Fat distribution and cancer risk -
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Nat Rev Cancer 15 : — Roswall N, Freisling H, Bueno-de-Mesquita HBA, Ros M, Christensen J, Overvad K, Boutron-Ruault M-C, Severi G, Fagherazzi G, Chang-Claude J, Kaaks R, Steffen A, Boeing H, Argüelles M, Agudo A, Sánchez M-J, Chirlaque M-D, Barricarte Gurrea A, Amiano P, Wareham N, Khaw K-T, Bradbury KE, Trichopoulou A, Papatesta H-M, Trichopoulos D, Palli D, Pala V, Tumino R, Sacerdote C, Mattiello A, Peeters PH, Ehrnström R, Brennan P, Ferrari P, Ljungberg B, Norat T, Gunter M, Riboli E, Weiderpass E, Halkjaer J Anthropometric measures and bladder cancer risk: A prospective study in the EPIC cohort.
Steffen A, Huerta J-M, Weiderpass E, Bueno-de-Mesquita HB, May AM, Siersema PD, Kaaks R, Neamat-Allah J, Pala V, Panico S, Saieva C, Tumino R, Naccarati A, Dorronsoro M, Sánchez-Cantalejo E, Ardanaz E, Quirós JR, Ohlsson B, Johansson M, Wallner B, Overvad K, Halkjaer J, Tjønneland A, Fagherazzi G, Racine A, Clavel-Chapelon F, Key TJ, Khaw K-T, Wareham N, Lagiou P, Bamia C, Trichopoulou A, Ferrari P, Freisling H, Lu Y, Riboli E, Cross AJ, Gonzalez Ca, Boeing H General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition.
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Cancer : — AICR: Washington DC, USA. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. Available at: www. Available at: wcrf. Download references.
Data used throughout the present study are derived from the CHANCES project. The project is coordinated by the Hellenic Health Foundation, Greece.
The project received funding by the FP7 framework programme of DG-RESEARCH in the European Commission grant agreement no. EPIC Greece: funded by the Hellenic Health Foundation. EPIC Netherlands: funded by European Commission DG SANCO ; Dutch Ministry of Public Health, Welfare and Sports VWS ; The National Institute for Public Health and the Environment; the Dutch Cancer Society, the Netherlands Organisation for Health Research and Development ZONMW ; World Cancer Research Fund WCRF.
ESTHER: funded by the Baden-Württemberg state Ministry of Science, Research and Arts Stuttgart, Germany , the Federal Ministry of Education and Research Berlin, Germany , and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth Berlin, Germany.
Tromsø: funded by: UiT The Arctic University of Norway, the National Screening Service, and the Research Council of Norway. Kari Kuulasmaa, Ben Schöttker, Ute Mons, Kai-Uwe Saum, Bernd Holleczek, Alun Evans, John Yarnell.
This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution-NonCommercial-Share Alike 4.
Section of Nutrition and Metabolism, International Agency for Research on Cancer IARC-WHO , Cours Albert Thomas, Lyon, , France.
Section of Cancer Surveillance, International Agency for Research on Cancer IARC-WHO , Cours Albert Thomas, Lyon, , France. Network Aging Research NAR , Heidelberg University, Bergheimer Straße 20, Heidelberg, , Germany. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center DKFZ , Im Neuenheimer Feld , Heidelberg, , Germany.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK. WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 27, Greece.
Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, PO Box 17, Wageningen, AA, The Netherlands. Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, , Germany.
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Ioannina, , Greece. Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, DK , Denmark. Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, , NY, USA.
Department for Determinants of Chronic Diseases DCD , National Institute for Public Health and the Environment RIVM , PO Box 1, Bilthoven, BA, The Netherlands. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, Murcia, , Spain.
CIBER Epidemiología y Salud Pública CIBERESP , Melchor Fernández Almagro, , Madrid, , Spain. Division of Preventive Oncology, German Cancer Research Center DKFZ and National Center for Tumor Diseases NCT , Im Neuenheimer Feld , Heidelberg, , Germany.
German Cancer Consortium DKTK , German Cancer Research Center DKFZ , Im Neuenheimer Feld , Heidelberg, , Germany. Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, , Norway. You can also search for this author in PubMed Google Scholar. Correspondence to Heinz Freisling.
Supplementary Information accompanies this paper on British Journal of Cancer website. From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 4. Reprints and permissions. Freisling, H.
et al. Comparison of general obesity and measures of body fat distribution in older adults in relation to cancer risk: meta-analysis of individual participant data of seven prospective cohorts in Europe. Br J Cancer , — Download citation.
