Why Weight is Important in Cancer | Dr Martin Wiseman
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Dr Martin Wiseman's keynote speech 'Why Weight is Important in Cancer' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
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Why Weight is Important in Cancer | Dr Martin Wiseman
- 1. Martin Wiseman World Cancer Research Fund International University of Southampton, UK OBESITY IN THE DEVELOPMENT AND PROGRESSION OF CANCER
- 5. Obesity and overweight in Scotland 1995 - 2010 Scottish Health Survey 2010
- 6. Obesity and overweight in Scotland 1995 - 2010 Scottish Health Survey 2010 29% 64%
- 7. Prevalence of obesity among adults Health Survey for England 1993-2011 (3-year average) 0% 5% 10% 15% 20% 25% 30% Prevalenceofobesity Women Men 24%
- 8. Prevalence of overweight among adults Health Survey for England 1993-2011 (3-year average) 30% 35% 40% 45% 50% 55% 60% 65% 70% Prevalenceofoverweight Men Women 58-66%
- 9. Prevalence of obesity BMI>30 16-64y OPCS 1980 NDNS 1987- 2000 HSE 1991-1998
- 10. Obesity in Scotland - 2010 Scottish Health Survey 2010
- 11. Adult obesity prevalence by age Health 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+ Prevalenceofobesity Men Women
- 12. Obesity in Scotland - 2010 Scottish Health Survey 2010
- 13. Obesity costs 1. NHS: £5.1 billion (Scarborough 2011) 2. Economy: £16 billion (Foresight 2007) 3. Economy projected to 2050 £50 billion (Foresight 2007)
- 14. The most rigorous, systematic, comprehensive and authoritative reviews of the accumulated evidence in the field of food, nutrition, physical activity and cancer
- 16. 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)
- 17. The Panel emphasises the importance of not smoking and of avoiding exposure to tobacco smoke
- 18. The Panel emphasises the importance of not smoking and of avoiding exposure to tobacco smoke
- 19. 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)
- 20. Obesity and cancer BREAST (Postmenopause) COLON and RECTUM ENDOMETRIUM OESOPHAGUS PANCREAS GALLBLADDER KIDNEY
- 21. 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 Thrombosis Atherosclerosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005 Elevated oestrogen Aromatase
- 22. Obesity and cancer Mechanisms 1. 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
- 23. Around one third of the commonest cancers estimated avoidable through appropriate food, nutrition and physical activity
- 25. 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
- 26. Obesity and cancer progression US Expert WORKSHOP 2011 Prostate cancer • Sparse and conflicting evidence Colon cancer • Limited early evidence only
- 28. Cancer incidence by weight loss tertile SOS
- 29. 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.
- 30. 0 1 2 3 4 5 6 7 8 Fatness, Fitness & Cardiovascular Disease Mortality Lean <16.7% RelativeRiskofCVDMortality Body Fat Category (% Fat) Lee et al. Am J Clin Nutr 1999;69:373. Normal 16.7%-24.9% Obese >25% Fit Unfit
- 31. 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 Numbers
- 32. 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
- 33. Conclusions 1. 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