cancer and obesity

8/20/2019 Cancer and Obesity

1/47

Obesity and cancer

Kim Robien, PhD, RD, CSO, FAND Associate Professor

Department of Exercise and Nutrition SciencesMilken Institute School of Public Health

George ashington !ni"ersit#

krobien$g%u&edu

National Press 'oundation( )ancer Program *+,-


2/47

Obesity•

Defined as the presence of excess body fat• Adipose tissue is metabolically active and critical to

health – Storage of energy for periods of fasting –

Cushioning to protect organs and bones from injury – Important for maintaining body temperature – Endocrine functions: production of hormones such as leptin

adiponectin angiotensin estradiol – Involved in production of other important proteins: aromatase

cyto!ines

• "ot all body fat is e#ual: visceral fat may be moremetabolically active than subcutaneous


3/47

Pulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome

Nonalcoholic fatty liverdiseasesteatosis

steatohepatitiscirrhosis

Coronary heart disease Diabetes

Dyslipidemia $ypertension

Gynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome

Osteoarthritis

Skin

Gall bladder disease

Cancer breast endometrial ovarianprostate colorectalesophagus pancreas liver !idney gall bladder

Phlebitisvenous stasis

Gout

%edical Complications of ObesityIdiopathic intracranialhypertension

Stroke

Cataracts

Severe pancreatitis


4/47

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*B ! "#$, or % #$ lbs. o&er'eig t )or 5 + -erson

No Data


5/47


Obesity Trends* Among U.S. AdultsBRFSS, 198/


No Data


6/47



No Data


7/47Source: Behavioral Risk Factor Surveillance System, CDC.



No Data





No Data



Obesity Trends* Among U.S. AdultsBRFSS, 199$


No Data





No Data



Obesity Trends* Among U.S. AdultsBRFSS, 199#


No Data



Obesity Trends* Among U.S. AdultsBRFSS, 199+


No Data





No Data



Obesity Trends* Among U.S. AdultsBRFSS, 199/


No Data


16/47




No Data


17/47




No Data


18/47




No Data


19/47


Obesity Trends* Among U.S. AdultsBRFSS, $$$


No Data


20/47


Obesity Trends* Among U.S. AdultsBRFSS, $$1


No Data


21/47



Obesity Trends* Among U.S. AdultsBRFSS, $$

No Data


22/47


Obesity Trends* Among U.S. AdultsBRFSS, $$#


No Data


23/47


Obesity Trends* Among U.S. AdultsBRFSS, $$+


No Data


24/47




No Data


25/47


Obesity Trends* Among U.S. AdultsBRFSS, $$/


No Data


26/47




No Data


27/47




No Data


28/47




No Data


29/47


Obesity Trends* Among U.S. AdultsBRFSS, $1$


No Data


30/47


$$$

Obesity Trends* Among U.S. AdultsBRFSS, 199$, $$$, $1$

(*B ! #$, or 2bout #$ lbs. o&er'eig t )or 5 + -erson

$1$

199$

No Data


31/47


3re&2len4e o) Sel)6Re-orted Obesity Among U.S.Adults by St2te 2nd Territory, BRFSS, $1+

¶ 3re&2len4e estim2tes re)le4t BRFSS met odologi42l 4 2nges st2rted in $11.T ese estim2tes s ould not be 4om-2red to -re&2len4e estim2tes be)ore $11.

*S2m-le si7e 5$ or t e rel2ti&e st2nd2rd error (di&iding t e st2nd2rd error by t e -re&2len4e " #$ .


