Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK.
Br J Cancer. 2021 Mar;124(6):1057-1065. doi: 10.1038/s41416-020-01155-2. Epub 2020 Nov 25.
Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.
早期诊断和更有效的治疗意味着，到 2030 年，英国预计将有 400 万癌症幸存者。然而，人们越来越意识到，过多的体脂肪（EBF）可能会影响癌症生存质量和无病生存。几十年来，癌症患者的体重管理讨论一直受到对非故意体重减轻、低体重和增加体重的干预措施的关注，这种关注通常因肥胖悖论的存在而得到加强，肥胖悖论表明，高体重与某些类型癌症的生存获益相关。然而，观察性证据为检验这样一种假设提供了有力依据，即促进超重和肥胖癌症幸存者有意减少体脂肪和维持骨骼肌的干预措施，将在生存结果和对治疗相关副作用的长期影响方面带来重要的健康益处。本文概述了需要开展研究，以增进对减肥干预措施的健康益处的了解，例如低热量健康饮食计划结合身体活动。特别是迫切需要设计合理的复杂干预试验，以制定有效的、临床实用的、基于证据的策略，减少 EBF 并优化常见癌症患者及其后的人群的身体成分。
