Department of Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
Cancer Metastasis Rev. 2022 Sep;41(3):471-489. doi: 10.1007/s10555-022-10054-2. Epub 2022 Jul 30.
Excess body weight has been established as a risk factor for at least twelve cancer sites, though questions remain as to the timing of associations for adiposity and cancer risk throughout the life course. We conducted a narrative review summarizing existing evidence to provide insights into the complex timing relationship between adiposity and risk of seven common obesity-related cancers. We considered five types of studies, including traditional epidemiologic studies examining adiposity at different time points, studies examining weight gain in specific life phases, studies examining weight loss over a period including from bariatric surgery, life course trajectory analysis, and Mendelian randomization studies. The results showed that lifetime excess body weight is associated with increased risk of cancers of endometrium, colorectum, liver, kidney, and pancreas. Early life obesity is one of the strongest risk factors for pancreatic cancer but less directly important than adult obesity for endometrial and kidney cancer. Interestingly, heavy weight during childhood, adolescence, and early adulthood is protective against pre- and postmenopausal breast cancer and possibly advanced prostate cancer. It is apparent that preventing weight gain later in adulthood would likely reduce risk of many cancers, including postmenopausal breast cancer, endometrial cancer, colorectal cancer (especially in men), liver cancer, kidney cancer, and probably advanced prostate cancer. Furthermore, weight loss even late in life may confer benefits for cancers of breast, endometrium, colorectum, and liver among patients with obesity, as mostly demonstrated by studies of bariatric surgery. Overall, maintaining a healthy weight throughout the life course will help prevent a large number of cancers.
超重已被确定为至少 12 种癌症的风险因素，尽管人们对于脂肪含量与癌症风险在整个生命周期中的关联时间仍存在疑问。我们进行了一项叙述性综述，总结了现有证据，深入了解了肥胖与七种常见肥胖相关癌症风险之间复杂的时间关系。我们考虑了五种类型的研究，包括在不同时间点检查肥胖的传统流行病学研究、研究特定生命阶段体重增加的研究、研究特定生命阶段体重增加的研究、研究在一段时间内（包括减重手术后）体重减轻的研究、生命历程轨迹分析和孟德尔随机化研究。结果表明，终生超重与子宫内膜癌、结直肠癌、肝癌、肾癌和胰腺癌风险增加有关。生命早期肥胖是胰腺癌的最强危险因素之一，但对子宫内膜癌和肾癌的影响不如成年肥胖重要。有趣的是，儿童期、青春期和成年早期体重过重可预防绝经前和绝经后乳腺癌，并可能预防晚期前列腺癌。显然，防止成年后期体重增加可能会降低许多癌症的风险，包括绝经后乳腺癌、子宫内膜癌、结直肠癌（尤其是男性）、肝癌、肾癌和可能的晚期前列腺癌。此外，肥胖患者即使在生命后期减肥也可能对乳腺癌、子宫内膜癌、结直肠癌和肝癌有益，这主要是由减重手术研究证明的。总的来说，在整个生命周期中保持健康的体重将有助于预防大量癌症。
