The Role of Energy Balance on Colorectal Cancer Survival
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Purpose of Review
Body weight and body composition (i.e., skeletal muscle and adipose tissue) are indicators of long-term energy balance and substrate metabolism. The objective of the current review was to describe the role of energy balance on survival and the potential mechanisms of this relationship in patients with colorectal cancer (CRC).
Energy balance consists of total energy expenditure and dietary intake over time, although these components have been sparsely characterized in CRC. Several large trials have suggested that BMI around 28 kg/m2 at diagnosis is most advantageous for survival and that severe weight loss (i.e., body mass index loss ≥ 7% or ≥ 10% baseline weight) is associated with poor survival. These patterns are likely due to skeletal muscle. Higher skeletal muscle mass is associated with improved survival, although the relative impact is mediated by sex and adipose tissue. Inflammation, physical inactivity, anti-cancer therapy, altered amino acid metabolism, and co-morbidities accelerate loss of muscle mass in people with cancer. Low muscle mass and muscle mass loss represent impaired physiological reserves which impact physical function, anti-cancer therapy toxicities, increased infection rates, and shorter survival. Higher visceral adipose tissue negatively impacts survival, possibly because it is associated with metabolic derangements such as systemic inflammation, insulin resistance, and adipokine secretion.
Body weight and composition are important prognostic factors for CRC survival. An improved understanding of the mechanisms driving energy imbalance is warranted, with translation to optimal interventions for improving overall health and survival.
KeywordsColorectal cancer Body weight Obesity Body composition Energy balance
Compliance with Ethical Standards
Conflict of Interest
Sarah A. Purcell declares that she has no conflict of interest. Jingjie Xiao declares that she has no conflict of interest. Katherine L. Ford declares that she has no conflict of interest. Carla M. Prado is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Salary Award and the Campus Alberta Innovates Program.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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