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This article has been updated. Abstract Background: We evaluated the associations of anthropometric indicators of general obesity body mass index, BMI , an established risk factor of various cancer, and body fat distribution waist circumference, WC; hip circumference, HC; and waist-to-hip ratio, WHR , which may better reflect metabolic complications of obesity, with total obesity-related and site-specific colorectal and postmenopausal breast cancer incidence.
Results: After a median follow-up period of 12 years, first-incident obesity-related cancers defined as postmenopausal female breast, colorectum, lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney had occurred in men and women.
Conclusions: BMI, WC, HC, and WHR show comparable positive associations with obesity-related cancers combined and with colorectal cancer in older adults. Materials and methods Study population The Consortium on Health and Ageing: Network of Cohorts in Europe and the United States CHANCES project is a multi-country study, which aims to harmonise the data from ongoing prospective cohort studies in Europe and North America Boffetta et al, Table 1 Study and participants characteristics by cohort in the CHANCES consortium of middle-aged and older adults Full size table.
Figure 1. Flowchart of participant inclusion. Full size image. Figure 2. Figure 3. Figure 4. Figure 5. Table 2 Changes in risk discrimination for the risk of incident cancer in men and women combined after addition of anthropometric indicators to the null model Full size table.
Conclusions General adiposity as measured by BMI and body fat distribution as measured by WC, HC, or WHR show comparable positive associations with obesity-related cancers combined, with CRC, and with postmenopausal breast cancer.
Change history 23 May This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication. References Anderson AS, Key TJ, Norat T, Scoccianti C, Cecchini M, Berrino F, Boutron-Ruault MC, Espina C, Leitzmann M, Powers H, Wiseman M, Romieu I European code against cancer 4th edition: Obesity, body fatness and cancer.
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Article CAS Google Scholar Moore LL, Bradlee ML, Singer MR, Splansky GL, Proctor MH, Ellison RC, Kreger BE BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults.
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Article Google Scholar Park J, Morley TS, Kim M, Clegg DJ, Scherer PE Obesity and cancer—mechanisms underlying tumour progression and recurrence. Article CAS Google Scholar Pischon T, Lahmann PH, Boeing H, Friedenreich C, Norat T, Tjønneland A, Halkjaer J, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Guernec G, Bergmann MM, Linseisen J, Becker N, Trichopoulou A, Trichopoulos D, Sieri S, Palli D, Tumino R, Vineis P, Panico S, Peeters PHM, Bueno-de-Mesquita HB, Boshuizen HC, Van Guelpen B, Palmqvist R, Berglund G, Gonzalez CA, Dorronsoro M, Barricarte A, Navarro C, Martinez C, Quirós JR, Roddam A, Allen N, Bingham S, Khaw KT, Ferrari P, Kaaks R, Slimani N, Riboli E Body size and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition EPIC.
Article Google Scholar Renehan AG, Flood A, Adams KF, Olden M, Hollenbeck AR, Cross AJ, Leitzmann MF Body mass index at different adult ages, weight change, and colorectal cancer risk in the National Institutes of Health-AARP cohort. Article Google Scholar Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.
Article Google Scholar Renehan AG, Zwahlen M, Egger M Adiposity and cancer risk: new mechanistic insights from epidemiology. Article CAS Google Scholar Roswall N, Freisling H, Bueno-de-Mesquita HBA, Ros M, Christensen J, Overvad K, Boutron-Ruault M-C, Severi G, Fagherazzi G, Chang-Claude J, Kaaks R, Steffen A, Boeing H, Argüelles M, Agudo A, Sánchez M-J, Chirlaque M-D, Barricarte Gurrea A, Amiano P, Wareham N, Khaw K-T, Bradbury KE, Trichopoulou A, Papatesta H-M, Trichopoulos D, Palli D, Pala V, Tumino R, Sacerdote C, Mattiello A, Peeters PH, Ehrnström R, Brennan P, Ferrari P, Ljungberg B, Norat T, Gunter M, Riboli E, Weiderpass E, Halkjaer J Anthropometric measures and bladder cancer risk: A prospective study in the EPIC cohort.
