Metabolically healthy and unhealthy obesity increase obesity-related cancer risk
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Key takeaways:
- Metabolically unhealthy obesity appeared associated with highest risk for any obesity-associated cancer.
- The findings have important public health implications.
Metabolically healthy and unhealthy obesity appeared associated with increased risk for various obesity-associated cancer types, according to study results presented at European Congress on Obesity.
The findings, published simultaneously in JNCI: Journal of National Cancer Institute, showed the strongest relationship between cancer and metabolically unhealthy obesity.
Rationale and methods
Few studies have explored potential associations of metabolically unhealthy obesity (obesity with metabolic complications) or healthy obesity (obesity without metabolic complications) and risk for cancer.
For this reason, Ming Sun, MSc, doctoral student in the department of translational medicine at Lund University in Sweden, and colleagues examined BMI in combination and interaction with metabolic health status and obesity-associated cancer risk among 797,193 European individuals (mean baseline age, 42.8 years; 50.2% men; mean BMI, 25.2 kg/m²; 35% overweight, 10% obese).
Researchers used a metabolic score that included blood pressure, plasma glucose and triglycerides to define metabolically healthy and unhealthy status, and statistical modeling to estimate any association with cancer risk.
They grouped individuals into six different categories — metabolically unhealthy obesity (6.8%), metabolically healthy obesity (3.4%), metabolically unhealthy overweight (15.4%), metabolically healthy overweight (19.9%), metabolically unhealthy normal weight (12.5%) and metabolically healthy normal weight (42%).
Follow-up was 40 years (mean, 19.7 years).
Findings
Overall, researchers identified 23,630 cases of obesity-associated cancer (68% women).
Results showed metabolically unhealthy obesity appeared associated with an increased relative risk for any obesity-associated cancer and for endometrial cancer (HR = 3; 95% CI, 2.65-3.39), liver cancer (HR = 2.74; 95% CI, 2.13-3.53) and renal cell cancer (HR = 2.55; 95% CI, 2.18-2.98).
Among those with metabolically unhealthy obesity, men (HR = 1.85; 95% CI, 1.61-2.12) appeared at higher risk for colon cancer than women (HR = 1.21; 95% CI, 1.05-1.39).
In addition, researchers observed additive, positive interactions between BMI and metabolic health status on obesity-related and rectal cancer among men and on endometrial cancer among women (P < .05).
Metabolically healthy normal-weight women had a risk for developing any obesity-associated cancer by age 80 years of 10.7% vs. 14.4% for women with metabolically unhealthy obesity; metabolically healthy normal weight men had a 4.5% risk vs. 7% for men with metabolically unhealthy obesity.
Implications
The findings have important public health implications, suggesting that a significant number of cancer cases could potentially be prevented by targeting the co-existence of metabolic problems and obesity, according to the researchers.
“This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk,” they wrote. “In general, metabolic aberrations further increased the obesity-related cancer risk, suggesting that obesity and metabolic aberrations are useful targets for prevention.”
References:
- Study shows how both metabolically healthy and unhealthy ‘forms’ of obesity increase risk of various obesity-related cancers (press release). Available at: https://www.eurekalert.org/news-releases/988952. Published May 13, 2023. Accessed May 16, 2023.
- Sun M, et al. Poster abstract P2.027. Presented at: European Congress on Obesity; May 17-20, 2023; Dublin, Ireland.
- Sun M, et al. J Natl Cancer Inst. 2023;doi:10.1093/jnci/djad008.
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