198 subjects who had bariatric surgery and 66,427 non-surgical subjects matched on sex, age, study site, BMI and Elixhauser comorbidity index. Multivariable Cox proportional hazards models were used to examine incident cancer up to 10 years after bariatric surgery compared to the matched non-surgical patients.

The outcomes showed that after a mean follow-up of 3.5 years, 2,543 incident cancers were identified. Patients undergoing bariatric surgery had a 33% lower hazard of developing any cancer during follow-up (HR 0.67, 95% C.I. 0.60, 0.74, p<0.001) compared to matched patients with severe obesity who did not undergo bariatric surgery, and results were even stronger when the outcome was restricted to obesity-associated cancers (HR 0.59, 95% C.I. 0.51, 0.69, p<0.001).

Among the obesity-associated cancers, the risk of postmenopausal breast (HR 0.58, 95% C.I. 0.44, 0.77, p<0.001), colon (HR 0.59, 95% C.I. 0.36, 0.97, p=0.04), endometrial (HR 0.50, 95% C.I. 0.37, 0.67, p<0.001), and pancreatic cancer (HR 0.46, 95% C.I. 0.22, 0.97, p=0.04) were each statistically significantly lower among those who had undergone bariatric surgery compared to matched non-surgical patients.

“In this large, multisite cohort of patients with severe obesity, bariatric surgery was associated with a lower risk of incident cancer, particularly obesity-associated cancers, such as post-menopausal breast, endometrial, and colon cancer,” the authors concluded.

The authors of this paper were Drs Daniel Schauer, Heather Spencer Feigelson, Corinna Koebnick, Bette Caan, Sheila A Weinmann, Anthony C Leonard, J David Powers, Panduranga R Yenumula and David Arterburn. 

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