Skip to main content
SpringerLink
Log in

Sex/Gender-Specific Medicine for Impact of Overweight, Obese, and Underweight on Gastric Cancer

  • Chapter
  • First Online:
Sex/Gender-Specific Medicine in the Gastrointestinal Diseases

Abstract

Previously, there have been several reports showing a gender difference in the increased risk of cardia gastric cancer (GC) associated with obesity, with the degree of elevated cardia GC risk related to obesity being greater in males than in females. There are two mechanisms for such difference. First, increased concentrations of female hormones in obese females might have a protective effect against GC. Second, different prevalence of cardia GC precursors according to sex might contribute to such difference. The prevalence of Barrett’s esophagus, a risk factor of cardia GC, is higher in males than in females. The prevalence of erosive esophagitis, a risk factor for Barrett’s esophagus, is also higher in males than in females. Meanwhile, several recent studies have suggested that being underweight increases the risk of non-cardia GC. These results have been mainly reported in Asian countries where non-cardia GC accounts for most GC cases. Such elevated GC risk in underweight population could be related to their low levels of micronutrients or lower immunity in underweight group since low level of micronutrients or immune response implies decreased protective effects of micronutrient against cancer development or elevated risk of Helicobacter pylori infection, a major carcinogen of non-cardia GC. So far, sex difference in the risk of non-cardia GC associated with underweight has not been solidly established yet. However, potential of sex difference in terms of impact of underweight on non-cardia GC can be inferred since lower female hormone level in underweight population can be a risk factor of GC and changes in female hormone concentrations according to body fat levels may be greater in females than in males. In this review, we reviewed on sex/gender-specific medicine for association of overweight, obese, and underweight with GC.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2,416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

    Article  Google Scholar 

  2. Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121:21–33.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Basen-Engquist K, Chang M. Obesity and cancer risk: recent review and evidence. Curr Oncol Rep. 2011;13:71–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: AICR; 2007.

    Google Scholar 

  5. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.

    Article  PubMed  Google Scholar 

  6. Mukaisho KI, Nakayama T, Hagiwara T, Hattori T, Sugihara H. Two distinct etiologies of gastric cardia adenocarcinoma: interactions among pH, Helicobacter pylori, and bile acids. Front Microbiol. 2015;6:412.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim JY, Lee HS, Kim N, Shin CM, Lee SH, Park YS, et al. Prevalence and clinicopathologic characteristics of gastric cardia cancer in South Korea. Helicobacter. 2012;17:358–68.

    Article  PubMed  Google Scholar 

  8. Chen Y, Liu LX, Wang XL, Wang J, Yan Z, Cheng J, et al. Body mass index and risk of gastric cancer: a meta-analysis of a population with more than ten million from 24 prospective studies. Cancer Epidem Biomar. 2013;22:1395–408.

    Article  Google Scholar 

  9. Fan JH, Wang JB, Wang SM, Abnet CC, Qiao YL, Taylor PR. Body mass index and risk of gastric cancer: a 30-year follow-up study in the Linxian general population trial cohort. Cancer Sci. 2017;108:1667–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hirabayashi M, Inoue M, Sawada N, Saito E, Abe SK, Hidaka A, et al. Effect of body-mass index on the risk of gastric cancer: a population-based cohort study in A Japanese population. Cancer Epidemiol. 2019;63:101622.

    Article  PubMed  Google Scholar 

  11. Jang J, Cho EJ, Hwang Y, Weiderpass E, Ahn C, Choi J, et al. Association between body mass index and gastric cancer risk according to effect modification by Helicobacter pylori infection. Cancer Res Treat. 2019;51:1107–16.

    Article  CAS  PubMed  Google Scholar 

  12. Jang J, Wang TY, Cai H, Ye F, Murphy G, Shimazu T, et al. The U-shaped association between body mass index and gastric cancer risk in the Helicobacter pylori Biomarker Cohort Consortium: a nested case-control study from eight East Asian cohort studies. Int J Cancer. 2020;147:777–84.