Article CAS Google Scholar Steffen A, Huerta J-M, Weiderpass E, Bueno-de-Mesquita HB, May AM, Siersema PD, Kaaks R, Neamat-Allah J, Pala V, Panico S, Saieva C, Tumino R, Naccarati A, Dorronsoro M, Sánchez-Cantalejo E, Ardanaz E, Quirós JR, Ohlsson B, Johansson M, Wallner B, Overvad K, Halkjaer J, Tjønneland A, Fagherazzi G, Racine A, Clavel-Chapelon F, Key TJ, Khaw K-T, Wareham N, Lagiou P, Bamia C, Trichopoulou A, Ferrari P, Freisling H, Lu Y, Riboli E, Cross AJ, Gonzalez Ca, Boeing H General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition.
Article CAS Google Scholar Stolzenberg-Solomon RZ, Schairer C, Moore S, Hollenbeck A, Silverman DT Lifetime adiposity and risk of pancreatic cancer in the NIH-AARP Diet and Health Study cohort.
Article CAS Google Scholar White AJ, Nichols HB, Bradshaw PT, Sandler DP Overall and central adiposity and breast cancer risk in the sister study. Acknowledgements Data used throughout the present study are derived from the CHANCES project.
Collaborators on behalf of the CHANCES consortium Kari Kuulasmaa, Ben Schöttker, Ute Mons, Kai-Uwe Saum, Bernd Holleczek, Alun Evans, John Yarnell. View author publications.
Ethics declarations Competing interests The authors declare no conflict of interest. Additional information Supplementary Information accompanies this paper on British Journal of Cancer website.
Supplementary information. Supplementary Information DOCX kb. Rights and permissions From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 4.
About this article. Cite this article Freisling, H. Copy to clipboard. Compared with people of healthy weight, those with overweight or obesity are at greater risk for many diseases, including diabetes , high blood pressure , cardiovascular disease , stroke , and at least 13 types of cancer, as well as having an elevated risk of death from all causes 2 — 5.
To determine if someone has obesity, researchers commonly use a measure known as the body mass index BMI. BMI provides a more accurate measure of obesity than weight alone, and for most people it is a good although imperfect indicator of body fatness. The National Heart Lung and Blood Institute has a BMI calculator for adults.
The standard weight categories based on BMI for adults ages 20 years or older are:. The Centers for Disease Control and Prevention CDC has a BMI percentile calculator for children and teens. Measurements that reflect the distribution of body fat are sometimes used along with BMI as indicators of obesity and disease risks.
These measurements include waist circumference, waist-to-hip ratio the waist circumference divided by the hip circumference , waist-to-height ratio, and fat distribution as measured by dual-energy X-ray absorptiometry DXA or DEXA or imaging with CT or PET.
These measures are used because the distribution of fat is increasingly understood to be relevant to disease risks. In particular, visceral fat—fat that surrounds internal organs—seems to be more dangerous, in terms of disease risks, than overall fat or subcutaneous fat the layer just under the skin.
Obesity and severe obesity have become more common in the United States in recent years 7. The percentage of children and adolescents ages 2—19 years with obesity or severe obesity has also increased 6.
According to the CDC, the prevalence of obesity in the United States differs among racial and ethnic groups 7. In , the proportions of adults ages 18 years or older with obesity or severe obesity were:.
In —, the proportions of obesity among children and adolescents ages 2—19 years were 6 :. The prevalence of obesity has increased more quickly recently, possibly due to the COVID pandemic 8. CDC has state-level estimates of adult obesity prevalence in the United States.
Nearly all of the evidence linking obesity to cancer risk comes from large cohort studies, a type of observational study.
However, data from observational studies cannot definitively establish that obesity causes cancer. That is because people with obesity or overweight may differ from people without these conditions in ways other than their body fat, and it is possible that these other differences—rather than their body fat—explain their increased cancer risk.
An International Agency for Research on Cancer IARC Working Group concluded that there is consistent evidence that higher amounts of body fat are associated with an increased risk of a number of cancers. The table below shows the risks reported in representative studies.
People who have a higher BMI at the time their cancer is diagnosed 29 or who have survived cancer 30 , 31 have higher risks of developing a second, unrelated cancer a second primary cancer.
Several possible mechanisms have been suggested to explain how obesity might increase the risks of some cancers 32 , Other possible mechanisms by which obesity could affect cancer risk include impaired tumor immunity and changes in the mechanical properties of the scaffolding tissue that surrounds developing tumors In addition to biological effects, obesity can lead to difficulties in screening and management.
For example, women with overweight or obesity have an increased risk of cervical cancer compared with women of healthy weight, likely due to less effective cervical cancer screening in these individuals A nationwide cross-sectional study using BMI and cancer incidence data from the US Cancer Statistics database estimated that each year in to among people ages 30 and older, about 37, new cancer cases in men 4.
