Obese Colon Cancer Survivors Face Poorer Prognosis
Colon cancer survivors who are moderately or severely obese face tougher survival odds following treatment compared with their normal-weight peers, a new study reveals.
The finding builds on prior research that established that being obese raises the risk for developing colon cancer in the first place.
“Previous studies have shown that obesity does influence the risk of developing colon cancer, but this study takes it one step further,” said study author Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn. “Because now we know that if you’re obese, you have a higher risk of cancer recurrence or death for patients who have established colon cancer.”
Sinicrope and his colleagues, whose work was funded in part by the U.S. National Cancer Institute, report their findings in the March 15 issue of Clinical Cancer Research.
The American Cancer Society estimates that last year more than 106,000 Americans were newly diagnosed with colon cancer, while nearly 50,000 men and women died from the disease.
To explore a potential connection between obesity and colon cancer survival, the authors analyzed data concerning 4,381 men and women who had been diagnosed with either stage II or stage III colon cancer. All of the patients had undergone both surgical removal of their cancer and subsequent chemotherapy.
Based on body mass index (BMI), which is a measurement that takes into account weight and height, the researchers determined that approximately 20 percent of the patients were obese (above 30 on the BMI chart). Among that group, about seven in 10 patients were classified as “moderately obese” (BMI between 30 and 34.9), while slightly more than one-quarter were “very obese” (BMI of 35 and up).
About 37 percent of the patients were normal weight (BMI of 20 to 24.9), while a similar number were deemed overweight (BMI of 25 to 29.9). Six percent were classified as underweight (BMI under 20).
Tracking all the cancer survivors for an average of eight years, Sinicrope and his associates observed that 36 percent went on to experience cancer recurrence, while 42 percent ultimately died.
Furthermore, the researchers found that, taken as a group, being either moderately or very obese was associated on average with a 19 percent increase in the risk for death, when compared with normal-weight cancer patients.
Although the pool of underweight patients was considerably smaller, the researchers found that the underweight group also had a much poorer survival rate than normal-weight patients. And while overweight patients actually seemed to fare slightly better (by 6 percent) than normal-weight survivors, Sinicrope indicated that more sophisticated obesity measurements that take into account muscle-mass ratios (not revealed by BMI) could yield slightly different results.
Gender differences were also apparent.
With a patient pool that was more or less evenly divided between men and women, the authors found that taken on their own, the most severely obese men faced the highest risk for cancer recurrence and death — tagged as a 35 percent increase, relative to normal-weight patients.
However, women on the lowest end of the obesity scale were linked to a 24 percent increased risk for death — a risk that actually dropped down to 11 percent as obesity rose.
“For now, we don’t really have a clear explanation for why the moderately obese women did worse than the very obese women,” said Sinicrope. “Menopausal status and hormone replacement therapy — which could be protective against colon cancer — could both be factors. But we don’t know which women were pre- or postmenopausal and which were taking this medication.”
As for what general underlying cause accounts for the obesity-survival risk connection, Sinicrope said the question remains unanswered. But he speculated that the association might result from the presence of higher insulin and insulin-like growth-factor-1 hormone levels in obese patients.
“We know the obese patients have higher levels of both these hormones, which have been associated with both obesity and colon cancer risk in the past,” he noted. “So we think that could be playing a role in this risk.”
A number of variables could explain the findings, said Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City.
“Obesity is often associated with a higher likelihood for diabetes and other diseases, and overall secondary immune dysfunction. And since colon cancer is somewhat of an immune disease, that is going to be a driving factor,” he noted.
“There is also a good deal of data already regarding the supportive benefit of exercise and activity after colon cancer treatment in terms of prognosis,” Martz added. “So I think that goes along with the concept that obese individuals are less likely to be in shape. Also, there may be some inherent surgical limitations that could compromise the technical ability to achieve complete removal of the cancer and the potentially affected lymph node tissues when operating on an obese person. All of this may play a role.”
On a related front, a separate study published this week in the Journal of the National Cancer Institute provides fresh evidence that being obese does appear to be linked to a higher risk for colon cancer.