    Article  CAS  PubMed  Google Scholar 

  13. Colquhoun A, Arnold M, Ferlay J, Goodman KJ, Forman D, Soerjomataram I. Global patterns of cardia and non-cardia gastric cancer incidence in 2012. Gut. 2015;64:1881–8.

    Article  CAS  PubMed  Google Scholar 

  14. Lou L, Wang L, Zhang Y, Chen G, Lin L, Jin X, Huang Y, et al. Sex difference in incidence of gastric cancer: an international comparative study based on the Global Burden of Disease Study 2017. BMJ Open. 2020;10:e033323.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body fatness and cancer - viewpoint of the IARC Working Group. New Engl J Med. 2016;375:794–8.

    Article  PubMed  Google Scholar 

  17. Samanic C, Gridley G, Chow WH, Lubin J, Hoover RN, Fraumeni JF Jr. Obesity and cancer risk among white and black United States veterans. Cancer Cause Control. 2004;15:35–43.

    Article  Google Scholar 

  18. Lindblad M, Rodriguez LAG, Lagergren J. Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric non-cardia adenocarcinoma among men and women in a nested case-control study. Cancer Cause Control. 2005;1:285–94.

    Article  Google Scholar 

  19. MacInnis RJ, English DR, Hopper JL, Giles GG. Body size and composition and the risk of gastric and oesophageal adenocarcinoma. Int J Cancer. 2006;118:2628–31.

    Article  CAS  PubMed  Google Scholar 

  20. Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF Jr. Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Cause Control. 2006;17:901–9.

    Article  Google Scholar 

  21. Merry AH, Schouten LJ, Goldbohm RA, van den Brandt PA. Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study. Gut. 2007;56:1503–11.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk of esophageal and gastric cardia carcinomas. Cancer Epidem Biomar. 2008;17:352–8.

    Article  Google Scholar 

  23. O’Doherty MG, Freedman ND, Hollenbeck AR, Schatzkin A, Abnet CC. A prospective cohort study of obesity and risk of oesophageal and gastric adenocarcinoma in the NIH-AARP Diet and Health Study. Gut. 2012;61:1261–8.

    Article  PubMed  Google Scholar 

  24. World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and oesophageal cancer. In: Continuous Update Project Expert Report 2018. 2018. dietandcancerreport.org. Accessed 18 Aug 2021.

  25. Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol. 2018;6:95–104.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Derakhshan MH, Malekzadeh R, Watabe H, Yazdanbod A, Fyfe V, Kazemi A, et al. Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer. Gut. 2008;57:298–305.

    Article  CAS  PubMed  Google Scholar 

  27. Horii T, Koike T, Abe Y, Kikuchi R, Unakami H, Iijima K, et al. Two distinct types of cancer of different origin may be mixed in gastroesophageal junction adenocarcinomas in Japan: Evidence from direct evaluation of gastric acid secretion. Scand J Gastroenterol. 2011;46:710–9.

    Article  PubMed  Google Scholar 

  28. Alemán JO, Eusebi LH, Ricciardiello L, Patidar K, Sanyal AJ, Holt PR. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology. 2014;146:357–73.

    Article  PubMed  Google Scholar 

  29. Olefson S, Moss SF. Obesity and related risk factors in gastric cardia adenocarcinoma. Gastric Cancer. 2015;18:23–32.

    Article  PubMed  Google Scholar 

  30. Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:2619–28.

    Article  PubMed  Google Scholar 

  31. Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalovski M. Prospective evaluation of intestinal metaplasia and dysplasia within the cardia of patients with Barrett’s esophagus. Dig Dis Sci. 1997;42:597–602.

    Article  CAS  PubMed  Google Scholar 

  32. Cameron AJ, Lomboy CT, Pera M, Carpenter HA. Adenocarcinoma of the esophagogastric junction and Barrett’s esophagus. Gastroenterology. 1995;109:1541–6.