Globally, a study found that in , excess body weight accounted for approximately 3. Most of the data about whether losing weight reduces cancer risk comes from cohort and case—control studies. Observational studies of obesity and cancer risk should be interpreted with caution because they cannot definitively establish that obesity causes cancer and people who lose weight may differ in other ways from people who do not.
Some of these studies have found decreased risks of breast, endometrial, colon, and prostate cancers among people with obesity who had lost weight.
However, unintentional weight loss was not associated with cancer risk in this study. However, in a study that pooled data from 10 cohorts, sustained weight loss was associated with lower breast cancer risk among women 50 years and older To better understand the relationship between weight loss among people with obesity and cancer risk, some researchers are examining cancer risk in people with obesity who have undergone bariatric surgery surgery performed on the stomach or intestines to provide maximum and sustained weight loss.
Studies have found that bariatric surgery among people with obesity, particularly women, is associated with reduced risks of cancer overall 44 ; of hormone-related cancers, such as breast, endometrial, and prostate cancers 45 ; and of obesity-related cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer Most of the evidence about obesity in cancer survivors comes from people who were diagnosed with breast, prostate, or colorectal cancer.
Research indicates that obesity may worsen several aspects of cancer survivorship, including quality of life , cancer recurrence , cancer progression , prognosis survival , and risk of certain second primary cancers 29 , 30 , 47 , For example, obesity is associated with increased risks of treatment-related lymphedema in breast cancer survivors 49 and of incontinence in prostate cancer survivors treated with radical prostatectomy In a large clinical trial of patients with stage II and stage III rectal cancer, those with a higher baseline BMI particularly men had an increased risk of local recurrence Most studies of this question have focused on breast cancer.
Several randomized clinical trials in breast cancer survivors have reported weight loss interventions that resulted in both weight loss and beneficial changes in biomarkers that have been linked to the association between obesity and prognosis 53 , However, there is little evidence about whether weight loss reduces the risk of breast cancer recurrence or death The NCI-sponsored Breast Cancer WEight Loss BWEL Study , an ongoing randomized phase III trial, is examining whether participating in a weight loss program after breast cancer diagnosis affects invasive disease-free survival and recurrence in overweight and obese women Many studies are exploring mechanisms that link obesity and cancer 34 , One research area involves understanding the role of the microbes that live in the human gastrointestinal tract collectively called the gut microbiota, or microbiome in both type 2 diabetes and obesity.
Both diseases are associated with dysbiosis, an imbalance in the community of these microbes. For example, the gut microbiomes of people with obesity differ from and are less diverse than those of people of healthy weight.
Imbalances in the gut microbiota are associated with inflammation , altered metabolism , and genotoxicity, which may in turn be related to cancer.
Yang Cao Fat distribution and cancer risk, Bin XiaAcncer Zhang distribuhion, Dan HuNutritional shakes for athletes HuangRiisk YuanFangping Li; Distribtuion of Fat distribution and cancer risk Fat Distribution and Risk of Breast Cancer in Pre- and Postmenopausal Women. Obes Distribuyion 10 Diatribution ; 16 4 : — Introduction: Obesity is a risk factor for both the development of and mortality from breast cancer in postmenopausal but not in premenopausal women. However, which part of the fat mass is associated with risk remains unclear, and whether the difference in the risk for breast cancer is associated with discrepancy in the distribution of fat with menstrual status requires further study. Methods: A dataset from the UK Biobank, which includedfemale participants and 5, females who developed breast cancer during a mean follow-up of 6. Ft Although obesity has been linked to an increased Fay of colorectal cancer CRCHunger control methods risk associated with long-term status or change of body fat distribution cancfr not distrjbution fully elucidated. Results: High waist circumference, hip canccer and waist-to-hip Fat distribution and cancer risk were all associated with a cnacer CRC dsitribution in Lycopene and mood enhancement, even after ris, for body mass index. The association was attenuated to null in women after adjusting for body mass index. This association appeared to be independent of weight change. Conclusions: Abdominal adiposity, independent of overall obesity, is associated with an increased CRC risk in men but not in women. Our findings also provide the first prospective evidence that waist circumference gain during adulthood may be associated with higher CRC risk in men, thus highlighting the importance of maintaining a healthy waist for CRC prevention. Long-term abdominal adiposity during adulthood, independent of overall obesity, is associated with an increased risk of colorectal cancer in men but not in women.
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