The Obesity Paradox in Cancer: Epidemiologic Insights and Perspectives

Overview

Journal Curr Nutr Rep

Specialty Nutritional Sciences

Date 2019 May 27

PMID 31129887

Citations 68

Authors

Dong Hoon Lee

Edward L Giovannucci

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Controversy exists whether excess body fatness (measured by body mass index (BMI)) is associated with better cancer survival ("obesity paradox"). Here, we review the obesity paradox in cancer research and discuss potential explanations and future research directions.

Recent Findings: Overweight and obese cancer patients have better survival for diverse cancers. This apparent obesity paradox may be largely explained by methodological limitations including reverse causation, selection bias, confounding, and reliance of BMI as a measure of adiposity in cancer patients. A growing number of studies show promising evidence that precisely quantified body composition can provide important prognostic information in cancer care, such that low muscle and high adiposity are associated with worse clinical outcomes in cancer patients. The term obesity paradox in cancer, implying a causally beneficial role of adiposity, is misleading. Understanding the role of muscle and adiposity may reduce the confusion and inform precision oncology care.

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References

Ebadi M, Martin L, Ghosh S, Field C, Lehner R, Baracos V . Subcutaneous adiposity is an independent predictor of mortality in cancer patients. Br J Cancer. 2017; 117(1):148-155. PMC: 5520211. DOI: 10.1038/bjc.2017.149. View

Stiles Z, Rist T, Dickson P, Glazer E, Fleming M, Shibata D . Impact of body mass index on the short-term outcomes of resected gastrointestinal stromal tumors. J Surg Res. 2017; 217:123-130. DOI: 10.1016/j.jss.2017.05.010. View

Cespedes Feliciano E, Kroenke C, Bradshaw P, Chen W, Prado C, Weltzien E . Postdiagnosis Weight Change and Survival Following a Diagnosis of Early-Stage Breast Cancer. Cancer Epidemiol Biomarkers Prev. 2016; 26(1):44-50. PMC: 5224999. DOI: 10.1158/1055-9965.EPI-16-0150. View

Brown J, Cespedes Feliciano E, Caan B . The evolution of body composition in oncology-epidemiology, clinical trials, and the future of patient care: facts and numbers. J Cachexia Sarcopenia Muscle. 2019; 9(7):1200-1208. PMC: 6351674. DOI: 10.1002/jcsm.12379. View

Banack H, Kaufman J . Does selection bias explain the obesity paradox among individuals with cardiovascular disease?. Ann Epidemiol. 2015; 25(5):342-9. DOI: 10.1016/j.annepidem.2015.02.008. View

Song M, Giovannucci E . Estimating the Influence of Obesity on Cancer Risk: Stratification by Smoking Is Critical. J Clin Oncol. 2016; 34(27):3237-9. DOI: 10.1200/JCO.2016.67.6916. View

Gao C, Patel C, Michailidou K, Peters U, Gong J, Schildkraut J . Mendelian randomization study of adiposity-related traits and risk of breast, ovarian, prostate, lung and colorectal cancer. Int J Epidemiol. 2016; 45(3):896-908. PMC: 6372135. DOI: 10.1093/ije/dyw129. 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

Sealy M, Dechaphunkul T, van der Schans C, Krijnen W, Roodenburg J, Walker J . Low muscle mass is associated with early termination of chemotherapy related to toxicity in patients with head and neck cancer. Clin Nutr. 2019; 39(2):501-509. DOI: 10.1016/j.clnu.2019.02.029. View

10.

WEISS L, Melchardt T, Habringer S, Boekstegers A, Hufnagl C, Neureiter D . Increased body mass index is associated with improved overall survival in diffuse large B-cell lymphoma. Ann Oncol. 2013; 25(1):171-6. DOI: 10.1093/annonc/mdt481. View

11.

Smith L, Brinton L, Spitz M, Lam T, Park Y, Hollenbeck A . Body mass index and risk of lung cancer among never, former, and current smokers. J Natl Cancer Inst. 2012; 104(10):778-89. PMC: 3352831. DOI: 10.1093/jnci/djs179. View

12.

Chiolero A, Faeh D, Paccaud F, Cornuz J . Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008; 87(4):801-9. DOI: 10.1093/ajcn/87.4.801. View

13.

Schlesinger S, Siegert S, Koch M, Walter J, Heits N, Hinz S . Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis. Cancer Causes Control. 2014; 25(10):1407-18. DOI: 10.1007/s10552-014-0435-x. View

14.

Li S, Wang Z, Huang J, Fan J, Du H, Liu L . Systematic review of prognostic roles of body mass index for patients undergoing lung cancer surgery: does the 'obesity paradox' really exist?. Eur J Cardiothorac Surg. 2017; 51(5):817-828. DOI: 10.1093/ejcts/ezw386. View

15.

Fearon K, Strasser F, Anker S, Bosaeus I, Bruera E, Fainsinger R . Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011; 12(5):489-95. DOI: 10.1016/S1470-2045(10)70218-7. View

16.

Secord A, Hasselblad V, von Gruenigen V, Gehrig P, Modesitt S, Bae-Jump V . Body mass index and mortality in endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol. 2015; 140(1):184-90. PMC: 7065832. DOI: 10.1016/j.ygyno.2015.10.020. View

17.

Lennon H, Sperrin M, Badrick E, Renehan A . The Obesity Paradox in Cancer: a Review. Curr Oncol Rep. 2016; 18(9):56. PMC: 4967417. DOI: 10.1007/s11912-016-0539-4. View

18.

Caan B, Meyerhardt J, Kroenke C, Alexeeff S, Xiao J, Weltzien E . Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study). Cancer Epidemiol Biomarkers Prev. 2017; 26(7):1008-1015. PMC: 5647152. DOI: 10.1158/1055-9965.EPI-17-0200. View

19.

Hernan M, Hernandez-Diaz S, Robins J . A structural approach to selection bias. Epidemiology. 2004; 15(5):615-25. DOI: 10.1097/01.ede.0000135174.63482.43. View

20.

Carreras-Torres R, Johansson M, Haycock P, Wade K, Relton C, Martin R . Obesity, metabolic factors and risk of different histological types of lung cancer: A Mendelian randomization study. PLoS One. 2017; 12(6):e0177875. PMC: 5464539. DOI: 10.1371/journal.pone.0177875. View