Obesity: impact on Colorectal Carcinoma
Abstract
Introduction: The increasing prevalence of obesity is a serious public health problem which is associated with an increased risk of many diseases that result in great morbidity and mortality. Some cancers seem to be among these, one of these being colorectal carcinoma (CRC). The aim of this study is to evaluate the impact of obesity as a risk factor for CRC and to discuss the mechanisms that may establish a link between this cancer and obesity. Methods: A research was conducted in PubMed database, limited to ten years, with the articles considered to be relevant being selected after reading the title and abstract. Results: There is a statistically significant positive association between CRC and obesity, with the risk being higher for males and for colon compared with the rectum, for most studies. In spite of body mass index (BMI) being the most widely used measure for obesity estimation in studies in the CRC area, it was found an increased risk of this neoplasm when using measurements of visceral obesity, such as waist circumference or waist-hip ratio, compared to BMI, reflecting the importance of body fat distribution in this association. The most inconsistent results were observed for the risk of rectal cancer in females. In what concerns the association comparing between proximal and distal colon and the effect of a weight change during adulthood in the risk of colon carcinoma, the evidence is still limited and discordant. Conclusions: Although the mechanisms that underlie the observed association between obesity and CRC are not yet fully understood, some hypothesis have been proposed, focusing primarily on metabolic and hormonal activity of visceral adiposity. This study highlights the importance of obesity as a risk factor for CRC, reinforcing the importance of the weight control and the avoidance of excess body fat accumulation. New research approaches may become more relevant in the future and may help to clarify some issues for which the evidence is still limited.
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References
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13. Andrieu N, Launoy G, Guillois R, Ory-Paoletti C, Gignoux M: Familial relative risk of colorectal cancer: a population-based study. Eur J Cancer 2003;39(13)1904-11
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18. Mokdad AH, Marks JS, Stroup DF, Gerberding JL: Actual causes of death in the United States, 2000. JAMA 2004;291(10)1238-45
19. Moore LL, Bradlee ML, Singer MR, et al.: BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 2004;28(4)559-67
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22. WHO. Waist Circumference and Waist–Hip Ratio: Report of a WHO Expert Consultation. Geneva: 2008. Disponível em: http://whqlibdoc.who.int/publications/2011/978 9241501491_eng.pdf
23. IARC. Handbooks of Cancer Prevention. In: Weight Control and Physical Activity. Lyon: 2002
24. Dai Z, Xu YC, Niu L: Obesity and colorectal cancer risk: a meta-analysis of cohort studies. World J Gastroenterol 2007;13(31)4199-206
25. Harriss DJ, Atkinson G, George K, et al.: Lifestyle factors and colorectal cancer risk (1): systematic review and meta-analysis of associations with body mass index. Colorectal Dis 2009;11(6)547-63
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27. Larsson SC, Wolk A: Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. Am J Clin Nutr 2007;86(3)556-65
28. Ning Y, Wang L, Giovannucci EL: A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev 2010;11(1)19-30
29. Ma Y, Yang Y, Wang F, et al.: Obesity and risk of colorectal cancer: a systematic review of prospective studies. PloS One 2013;8(1)e53916
30. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;988
31. Le Marchand L, Wilkens LR, Mi MP: Obesity in youth and middle age and risk of colorectal cancer in men. Cancer Causes Control 1992;3(4)349-54
32. Laake I, Thune I, Selmer R, Tretli S, Slattery ML, Veierod MB: A prospective study of body mass index, weight change, and risk of cancer in the proximal and distal colon. Cancer Epidemiol Biomarkers Prev 2010;19(6)1511-22
33. Caan BJ, Coates AO, Slattery ML, Potter JD, Quesenberry CP, JR., Edwards SM: Body size and the risk of colon cancer in a large casecontrol study. Int J Obes Relat Metab Disord 1998;22(2)178 -84
34. Macinnis RJ, English DR, Hopper JL, Haydon AM, Gertig DM, Giles GG: Body size and composition and colon cancer risk in men. Cancer Epidemiol Biomarkers Prev 2004;13(4)553-9
35. Matsuo K, Mizoue T, Tanaka K, et al.: Association between body mass index and the colorectal cancer risk in Japan: pooled analysis of population-based cohort studies in Japan. Ann Oncol 2012;23(2)479-90
36. Nomura A, Heilbrun LK, Stemmermann GN: Body mass index as a predictor of cancer in men. J Natl Cancer Inst 1985;74(2)319-23
37. Thygesen LC, Gronbaek M, Johansen C, Fuchs CS, Willett WC, Giovannucci E: Prospective weight change and colon cancer risk in male US health professionals. Int J Cancer 2008;123(5)1160-5
38. Campbell PT, Cotterchio M, Dicks E, Parfrey P, Gallinger S, McLaughlin JR: Excess body weight and colorectal cancer risk in Canada: associations in subgroups of clinically defined familial risk of cancer. Cancer Epidemiol Biomarkers Prev 2007;16(9)1735-44
39. Bassett JK, Severi G, English DR, et al.: Body size, weight change, and risk of colon cancer. Cancer Epidemiol Biomarkers Prev 2010;19(11)2978 -86
40. Nock NL, Thompson CL, Tucker TC, Berger NA, LI L: Associations between obesity and changes in adult BMI over time and colon cancer risk. Obesity 2008;16(5)1099-104
41. Aleksandrova K, Pischon T, Buijsse B, et al.: Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Eur J Cancer 2013;49(16)3526-36
42. Rapp K, Klenk J, Ulmer H, et al.: Weight change and cancer risk in a cohort of more than 65,000 adults in Austria. Ann Oncol 2008;19(4)641-8
43. Steins Bisschop CN, Van Gils CH, Emaus MJ, et al.: Weight change later in life and colon and rectal cancer risk in participants in the EPIC-PANACEA study. Am J Clin Nutr 2014;99(1)139-47
44. Adams TD, Stroup AM, Gress RE, et al.: Cancer incidence and mortality after gastric bypass surgery. Obesity 2009;17(4)796-802
45. Kahn BB, Flier JS: Obesity and insulin resistance. J Clin Invest 2000;106(4)473-81
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