ESPEN Congress Madrid 2018

Transcription

1 ESPEN Congress Madrid 2018 The Role Of Obesity In Cancer Survival And Cancer Recurrence Obesity As A Risk Factor For Cancer P. Ravasco (PT)

2 Obesity as a risk factor for Cancer Paula Ravasco, Nutric, MD, PhD p.ravasco@medicina.ulisboa.pt University Hospital of Santa Maria Centre for Interdiscipliary Research in Health - UCP Portugal

3 Disclosure In compliance with COI policy, ESPEN requires the following disclosures to the session audience: Shareholder Grant / Research Support Consultant Employee Paid Instructor Speaker bureau Other No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare No relevant conflicts of interest to declare Presentation includes discussion of the following off-label use of a drug or medical device: <N/A>

4 LEARNING OBJECTIVES Concepts: nutritional status, obesity Pathophisiology of Obesity in Cancer Epidemiology: cancer, obesity

5 Mortality and Morbidity Associated with Obesity Effects of excess weight on mortality and morbidity recognized for >2000 years. Hippocrates recognized that sudden death is more common in those who are naturally fat than in the lean. Flegal, 2012, JAMA, 307(5), ; Endocrinol Metab Clin N Am. 2003; 32:

6 BMI associated with overall mortality - U shape Lee, 1999, Am J Clin Nutr, 68, Overweight + Obesity increasing and is pandemic Flegal, 2012, JAMA, 307(5),

7 Male Obesity Epidemiology The Lancet, 2015

8 Cancer Epidemiology Male Ferlay et al., European Journal of Cancer. 49:

9 Female Cancer Epidemiology Ferlay et al., European Journal of Cancer. 49:

10 Obesity Obesity associated with double the risk of cancer compared to people who are of normal weight

11 Energy Imbalance - Obesity Excess energy stored in adipocytes Enlargement hypertrophy Multiplication hyperplasia Enlarged adipocytes: weight or mass of the extra fat secretion of FFA + proliferative peptides Fat cells J La State Med Soc.2005; 156 (1): S42-49.

12 Nimptsch, 2015

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15 Mortality - men - various types of cancer according to BMI

16 Mortality - women - various types of cancer according to BMI

17 Number of patients 63% obese n=450 N = 450? prognosis Aggressive cancers (moderate + poorly differentiated) prevalent in undernutrition & obesity A - well nourished B - moderately undernourished C - severely undernourished 29% undernourished 0 1- well differentiated 2- moderately differentiated 3- poorly differentiated Ravasco P et al. The Oncologist 2010

18 Number of patients Fat mass, fat free mass, histology 1 well differentiated; 2 moderately differentiated; 3 poorly differentiated Histological grade Excess FM Normal FM N = % pts: excess Fat Mass & loss Fat Free Mass more aggressive histologies TNF-a, IL-1ra, IL-6 Ravasco P et al 2018 (under review)

19 Lipid intake N = 210 excesso excess cumpre necessidades défice deficit ~ requirements 39% 10% 51% mean ± SD 38% ± 4% total energy value Saturated fatty acids 41% Excessive intake Polyunsaturated fatty acids 94% Deficient intake 40% ~ requirements excess sat FA + deficient PUFAs cumpre necessidades excesso de AG saturados + défice de AG polinsaturados mean ± SD Sat FAs: 15% ± 2% PUFAs: 5% ± 1% total energy value Ravasco P 2018 (under review)

20 BMI Breast Cancer - Portugal N= 956 Underweight Normal Overweight Obese Total PreM PoM - Comparing with epidemiological studies in Portuguese Women, mean BMI was higher in breast cancer - There was a greater % overweight/obese - BMI of PreM and PoM were above the recommended maximum Ravasco P, Muller S, 40th ESPEN Congress 2018; LB416

21 Body composition Caan et al., Cancer Epidemiology Biomarkers & Prevention, 26(7),

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23 IMC está associado ao aumento do risco de mortalidade em mulheres com Cancro da Mama. Reeves et al., Cancer Epidemiology Biomarkers & Prevention, 16(7),

24 Higher BMI associated with increased mortality in women diagnosed with breast cancer Whiteman, M. K., Cancer Epidemiology Biomarkers & Prevention, 14(8),

25 Higher waist circumference associated with mortality in breast cancer survivors George et al., Breast Cancer Research and Treatment, 146(3),

26 Obesity and colon cancer Moore at al., International Journal of Obesity, 28(4),

27 Cancer Survivors After patients symptoms improve, nutrition therapy shifts toward health promotion and cancer prevention. Overweight/obesity increase risk of Cancer Recurrence or developing new primaries Intentional weight loss for overweight or obese survivors post-treatment, may reduce cancer recurrence and other co-morbidities.

28 Strength of Evidence of Associations Between Nutrition- Related Factors and Cancer recurrence Factors Lung Rectum and Colon Breast Prostate Head and Neck Endometrial Diet rich in plantbased foods decrease risk Probabl e Probable Possible Possible Probable Possible Moderate Physical Activity decreases risk Obesity increases risk Alcohol increases risk Lacking Convincing Convincing Weak Weak Probable Lacking Convincing Convincing Convincing Probable Convincing Lacking Possible Probable Lacking Convincing Weak The clinical guide to oncology nutrition/oncology Nutrition Dietetic Practice Group; Elliot et al. 2 nd edition

29 Recommendation Details Benefits Be as lean as possible without becoming underweight Be physically active for at least 30 minutes daily. Avoid sedentary habits like watching T.V. Cancer survivors should follow the recommendations for cancer prevention Avoid weight gain and increased waist circumference throughout adulthood. Healthy BMI min of mod. intense activity daily and as fitness improve, 60 min of mod or 30 min of vigorous activity daily. Once treatment has been completed and unless otherwise advised, aim to follow cancer prevention recommendations for diet, physical activity and healthy weight Protects against colon, pancreatic, endometrium, and postmenopausal breast cancer Strengthens immune system, keeps GI tract healthy, maintains weight Physical activity, healthy weight, and balanced diet, may help to prevent cancer recurrence

30 Maintain a healthy body weight throughout life may be the most important lifestyle factor to reduce cancer recurrence. BMI >40 52% higher risk for all cancers in men 62% higher risk for all cancers in women

31 Primary prevention, survival, recurrence AICR.org