32/47

http:&&'''(cdc(gov&nchs&data&hestat&obesity)child)**)*+&obesity)child)**)*+(pdf


33/47

$o' do 'e measure obesity,


34/47

-ody %ass Index

-%I . 'eight /!g0& height /m +0

"$1-I -%I Calculator: http:&&'''(nhlbisupport(com&bmi

2eight status category -%I

3nder 'eight 4 *5(6

$ealthy 'eight *5(6 7 +8(9

Over'eight +6( 7 +9(9Obese I ; ( 7 ;8(9

Obese II ;6( 7 ;9(9

Extreme obesity < 8 (


35/47

-%I

Strengths:• =rovides a more accurate measure of total body fat compared 'ith

the assessment of body 'eight alone(• Inexpensive easily calculated•

%ost practical method of assessing body composition for largeepidemiologic studies(

1imitations:• Overestimates body fat in persons 'ho are very muscular(• Can underestimate body fat in persons 'ho have lost muscle mass

/example: many elderly0


36/47

Other methods of measuring bodycomposition .primaril# used in research/

%ethod Strengths 1imitations

$ydrostatic/under'ater0 'eighing

Considered the goldstandard

1imited availability-urdensome&traumatic for participants

Computed tomography/C>0

Can #uantify compositionin specific body parts

Expensive1imited availability

%agnetic resonanceimaging /%?I0


Expensive1imited availability

Dual @ rayabsorptiometry /DE@A0


%oderately expensive1imited availability

-ioelectric impedence

analysis /-IA0

=ortable Some'hat expensive

$ighly dependent on hydration statustime of day

-od=od 1o' participant burden %oderately expensive1imited availability

S!in foldmeasurements

?elatively inexpensive

=ortable

"ot terribly accurate

Significant variation bet'een operators


37/47

Obesity and cancer


38/47

orld )ancer 0esearch 'und .*++1/

Bood "utrition =hysical

Activity and the =revention ofCancer: A lobal =erspective• Systematic revie' of the nutrition physical activity and cancer literature

• Detailed revie' of the evidence supporting an association bet'eenobesity and cancer ris!(

• Entire document can be do'nloaded for free:'''(dietandcancerreport(org

• "o' being conducted as a Continuous 3pdate =roject

2Maintenance of a health# %eight throughout life ma# be oneof the most important %a#s to protect against cancer3


39/47


40/47

Cancer ris! associated 'ith 6 unit changein -%I by individual cancer site

http:&&'crf(org&int&cancer facts figures&lin! bet'een lifestyle cancer ris!&cancers lin!ed greater body fatness


41/47

Cancer preventability estimates for bodyfatness

http:&&'crf(org&int&cancer facts figures&preventability estimates&cancer preventability estimates body fatness


42/47

=ossible biologic mechanisms

• Inflammation

• Diabetes

• Alterations in hormone gro'th factor levels

• Adipose tissue may serve as a storage site for

environmental toxins=ersistent organic pollutants /=C- DD> dioxins0$eavy metals /mercury arsenic cadmium lead0Endocrine disrupting chemicals /bisphenol A phthalates0


43/47

Obesity may influence cancer screeningbehaviors• %orbidly obese 'omen are significantly less li!ely to

report recent mammography /=%ID: *9+ 9 0

•

Obese 'hite 'omen are less li!ely to report beingscreened for cervical cancer than their lean counterpartsand this does not hold true for blac! 'omen/=%ID: *599 5+0

• -%I 'as not associated 'ith colon cancer screening/=%ID: ++89+5;+0


44/47

Obesity and cancer survival


45/47

Obesity and survival after a cancerdiagnosis

=eople 'ho are over'eight&obese at cancer diagnosis tendto have poorer outcomes

F Associations bet'een obesity and cancer recurrence

F Increased ris! of complications follo'ing surgicalresection

F 3nclear ho' to dose chemotherapy for over'eightand obese patients


46/47

http:&&'crf(org&sites&default&files&-reast Cancer Survivors + *8 ?eport(pdf


47/47

IO% Conference on Obesity andCancer Survival and ?ecurrence

http:&&'''(iom(edu&?eports&+ *+&>he ?ole of Obesityin Cancer Survival and ?ecurrence(aspx

?eport available as a free =DB do'nload from the"ational Academies =resshttp:&&'''(nap(edu&catalog(php,record)id.*;;85

Summary article published in )ancer Epidemiolog#

4iomarkers and Pre"ention August + *+=%ID: ++ 96 ;6

cancer and obesity

Documents