Edna M.

Mora, MD, MS, FACS

Professor, Department of Surgery, School of Medicine,
Medical Sciences Campus, University of Puerto Rico and
Investigator UPR Comprehensive Cancer Center

I, or my immediate family member including

spouse/partner, have at present and/or have
had within the last 12 months, or anticipate
NO financial interest/arrangement or
affiliation with one or more organizations
that could perceived as a real or apparent
conflict of interest in context to the design,
implementation, presentation, evaluation
etc. of this presentation.

True or False
______ 1. Obesity is not a disease, but a judgement of weight by
society.
______ 2. Obesity promotes cancer.
______ 3. Obesity induces cancer.

Is obesity important in the cancer field?

Obesity and its relationship to cancer physiology and biology
Does obesity promote a cancer-promoting environment
(carcinogenesis)?
Does obesity increase the growth and metastatic potential of
tumors? (tumorogenesis)
How to manage obesity in the cancer patient receiving
treatment or after treatment?
Obesity definition
Conclusions

In the US, 33% of adults and 17% of children and adolescents

are categorized as obese.
In Puerto Rico, 32% overweight, 17% obese (children) 2012
66% overweight, 25-30% obese (adult)2011
Body mass index (BMI)- WHO categories
25-29.9 kg/m2- overweight
30 kg/m2- obesity
Obesity contributes to several major illnesses: cardiovascular,
diabetes, cancer. It increases the risk and mortality for all of
them.
Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014

Obesity increased cancer risk, recurrence and cancer-related

mortality in patients with early-stage cancer.
Breast cancer- obese at the time of diagnosis
75% increased in mortality in pre-menopausal women
34% increased in mortality in post-menopausal women
Prostate cancer- obese men
increase risk of developing biologically aggressive prostate
cancer and more likely to have advanced disease at the time
of diagnosis
Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014
Boeing H, et al Best Prac Res Clin Endo Meta 27:219-227, 2013

A BMI 35 kg/m2 may be associated with an increased risk of colon

cancer recurrence and mortality, but data is less consistent.
Endometrial cancer- risk increased linearly with increasing BMI. It is
mainly driven by general fatness attained at late adulthood.
Evidence for a relationship of fatness at diagnosis and survival is
weak.
Renal cell cancer- there are uncertainties regarding gender and
obesity effect on survival.
Esophageal cancer- risk driven by abdominal fat. No relationship
with survival.
Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014
Boeing H, et al Best Prac Res Clin Endo Meta 27:219-227, 2013

Other cancers related to obesity:

uterine
pancreatic
thyroid
gallbladder
ovarian
cervical
liver

Non-Hodking lymphoma
Multiple Myeloma

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014

Boeing H, et al Best Prac Res Clin Endo Meta 27:219-227, 2013

 Cancer

survivors are NO more likely to be

consuming a healthy diet, exercising, or
maintaining a healthy weight compared to
adults without history of cancer.

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014

Obesity- excess of adipose tissue

No all fat is equal!!!
Brown adipose tissue- only in mammals, major site of
thermogenesis.
brown vs beige/brite adipocytes
*PET-CT and cold environment

White adipose tissue- long term energy store of triglycerides.

Berriel Diaz M, et al Metabolism Clin Exp 1238-1249, 2014

Carcinogenesis

Tumorogenesis

Metastatses

Adipose tissue is a very active endocrine and metabolic organ.

Cells adipocytes
pre-adipocytes
fibroblasts
macrophages
blood vessels
Adipokines (cytokines)
leptin
adiponectin
Inflammatory mediators
plaminogen activator inhibitor (PAI)-1
VEGF
TNF-
IL-6
Van Kruijsdijk RCM, et al. Ca Epi Bio Prev 18: 2569-2578, 2009

Van Kruijsdijk RCM, et al. Ca Epi Bio Prev 18: 2569-2578, 2009

Immune System
Macrophages- M1 (increased), M2 (deceased)
Eosinophils
Neutrophils
Mast cells
T-lymphocytes
B-Lymphocytes

INFLAMMATION!!!!!

Catalan V et al. Frontiers in Physiology 4(275): 1-13, 2013

Catalan V et al. Frontiers in Physiology 4(275): 1-13, 2013

Perez-Hernandez AI, et al. Frontiers in Endocrinol 5(65): 1-17, 2014

Van Kruijsdijk RCM, et al. Ca Epi Bio Prev 18: 2569-2578, 2009

No need for dieting.

Exercise to tolerance.
Healthy nutrition intervention
NO SUGAR!!!
Education, education, education
Physician, health-related professionals,
patients, relatives

Education
Exercise program
Healthy nutrition intervention
with follow-up
Set goals
Involve the relatives

Oprah Magazine March 2014

Body Mass Indexdefinition-( weight (pounds)/height (inches)2 ) X 703

involves measurement and calculation
difficult to establish as screening

Waist to Height Ratiodefinition- waist (cm)/height (cm)

no measurement involved
easy to evaluate by visual assessment
Keep your waist circumference to less than half your height

Ashwell M, et al. BMC Medicine 12:207, 2014

Ligibel, JA, et al. Journal of Clinical Oncology 32: 1-7, 2014

Ashwell M, et al. BMC Medicine 12:207, 2014

Ashwell M, et al. BMC Medicine 12:207, 2014

Obesity is an important aspect of cancer.

Obesity increases the risk of several types of cancers and
increases the progression and survival of the disease.
Obesity acts as a carcinogenic, tumorogenic and metastatic
environment.
WHt ratio is more practical and functional than BMI in
associating obesity with risk of diseases.
We should start implementing educational strategies to
decrease obesity and overweight in children and adults.

True or False
______ 1. Obesity is not a disease, but a judgement of weight by
society.
______ 2. Obesity promotes cancer.
______ 3. Obesity induces cancer.

Gracias!!!
Preguntas??