Date post: | 06-Aug-2015 |
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Martin Wiseman
World Cancer Research Fund
International
University of Southampton, UK
OBESITY IN THE DEVELOPMENT AND
PROGRESSION OF CANCER
Obesity and overweight in Scotland
1995 - 2010
Scottish Health Survey 2010
Obesity and overweight in Scotland
1995 - 2010
Scottish Health Survey 2010
29%
64%
Prevalence of obesity among adultsHealth Survey for England 1993-2011 (3-year average)
0%
5%
10%
15%
20%
25%
30%
Pre
vale
nce
of o
be
sity
Women
Men
24%
Prevalence of overweight among adultsHealth Survey for England 1993-2011 (3-year average)
30%
35%
40%
45%
50%
55%
60%
65%
70%
Pre
vale
nce
of o
verw
eigh
t
Men
Women
58-66%
Prevalence of obesityBMI>30 16-64y
OPCS 1980
NDNS 1987- 2000
HSE 1991-1998
Obesity in Scotland - 2010
Scottish Health Survey 2010
Adult obesity prevalence by ageHealth Survey for England 2009-2011
9.4%
16.6%
23.1%
33.7% 33.4%
29.3%
25.8%
13.2%
19.3%
25.0%
29.3%31.0%
33.2%
28.2%
0%
5%
10%
15%
20%
25%
30%
35%
16-24 25-34 35-44 45-54 55-64 65-74 75+
Pre
vale
nce
of o
bes
ity
Men Women
Obesity in Scotland - 2010
Scottish Health Survey 2010
Obesity costs
1. NHS: £5.1 billion (Scarborough 2011)
2. Economy: £16 billion (Foresight 2007)
3. Economy projected to 2050
£50 billion (Foresight
2007)
The most rigorous, systematic, comprehensive and
authoritative reviews of the accumulated evidence in
the field of food, nutrition, physical activity and
cancer
Nutrition and cancer
1. OBESITY– BREAST (Postmenopause), COLORECTUM, ENDOMETRIUM,
OESOPHAGUS, PANCREAS, GALLBLADDER, KIDNEY
2. PHYSICAL ACTIVITY– COLON, BREAST, OBESITY
3. RED AND PROCESSED MEAT– COLORECTAL
4. PLANT FOODS– MOUTH, PHARYNX, LARYNX, OESOPHAGUS, STOMACH,
COLORECTAL (dietary fibre), LUNG, OBESITY
5. ALCOHOL– MOUTH, PHARYNX, LARYNX, COLORECTUM, LIVER
6. SALT– STOMACH
7. BREASTFEEDING– BREAST, EXCESS WEIGHT GAIN (CHILD)
The Panel emphasises the
importance of not smoking and of
avoiding exposure to tobacco smoke
The Panel emphasises the
importance of not smoking and of
avoiding exposure to tobacco smoke
Nutrition and cancer
1. OBESITY– BREAST (Postmenopause), COLORECTUM, ENDOMETRIUM,
OESOPHAGUS, PANCREAS, GALLBLADDER, KIDNEY
2. PHYSICAL ACTIVITY– COLON, BREAST, ENDOMETRIUM, OBESITY
3. RED AND PROCESSED MEAT– COLORECTAL
4. PLANT FOODS– MOUTH, PHARYNX, LARYNX, OESOPHAGUS, STOMACH,
COLORECTAL (dietary fibre), LUNG, OBESITY
5. ALCOHOL– MOUTH, PHARYNX, LARYNX, COLORECTUM, LIVER
6. SALT– STOMACH
7. BREASTFEEDING– BREAST, EXCESS WEIGHT GAIN (CHILD)
Obesity and cancer
BREAST (Postmenopause)
COLON and RECTUM
ENDOMETRIUM
OESOPHAGUS
PANCREAS
GALLBLADDER
KIDNEY
Effects of products of adipocytes
Adipose
tissue
↑ IL-6
↓ Adiponectin
↑ Leptin
↑ TNFα
↑ Adipsin
(Complement D)
↑ Plasminogen
activator inhibitor-1
(PAI-1)
↑ Resistin
↑ FFA
↑ Insulin
↑ Angiotensinogen↑ Lipoprotein lipase
↑ Lactate
Inflammation
Type
2 diabetes
Hypertension
Atherogenic
dyslipidaemia
ThrombosisAtherosclerosis
Lyon 2003; Trayhurn et al 2004; Eckel et al 2005
Elevated oestrogen
Aromatase
Obesity and cancer
Mechanisms1. Insulin resistance
• abnormal insulin/IGF axis
• excess growth factors
2. Inflammation• promotes oncogenic genetic signature
• increases proliferation, angiogenesis
• reduces apoptosis
3. Excess oestrogen• promotes proliferation and cancer in sensitive
tissues
Around one third of the commonest
cancers estimated avoidable
through appropriate food, nutrition
and physical activity
Obesity and cancer
progression
Expert US WORKSHOP 2011
Breast cancer• Normal weight at diagnosis associated with better outcomes
• Higher (and low) BMI at diagnosis associated with greater recurrence and death.
• Obesity: 30% increase in mortality
40+% increase in metastases after 10 y
• Importance of physical activity
Obesity and cancer
progression
US Expert WORKSHOP 2011
Prostate cancer• Sparse and conflicting evidence
Colon cancer• Limited early evidence only
Cancer incidence by weight loss tertile
SOS
Obesity and cancer
progression
Summary
Obesity is an adverse prognostic factor, but the impact of weight loss on outcome is less clear.
Nevertheless, weight management in cancer survivors is important, both for quality of life and for co-morbidities.
0
1
2
3
4
5
6
7
8
Fatness, Fitness & Cardiovascular Disease
Mortality
Lean
<16.7%
Rel
ativ
e R
isk
of
CV
D M
ort
alit
y
Body Fat Category (% Fat)
Lee et al. Am J Clin Nutr 1999;69:373.
Normal
16.7%-24.9%
Obese
>25%
Fit
Unfit
Is It Possible For Obese To Be Fit?
Normal Overwt Obese Normal Overwt Obese
0
2500
5000
7500
10000
12500
15000
17500
20000
Unfit
Fit
Men Women
Nu
mb
ers
Continuous Update Project
(CUP)• Keep evidence, conclusions and
recommendations updated into the future
• Working with team at ICL
• Same principles:
- Systematically review evidence
- Meta analysis
- Panel of experts-draw conclusions
-make recommendations
Conclusions1. With smoking, food, nutrition, body fatness and
physical activity are the most important factors affecting cancer risk
2. About 20% of the commonest cancers in high income countries could be prevented by maintaining a healthy body weight
3. There is strong evidence that being a healthy weight is linked to improved outcome in breast cancer survivors
4. Evidence for an effect in survivors of prostate and colon cancers is generally less compelling
5. Physical activity is also important –
– but separate
http://www.dietandcancerreport.org