However, the research team — led by Peter T. Campbell of the epidemiology research program at the American Cancer Society — also found that the obesity-survival link does not seem to hold for all tumors, but only for those that are so-called “microsatellite stable.” Obese patients who had this common type of tumor had lower five-year survival rates than obese patients with “microsatellite-high” tumors, suggesting that obesity has a varying impact on prognosis, depending on the kind of colon cancer at hand. By Alan Mozes, Yahoo Daily News
Americans Want Government’s Help Putting Healthy Foods On Their Dinner Table
New survey finds out what Americans are really paying attention to when choosing foods
Americans recognize things need to change in the grocery aisle, and they support Uncle Sam’s efforts to overhaul what is included in their food and on the packages. The majority also believe they are individually responsible for making the right food choices to avoid obesity, but will readily accept the government’s help to be successful, according to a new survey by FoodMinds.
“In light of all the recent attention around food labeling and nutrition guidance programs, we wanted to get a sense of what the consumer actually thought,” said Grant Prentice, FoodMinds’ director of Strategic Insights. “We heard clearly they believe things need to change – and that it makes sense for the government to lead that charge.”
Americans Want Uncle Sam…
…Involved in Food Labels
* Eighty-six percent of consumers are interested in the government implementing objective front-of-pack labeling that calls out calories and beneficial nutrients such as vitamin D or fiber
* Seventy-seven percent of shoppers are interested in front-of-package labels designed to warn them of products with high calories, low nutrients
- And, 64 percent said if their favorite food had a warning label on it, they would either eat less or stop buying the product entirely
…To Help Educate, Mitigate and Motivate
* Seventy-four percent favor government-sponsored nutrition education programs to help them better identify the “good” versus the “bad” foods
* Fifty-eight percent support the government banning advertising of “unhealthy” foods to children and young adults
* Half are in favor of the government allowing employers to reward healthier employees while levying higher costs or fines to punish those who engage in unhealthy behaviors
…But Not His Taxes
* Rejected by 65 percent of shoppers are proposed taxes on soft drinks and foods high in sugar and calories, but low in nutritional value
Just the (Nutrition) Facts, Ma’am
Consumers love food-related information – and want more of it, in particular basic, factual data.
* The Nutrition Facts panel ranks first with 93 percent of shoppers saying it’s a very or somewhat useful tool, followed by front-of-pack information (low fat, high in fiber, etc.) at 88 percent
* Not quite as popular are marketing-oriented claims such as “helps lose weight,” “helps build strong bones,” with 71 percent of shoppers finding them useful
* Three quarters of shoppers like seeing where their food comes from (“organic,” “natural” and “sustainable farming practices”)
Not It! Significant Minority Believes Others Responsible for Individuals’ Eating Habits
* When asked who holds the primary responsibility to make sure the public makes right food choices to avoid obesity, 38 percent chose: 14 percent said food companies, 12 percent said the government, nine percent said the health care system and three percent pointed to the educational systems
About the Food Temperance Survey
Created by the FoodMinds Strategic Insights department, the Food Temperance survey was conducted through Greenfield Online’s Omnibus service on January 18, 2010. The sample of 1045 adults is balanced on age, gender and region of the U.S. Sub-samples of 869 primary grocery shoppers and 182 Opinion Leader Shoppers were screened from the overall adult sample. The MOE is +/- 3% for primary grocery shoppers and +/- 7% for the opinion leader shoppers. redOrbit
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Drink Up Girls: Wine Isn’t Fattening
WOMEN who like a glass of wine after work can relax: they are likely to gain less weight than those who stick to mineral water.
Moderate female drinkers also have a lower risk of obesity than teetotallers, according to new research. The findings, from a study of more than 19,000 women, is at odds with most dietary advice: that alcohol consumption leads to weight gain.
The research suggests that a calorie from alcohol has less impact on weight than a calorie from other foods and that the way the body deals with alcohol is more complex than realised. One theory is that in regular drinkers the liver develops a separate metabolic pathway to break down alcohol, with surplus energy turned mainly into heat, not fat.
In the study, Lu Wang, a medical instructor at Brigham and Women’s hospital, Boston, and colleagues asked 19,220 American women aged 39 or older with a healthy body weight to describe their drinking habits in a questionnaire. About 38% drank no alcohol.
Over the next 13 years the researchers found that all the women tended to gain weight but the non-drinkers gained the most. The women’s overall weight gain decreased as alcohol intake increased.
There was also a difference according to the type of alcohol: red wine was associated with the lowest weight gain; beer and spirits were linked to the highest weight gain.
The report, published in the Archives of Internal Medicine, seems to confirm that there is no clear connection between alcohol consumption and weight gain. By Jonathan Leake, The Times