Impact of a Behaviorally-based Weight Loss Intervention on Parameters of Insulin Resistance in Breast Cancer Survivors

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2018 Mar 29

PMID 29587682

Citations 12

Authors

Kim L Dittus

Jean R Harvey

Janice Y Bunn

Nathan D Kokinda

Karen M Wilson

Jeff Priest

Richard E Pratley

Affiliations

Soon will be listed here.

Abstract

Background: Breast cancer survivors with excess weight are more likely to have negative breast cancer outcomes. Biomarkers related to insulin resistance may help explain this negative association. Weight loss is associated with improvements in insulin sensitivity. Our goal was to identify the impact of a behaviorally based weight loss intervention on indices of insulin resistance.

Methods: Overweight, early stage breast cancer survivors who completed initial cancer therapy were enrolled in a 6 month behaviorally based weight loss intervention that included calorie reduction, exercise and behavior modification. Biomarkers related to insulin resistance were obtained at baseline and after the intervention. Results from participants who achieved ≥5% weight loss were compared to those who lost less weight.

Results: Despite not having diabetes as a preexisting diagnosis prior to the study, 69% of all participants were considered to have pre-diabetes or diabetes at baseline based on American Diabetes Association definitions. Participants who achieved ≥5% weight loss had significantly lower fasting insulin, AUC insulin, and insulin resistance as measured by HOMA-IR. Beta cell function decreased as anticipated when insulin resistance improved. Additionally, leptin levels declined.

Conclusions: Breast cancer survivors who achieved ≥5% weight loss demonstrated significant improvements in indices of insulin resistance. Despite an exclusion criteria of diabetes at the time of enrolment, a high proportion met criteria for pre-diabetes or diabetes at baseline. Pre-diabetes appears to be under recognized in overweight breast cancer survivors. Behaviorally based weight loss interventions can result in weight loss and improvements in biomarkers related to breast cancer outcomes and additionally may decrease the chance of developing diabetes.

Trial Registration: NCT01482702 4/12/2010 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT01482702?term=Dittus&rank=4.

Citing Articles

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Assessing the evidence for health benefits of low-level weight loss: a systematic review.

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Effect of a lifestyle intervention program's on breast cancer survivors' cardiometabolic health: Two-year follow-up.

Natalucci V, Ferri Marini C, Lucertini F, Annibalini G, Sisti D, Vallorani L Heliyon. 2023; 9(11):e21761.

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References

Campbell K, Van Patten C, Neil S, Kirkham A, Gotay C, Gelmon K . Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. J Acad Nutr Diet. 2012; 112(4):559-67. DOI: 10.1016/j.jada.2011.10.022. View

Chan D, Vieira A, Aune D, Bandera E, Greenwood D, McTiernan A . Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014; 25(10):1901-1914. PMC: 4176449. DOI: 10.1093/annonc/mdu042. View

Befort C, Klemp J, Austin H, Perri M, Schmitz K, Sullivan D . Outcomes of a weight loss intervention among rural breast cancer survivors. Breast Cancer Res Treat. 2011; 132(2):631-9. PMC: 3314288. DOI: 10.1007/s10549-011-1922-3. View

Mann S, Beedie C, Balducci S, Zanuso S, Allgrove J, Bertiato F . Changes in insulin sensitivity in response to different modalities of exercise: a review of the evidence. Diabetes Metab Res Rev. 2013; 30(4):257-68. DOI: 10.1002/dmrr.2488. View

Vona-Davis L, Rose D . Angiogenesis, adipokines and breast cancer. Cytokine Growth Factor Rev. 2009; 20(3):193-201. DOI: 10.1016/j.cytogfr.2009.05.007. View

Jen K, Djuric Z, Dilaura N, Buison A, Redd J, Maranci V . Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens. Obes Res. 2004; 12(2):306-12. DOI: 10.1038/oby.2004.38. View

Matsuda M, DeFronzo R . Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999; 22(9):1462-70. DOI: 10.2337/diacare.22.9.1462. View

Mason C, Foster-Schubert K, Imayama I, Kong A, Xiao L, Bain C . Dietary weight loss and exercise effects on insulin resistance in postmenopausal women. Am J Prev Med. 2011; 41(4):366-75. PMC: 3185302. DOI: 10.1016/j.amepre.2011.06.042. View

Goodwin P . Obesity, insulin resistance and breast cancer outcomes. Breast. 2015; 24 Suppl 2:S56-9. DOI: 10.1016/j.breast.2015.07.014. View

10.

Guo S, Liu M, Wang G, Torroella-Kouri M, Gonzalez-Perez R . Oncogenic role and therapeutic target of leptin signaling in breast cancer and cancer stem cells. Biochim Biophys Acta. 2012; 1825(2):207-22. PMC: 3307887. DOI: 10.1016/j.bbcan.2012.01.002. View

11.

Wallace T, Levy J, Matthews D . Use and abuse of HOMA modeling. Diabetes Care. 2004; 27(6):1487-95. DOI: 10.2337/diacare.27.6.1487. View

12.

Mantzoros C, Petridou E, Dessypris N, Chavelas C, Dalamaga M, Alexe D . Adiponectin and breast cancer risk. J Clin Endocrinol Metab. 2004; 89(3):1102-7. DOI: 10.1210/jc.2003-031804. View

13.

Pi-Sunyer X, Kris-Etherton P . Improving health outcomes: future directions in the field. J Am Diet Assoc. 2005; 105(5 Suppl 1):S14-6. DOI: 10.1016/j.jada.2005.02.027. View

14.

Harrigan M, Cartmel B, Loftfield E, Sanft T, Chagpar A, Zhou Y . Randomized Trial Comparing Telephone Versus In-Person Weight Loss Counseling on Body Composition and Circulating Biomarkers in Women Treated for Breast Cancer: The Lifestyle, Exercise, and Nutrition (LEAN) Study. J Clin Oncol. 2015; 34(7):669-76. PMC: 4872022. DOI: 10.1200/JCO.2015.61.6375. View

15.

Allison D, Paultre F, Maggio C, Mezzitis N, Pi-Sunyer F . The use of areas under curves in diabetes research. Diabetes Care. 1995; 18(2):245-50. DOI: 10.2337/diacare.18.2.245. View

16.

Nichols H, Trentham-Dietz A, Egan K, Titus-Ernstoff L, Holmes M, Bersch A . Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev. 2009; 18(5):1403-9. PMC: 2715918. DOI: 10.1158/1055-9965.EPI-08-1094. View

17.

Carter S, Caron A, Richard D, Picard F . Role of leptin resistance in the development of obesity in older patients. Clin Interv Aging. 2013; 8:829-44. PMC: 3706252. DOI: 10.2147/CIA.S36367. View

18.

Cowey S, Hardy R . The metabolic syndrome: A high-risk state for cancer?. Am J Pathol. 2006; 169(5):1505-22. PMC: 1780220. DOI: 10.2353/ajpath.2006.051090. View

19.

Rose D, Komninou D, Stephenson G . Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev. 2004; 5(3):153-65. DOI: 10.1111/j.1467-789X.2004.00142.x. View

20.

Miller J, Pratley R, Goldberg A, Gordon P, Rubin M, Treuth M . Strength training increases insulin action in healthy 50- to 65-yr-old men. J Appl Physiol (1985). 1994; 77(3):1122-7. DOI: 10.1152/jappl.1994.77.3.1122. View