Overweight, obesity, and cancer risk

doi:10.1016/S1470-2045(02)00849-5

The Lancet Oncology

Volume 3, Issue 9, September 2002, Pages 565-574

https://doi.org/10.1016/S1470-2045(02)00849-5 Get rights and content

Summary

Over the past few decades the proportion of people with excess body weight has been increasing in both developed and less developed countries. About 50% of men and 35% of women in Europe are currently estimated to be overweight or obese. In addition to an increase in the risk of cardiovascular disease and type II diabetes, the evidence summarised here shows that excess body weight is directly associated with risk of cancer at several organ sites, including colon, breast (in postmenopausal women), endometrium, oesophagus, and kidney. In part, these associations with cancer risk may be explained by alterations in the metabolism of endogenous hormones-including sex steroids, insulin, and insulin-like growth factors-which can lead to distortion of the normal balance between cell proliferation, differentiation, and apoptosis. Avoidance of weight gain thus seems to be an important factor for cancer prevention.

Section snippets

Methods for assessing obesity

An individual's BMI is defined as their weight in kilograms divided by the square of their height in metres; it is generally used as an indirect measure of adiposity in epidemiological studies. ‘Normal weight’ is classified as BMI between 18·5 and 25 kg/m², ‘overweight’ is over 25 kg/m², and ‘obesity’ is defined as a BMI of greater than 30 kg/m².¹³ Although BMI does not distinguish directly between adipose tissue and lean body masses, there is a good correlation between BMI and the percentage

Adiposity and cancer risk

In this review, relative risks (RRs) are given for the highest versus the lowest categories of BMI (Figure 2, Figure 3, Figure 4, Figure 5). BMI ranges differed between cancer sites and between studies, but on average the ranges were:

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<22 kg/m² and >28·5 kg/m² for colon and breast cancer,
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<23·5 kg/m² and >30 kg/m² for endo-metrial cancer.
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<22·5 kg/m² and >27 kg/m² for kidney and prostate cancer, and
•
<21·5 kg/m² and >25 kg/m² for oeso-phageal cancer.

Case-control and prospective cohort studies

Mechanisms of altered cancer risk

The relation between excess body weight and cancer risk suggests that excess energy is an important risk factor for development of cancer. This notion is supported by experimental observations that energy restriction can confer a strong protection against the development of several types of tumours in different species.40, 41, 42, 43 Furthermore, there is evidence that individuals who take regular physical activity are protected against cancers of the breast, colon, and possibly the endometrium.

Weight control and physical activity

Avoidance of weight gain should become one of the mainstays of chronic disease prevention in modern societies. Weight control can be achieved by changes in energy intake and by increased physical activity. About half of the adult population of industrialised countries are insufficiently active in their leisure time and one quarter to one third can be classified as totally inactive.³⁸ Promotion of physical activity seems particularly effective for prevention of weight gain,⁷⁹ but results are

Conclusions

There is sufficient evidence that adiposity can cause cancers of the colon, breast (in postmenopausal women), endometrium, kidney, oesophagus, and gastric cardia. Furthermore, plausible mechanistic explanations exist for most of these associations. Nevertheless, uncertainties remain about the extent of excess weight that constitutes an increase in cancer risk. For prevention of diabetes and cardiovascular disease, a BMI in the range 18·5–25 kg/m² has been recommended. The breadth of this range

Search strategy and selection criteria

We did an exhaustive Medline search of scientific publications between 1966 and 2000, which formed the basis of a recent panel discussion by an international expert group convened by the International Agency for Research on Cancer, in Lyon, France.³⁸ We selected studies on the basis of the number of cases included—at least 200 cases for breast and colorectal cancers; 100 cases for colon adenomas, endometrial, and prostate cancers; and 50 cases for cancers at other organ sites. Only those

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Patients enrolled in the TOSCA trial between 2007-2013 with BMI data entered the study. The prognostic impact of BMI on survival outcomes was investigated through uni- and multivariable Cox regression analyses.
Overall, 1455 patients with stage II/III CC patients were included. The median follow-up was of 61.5 months; 16.1% of patients relapsed, 11.2% died and 19.5% patients relapsed or died. No impact of BMI on RFS was detected at univariate or multivariable analyses. By univariate analysis for OS, a significantly impact of a BMI > 30 kg/m² was reported (HR [>30 vs <25] 1.57, 95% CI 1.00-2.47, p = 0.049; HR [>30 vs <30] 1.55, 95% CI 1.01-2.37, p = 0.045). Multivariable analyses did not confirm this data. In the subgroup of stage III patients, a negative survival impact of BMI was found in univariate and multivariable models both for RFS and for OS.
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ReviewOverweight, obesity, and cancer risk

Summary

Section snippets

Methods for assessing obesity

Adiposity and cancer risk

Mechanisms of altered cancer risk

Weight control and physical activity

Conclusions

Search strategy and selection criteria

Prev Med

Am J Clin Nutr

Ann Epidemiol

Free Radic Biol Med

Mech Ageing Dev

Mutat Res

J Steroid Biochem Mol Biol

J Steroid Biochem Mol Biol

Am J Clin Nutr

Lancet

Incidence, increasing prevalence, and predictors of change in obesity and fat distribution over 5 years in the rapidly developing population of Mauritius

Int J Obes Relat Metab Disord

Overweight and obesity in the United States: prevalence and trends, 1960–1994.

Int J Obes Relat Metab Disord

The epidemiology of obesity

Shifting obesity trends in Brazil.

Eur J Clin Nutr

Global prevalence and secular trends in obesity

Obesity in women from developing countries.

Eur J Clin Nutr

The continuing epidemics of obesity and diabetes in the United States.

JAMA

Prevalence and trends of obesity in the Netherlands 1987–1991.

Int J Obes Relat Metab Disord

Trends in cardiovascular risk factors in Australia: results from the National Heart Foundation's Risk Factor Prevalence Study, 1980–1989.

Med J Aust

WWW publications from the WHO MONICA project

Overweight, obesity, and health risk

Arch Intern Med

Energy and protein requirements: report of a joint expert consultation

WHO TR 724

Body-mass index as a measure of body fatness: age- and sex-specific prediction formulas.

Br J Nutr

Body size and the risk of colon cancer in a large case-control study.

Int J Obes Relat Metab Disord

Diet, body mass and colorectal cancer: a case-referent study in Stockholm.

Int J Cancer

Leisure-time physical activity, body size, and colon cancer in women. Nurses' Health Study Research Group.

J Natl Cancer Inst

Obesity and colorectal adenomatous polyps.

J Natl Cancer Inst

Physical activity, obesity, and risk of colorectal adenoma in women (United States).

Cancer Causes Control

Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum.

Am J Epidemiol

Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer.

Cancer Res

The association of body size and large bowel cancer risk in Wisconsin (United States) women.

Cancer Causes Control

Obesity, weight gain and risk of colon adenomas in Japanese men.

Jpn J Cancer Res

A prospective study in general practice on breast-cancer risk in postmenopausal women.

Int J Cancer

Combined effects of body size, parity, and menstrual events on breast cancer incidence in seven countries.

Am J Epidemiol

Diet, body size, and breast cancer.

Epidemiol Rev

Dual effects of weight and weight gain on breast cancer risk.

JAMA

Body size in different periods of life and breast cancer risk in post-menopausal women.

Int J Cancer

Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer

Lancet

Review
Overweight, obesity, and cancer risk