Visceral Obesity and Colorectal Cancer: Are We Missing the Boat with BMI?
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Compared to subcutaneous fat, visceral fat is more metabolically active, leading to chronic inflammation and tumorigenesis. The aim of this study is to describe the effect of visceral obesity on colorectal cancer outcomes using computed tomography (CT) imaging to measure visceral fat.
Materials and Methods
We conducted a retrospective chart review of patients who underwent surgical resection for colorectal cancer. Visceral fat volume was measured by preoperative CT scans. Final analysis was performed by stratifying patients based on oncologic stage.
Two hundred nineteen patients met the inclusion criteria, 111 viscerally obese and 108 nonobese. Body mass index (BMI) weakly correlated with visceral fat volume measurements (R 2 = 0.304). Whereas obese patients had no difference in survival when categorizing obesity by BMI, categorizing based on visceral fat volume resulted in significant differences in stage II and stage III patients. In stage II cancer, viscerally obese patients had a nearly threefold decrease in disease-free survival (hazard ratio (HR) = 2.72; 95 % confidence interval (CI) = 1.21, 6.10). In stage III cancer, viscerally obese patients had a longer time to recurrence (HR = 0.39; 95 % CI = 0.16, 0.99).
This study shows that viscerally obese patients with stage II colorectal cancer are at higher risk for poor outcomes and should be increasingly considered for adjuvant chemotherapy.
- Flegal, K.M., et al., Overweight and obesity in the United States: prevalence and trends, 1960-1994. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1998. 22(1): p. 39-47. CrossRef
- Flegal, K.M., et al., Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA, 2012. 307(5): p. 491-7. CrossRef
- Services, U.S.D.o.H.a.H., The Surgeon General's Vision for a Healthy and Fit Nation, H.a.H. Services, Editor January 2010: Rockville, MD.
- Mokdad, A.H., et al., Actual causes of death in the United States, 2000. JAMA, 2004. 291(10): p. 1238-45. CrossRef
- Azagury, D.E. and D.B. Lautz, Obesity overview: epidemiology, health and financial impact, and guidelines for qualification for surgical therapy. Gastrointest Endosc Clin N Am, 2011. 21(2): p. 189-201. CrossRef
- Calle, E.E., et al., Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med, 2003. 348(17): p. 1625-38. CrossRef
- Bianchini, F., R. Kaaks, and H. Vainio, Overweight, obesity, and cancer risk. Lancet Oncol, 2002. 3(9): p. 565-74. CrossRef
- Renehan, A.G., et al., Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet, 2008. 371(9612): p. 569-78. CrossRef
- Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 2001. 285(19): p. 2486-97. CrossRef
- Grundy, S.M., et al., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 2005. 112(17): p. 2735-52. CrossRef
- Donohoe, C.L., S.L. Doyle, and J.V. Reynolds, Visceral adiposity, insulin resistance and cancer risk. Diabetol Metab Syndr, 2011. 3: p. 12. CrossRef
- Dusserre, E., P. Moulin, and H. Vidal, Differences in mRNA expression of the proteins secreted by the adipocytes in human subcutaneous and visceral adipose tissues. Biochim Biophys Acta, 2000. 1500(1): p. 88-96. CrossRef
- Aleksandrova, K., et al., Metabolic syndrome and risks of colon and rectal cancer: the European prospective investigation into cancer and nutrition study. Cancer Prev Res (Phila), 2011. 4(11): p. 1873-83. CrossRef
- Larsson, S.C. and A. Wolk, Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. The American Journal of Clinical Nutrition, 2007. 86(3): p. 556-65.
- Balentine, C.J., et al., Waist circumference predicts increased complications in rectal cancer surgery. J Gastrointest Surg, 2010. 14(11): p. 1669-79. CrossRef
- Haydon, A.M., et al., Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut, 2006. 55(1): p. 62-7. CrossRef
- Prizment, A.E., et al., Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev, 2010. 19(9): p. 2229-37. CrossRef
- Ballian, N., et al., Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol, 2012. 105(4): p. 365-70. CrossRef
- Guiu, B., et al., Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer. Gut, 2010. 59(3): p. 341-7. CrossRef
- Tsujinaka, S., et al., Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Diseases of the Colon and Rectum, 2008. 51(12): p. 1757-65; discussion 1765-7. CrossRef
- Seki, Y., et al., Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc, 2007. 21(6): p. 929-34. CrossRef
- Sakai, T., et al., Visceral fat volume and surgical outcomes of colorectal resection. Int Surg, 2009. 94(4): p. 370-2.
- Maurovich-Horvat, P., et al., Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. International Journal of Obesity, 2007. 31(3): p. 500-6. CrossRef
- Donohoe, C.L., et al., Obesity and gastrointestinal cancer. Br J Surg, 2010. 97(5): p. 628-42. CrossRef
- Wolin, K.Y., K. Carson, and G.A. Colditz, Obesity and cancer. Oncologist, 2010. 15(6): p. 556-65. CrossRef
- Katzmarzyk, P.T., et al., Racial differences in abdominal depot-specific adiposity in white and African American adults. The American journal of clinical nutrition, 2010. 91(1): p. 7-15. CrossRef
- Borkan, G.A., et al., Assessment of abdominal fat content by computed tomography. The American Journal of Clinical Nutrition, 1982. 36(1): p. 172-7.
- Ishii, Y., et al., Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg, 2005. 92(10): p. 1261-2. CrossRef
- Moon, H.G., et al., Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol, 2008. 15(7): p. 1918-22. CrossRef
- Tsukada, K., et al., Body fat accumulation and postoperative complications after abdominal surgery. Am Surg, 2004. 70(4): p. 347-51.
- Campbell, P.T., et al., Case-control study of overweight, obesity, and colorectal cancer risk, overall and by tumor microsatellite instability status. J Natl Cancer Inst, 2010. 102(6): p. 391-400. CrossRef
- Ribic, C.M., et al., Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med, 2003. 349(3): p. 247-57. CrossRef
- Galal, W., et al., The obesity paradox in patients with peripheral arterial disease. Chest, 2008. 134(5): p. 925-30. CrossRef
- Gruberg, L., et al., The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol, 2002. 39(4): p. 578-84. CrossRef
- Lainscak, M., et al., The obesity paradox in chronic disease: facts and numbers. J Cachexia Sarcopenia Muscle, 2012. 3(1): p. 1-4. CrossRef
- Meyerhardt, J.A., et al., Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer, 2003. 98(3): p. 484-95. CrossRef
- Meyerhardt, J.A., et al., Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol, 2004. 22(4): p. 648-57. CrossRef
- Visceral Obesity and Colorectal Cancer: Are We Missing the Boat with BMI?
Journal of Gastrointestinal Surgery
Volume 17, Issue 1 , pp 133-143
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Visceral obesity
- Colorectal cancer
- Industry Sectors
- Author Affiliations
- 1. Division of Colorectal Surgery, Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA
- 2. Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA