La obesidad puede matar: el papel de primaria de la salud y la prevención del cáncer.

Transcription

1 La obesidad puede matar: el papel de primaria de la salud y la prevención del cáncer. Obesity can kill: the role of primary health and cancer prevention. Luigi Ricciardiello, MD Department of Medical and Surgical Sciences University of Bologna, Italy 1

2 Colorectal Cancer Epidemiology 2008 data Jemal A et al. CA: A Cancer Journal for Clinicians 2011; 6:

3 Colorectal cancer incidence 2008 by world region Age Standardized Incidence per Jemal A et al. CA: A Cancer Journal for Clinicians 2011; 6:

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7 Trends in Colorectal Cancer Mortality Center MM et al. CA: A Cancer Journal for Clinicians 2009; 59(6):

8 Trends in Colorectal Cancer Incidence among young Adults USA Race/ethnicity Sex APC All races combined Non-Hispanic White Non-Hispanic Black Hispanic Asian American/Pacific Islander APC = Annual Percent Change Males Females Males Females Males Females Males Females Males Females Modified from Siegel R L et al. Cancer Epidemiol Biomarkers Prev 2009;18:

9 Trends in Colorectal Cancer Incidence among young Adults USA Non-Hispanic Whites Age Subsite Sex Age range APC Men Women Men Women APC = Annual Percent Change Proximal Distal Rectum Proximal Distal Rectum Modified from Siegel R L et al. Cancer Epidemiol Biomarkers Prev 2009;18:

10 Obesity The World Health Organization defines overweight and obesity as abnormal or excessive fat accumulation that may impair health 10

11 Evaluation of Obesity Body Mass Index (BMI) Overweight > kg/m 2 Obese Type I > kg/m 2 Type II > kg/m 2 Type III > 40 kg/m 2 CT for visceral adiposity the gold standard Waist circumference (WC) Waist to hip ratio (WHR) 11

12 Obesity Global Trends BMI increased by 0.4 kg/m 2 per decade In billion adults worldwide had a BMI > 25 Prevalence of obesity % in men and 7.9% in women % in men and 13.8% in women In 2008, 205 million men and 297 million women with BMI > 30 Finucane MM et al. The Lancet 2011; 377:

13 Finucane MM et al. The Lancet 2011; 377: Male Female 13

14 Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 14

15 Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

16 Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

17 Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

18 Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

19 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

20 Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

21 Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

22 Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

23 Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

24 Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

25 Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

26 Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

27 Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

28 Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

29 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

30 Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

31 Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

32 Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25%

33 Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 33

34 Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 34

35 Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 35

36 Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 36

37 Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 37

38 Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 38

39 Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 39

40 Obesity and social status Sturm R and An R. CA CANCER J CLIN 2014;64:

41 Obesity trends in men and women -USA Sturm R and An R. CA CANCER J CLIN 2014;64:

42 Food expenditure as percentage of disposable income Sturm R and An R. CA CANCER J CLIN 2014;64:

43 Worldwide trends in overweight and obesity in preschool children Incidence per Modified from de Onis Met al. Am J Clin Nutr 2010; 92:

44 Prevalence of overweight and obesity in school-age children WHO Region Up to 2005 Projected 2006 Projected 2010 Overw (incl obes) % Obesity (%) Overw (incl obes) % Obesity (%) Overw (incl obes) % Africa ( ) Americas ( ) Eastern Med ( ) Europe ( ) South East Asia ( ) West Pacific ( ) Obesity (%) Modified from Wang Y and Lobstein T. International Journal of Pediatric Obesity 2006;1(1):

45 Fifty-three percent of adult dogs and 55% of cats were classified as overweight or obese by their veterinarians

46 Is Obesity a risk factor for cancer?

47 Environment and colorectal cancer The multiethnic cohort study Incidence per Modified from Kolonel LN et al. Nature Reviews Cancer 2004; 4:

48 The link between obesity and cancer Alemán JO, Eusebi LH, Ricciardiello L et al. Gastroenterology

49 BMI and Incidence of cancer in men worldwide Renehan AG et al. The Lancet 2008; 371:

50 BMI and Incidence of cancer in women worldwide Renehan AG et al. The Lancet 2008; 371:

51 Colorectal cancer and waist circumference Moghaddam A A et al. Cancer Epidemiol Biomarkers Prev 2007;16:

52 Increased BMI and risk of cancer death in USA Men Calle et al. N Engl J Med 2003; 348:

53 Increased BMI and risk of cancer death in USA Women Calle et al. N Engl J Med 2003; 348:

54 BMI and Colorectal Cancer Death in the Asia- Pacific Cohort Studies Collaboration 77% Asian -23% ANZ Compared to normal weight, BMI>30 HR for colon cancer 1.50 ( ) HR for rectal cancer 1.68 ( ) Parr et al. Lancet Oncol 2010; 11:

55 BMI in Adolescence and the incidence of CRC among Israelis men Cancer Adjusted HR (95% CI) P Colon* 1.53 ( ) Rectum* 1.09 ( ) Colon, Nonmucinous* 1.68 (1.26, 2.23) * BMI 85th vs <85th Modified from Levi Z et al. Cancer Epidemiol Biomarkers Prev 2011;20:

56 BMI in Adolescence and Colon Cancer Mortality: a follow-up of 230,000 Norwegian Adolescents BMI <25th 25th 74th 75th 84 th >85 th Sex RR (CI) Males ( ) 2.1 ( ) Females ( ) 2.0 ( ) Bjørge T et al. Am J Epidemiol 2008;168:

57 Sedentary lifestyle as a risk factor for colorectal cancer Schmid D, Leitzmann MF. JNCI J Natl Cancer Inst (2014) 106(7)

58 Summary Obesity is rapidly increasing worldwide soon to become normality The global trend of overweight and obesity is extremely high in children This trend is occurring also in low-income countries 58

59 Overweight and Obese Patients do not recognize their own risk for CRC Survey on 195 overweight + obese patients 32% identified obesity as a risk factor for CRC BMI was not a risk factor for CRC in 57% BMI would not lead to increased risk during lifetime in 46% Leite-Pereira et al. J Canc Educ 2011; 26:

60 Body Mass Index and Colon Cancer Screening White men White women Normal Overweight Class I Class II Class III Normal Overweight Class I Class II Class III Maruthur et al, CEBP

61 Financial Times September

62 Medical Spending Attributable to Obesity USA Insurance catergory NHEA ($ billions) All payers* (1998) 60 All payers* (2006) 145 NHEA: National Health Expenditure Accounts * Includes Medicare, Medicaid and Private Australia (2005) ($ billions) Overweight 10.5 Obese 8.3 Modified from Finkelstein A et al. Health Affairs 2009 Colagiuri S et al. Med J Australia 2010, 192:

63 Conclusions In developed countries Increasing obesity poses higher risks for several types of tumors, including CRC In developing countries Increasing incidence of several types of cancers (including CRC) link to obesity and lifestyle changes High economic impact on Nation s budgets 63

64 Future TIME TO ACT NOW Increasing national and international policies to act on youth Pre-school and school dietary education Promote activity, reduce sedentary life especially in early years More affordable high-quality food only junk food is really affordable! Need to discuss cancer risks in depth with overweight/obese patients Maybe lowering CRC screening ages for obese adults? Obese tax??????? 64