Practice updates put emphasis on diet, exercise to address cancer, fatty liver in obesity

Physical activity and nutritional diets are among the key prevention and treatment strategies recommended by the Obesity Medicine Association for obesity-related cancer and fatty liver.

Presenting at the Obesity Medicine Association (OMA)’s Overcoming Obesity conference, Harold Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC, a clinical associate professor at the University of Louisville, discussed the OMA’s clinical practice statements, the relationship between cancer, fatty liver and obesity and how to address the diseases.

All the statements have been published in the OMA’s journal Obesity Pillars.

“Obesity’s complicated. It’s frustrating. But there are some essential truths,” Bays said. “That’s one of the things we try to do with Obesity Pillars, is to try to distill what is the best available evidence, not opinion, but evidence towards improving the care of patients.”

Cancer and obesity

Bays said that obesity is the second-most preventable cause of cancer and may soon overtake cigarette smoking as the primary cause. Breast cancer, gallbladder cancer, liver cancer, ovary cancer, pancreas cancer and stomach cancer are among the cancers most associated with obesity.

Foods made of processed meats, those heated at high temperatures and those with simple carbohydrates were can increase the risk for cancer in patients, according to Bay. An additional risk is epigenetic modification such as DNA methylone, which through harmful environmental settings — including unhealthy nutrition and physical inactivity — can contribute to cancer, obesity, cardiovascular disease and insulin resistance. In some ways, these are all the same disease,” Bays said. “They’re all the downstream effects of a central disease.”

Bays pointed to “appropriate nutrition” as a prime treatment option due to previous evidence and research.

“The Mediterranean diet is a perfect example. Thought to be beneficial in regard not just to cancer and obesity but cardiovascular disease, because at their core, all these things are the same disease,” he said, recommending whole foods rich in phytochemicals, fiber and antioxidants.

Bays also advocated for physical activity due to its risk reductions of developing cancer and improving outcomes of cancer, as well as weight reductions, which can have similar impacts along with improving immune response and body metabolism.

Fatty liver and obesity

Obesity has seen significant implications with nonalcoholic fatty liver disease (NAFLD), with one-half to two-thirds of patients with NALFD also having obesity, Bays reported.

Meanwhile, he said, more than three-fourths of patients with nonalcoholic steatohepatitis (NASH) — a development from NAFLD — also have obesity.

While presenting liver biopsy as the “gold standard” for NAFLD diagnosis, Bays listed several other screening options. More simple strategies include unexplained elevation in alanine transaminase and aspartate transaminase and looking for associated metabolic abnormalities, such as insulin resistance, metabolic syndrome, and type 2 diabetes mellitus.

Other diagnostic tests for NAFLD include:

• transient elastography;
• MRI proton density fat fraction;
• MR spectroscopy;
• the NAFLD activity score;
• Fibrosis-4 index/calculator;
• NAFLD Fibrosis score;
• hepascore;
• fibrometer.

Bays again promoted nutritional diets — highlighting both the Mediterranean diet and DASH diet — routine physical activity and weight reduction as treatment options for NALFD and advised against high fructose corn syrup, which typically has 50% fructose and 50% glucose along with a glycemic index of approximately 70.

“Natural whole fruits, fiber and natural sugars are generally more healthful than processed high fructose corn syrup,” he said, adding that high fructose corn syrup can interfere with insulin signaling due to increased hepatic diacylglycerol while driving hepatic gluconeogenesis. “It has a higher concentration of sugar than what’s in fruits and such.”