    Article  CAS  PubMed  Google Scholar 

  33. Fullard M, Kang JY, Neild P, Poullis A, Maxwell JD. Systematic review: does gastro-oesophageal reflux disease progress? Aliment Pharmacol Ther. 2006;24:33–45.

    Article  CAS  PubMed  Google Scholar 

  34. Cohen DH, LeRoith D. Obesity, type 2 diabetes, and cancer: the insulin and IGF connection. Endocr Relat Cancer. 2012;19:F27–45.

    Article  CAS  PubMed  Google Scholar 

  35. Tseng CH, Chen CJ, Landolph JR Jr. Diabetes and cancer: epidemiological, clinical, and experimental perspectives. Exp Diabetes Res. 2012;2012:101802.

    PubMed  PubMed Central  Google Scholar 

  36. Kim HJ, Kim N, Kim HY, Lee HS, Yoon H, Shin CM, et al. Relationship between body mass index and the risk of early gastric cancer and dysplasia regardless of Helicobacter pylori infection. Gastric Cancer. 2015;18:762–73.

    Article  PubMed  Google Scholar 

  37. Camargo MC, Goto Y, Zabaleta J, Morgan DR, Correa P, Rabkin CS. Sex hormones, hormonal interventions, and gastric cancer risk: a meta-analysis. Cancer Epidemiol Biomark Prev. 2012;21:20–38.

    Article  CAS  Google Scholar 

  38. Kim SM, Min BH, Lee J, An JY, Lee JH, Sohn TS, et al. Protective effects of female reproductive factors on Lauren intestinal-type gastric adenocarcinoma. Yonsei Med J. 2018;59:28–34.

    Article  CAS  PubMed  Google Scholar 

  39. Lukanova A, Lundin E, Zeleniuch-Jacquotte A, Muti P, Mure A, Rinaldi S, et al. Body mass index, circulating levels of sex-steroid hormones, IGF-I and IGF-binding protein-3: a cross-sectional study in healthy women. Eur J Endocrinol. 2004;150:161–71.

    Article  CAS  PubMed  Google Scholar 

  40. Madigan MP, Troisi R, Potischman N, Dorgan JF, Brinton LA, Hoover RN. Serum hormone levels in relation to reproductive and lifestyle factors in postmenopausal women (United States). Cancer Causes Control. 1998;9:199–207.

    Article  CAS  PubMed  Google Scholar 

  41. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, et al. Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring). 2006;14:1662–77.

    Article  CAS  Google Scholar 

  42. Hankinson SE, Willett WC, Manson JE, Hunter DJ, Colditz GA, Stampfer MJ, et al. Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Natl Cancer Inst. 1995;87:1297–302.

    Article  CAS  PubMed  Google Scholar 

  43. Boyapati SM, Shu XO, Gao YT, Dai Q, Yu H, Cheng JR, et al. Correlation of blood sex steroid hormones with body size, body fat distribution, and other known risk factors for breast cancer in post-menopausal Chinese women. Cancer Causes Control. 2004;15:305–11.

    Article  PubMed  Google Scholar 

  44. Bezemer ID, Rinaldi S, Dossus L, Gils CH, Peeters PH, Noord PA, et al. C-peptide, IGF-I, sex-steroid hormones and adiposity: a cross-sectional study in healthy women within the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control. 2005;16:561–72.

    Article  PubMed  Google Scholar 

  45. Choi IY, Choi YJ, Shin DW, Han KD, Jeon KH, Jeong S-M, et al. Association between obesity and the risk of gastric cancer in premenopausal and postmenopausal women: a nationwide cohort study. J Gastroenterol Hepatol. 2021;36:2834–40.

    Google Scholar 

  46. Ronkainen J, Talley NJ, Storskrubb T, Johansson SE, Lind T, Vieth M, et al. Erosive esophagitis is a risk factor for Barrett’s esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol. 2011;106:1946–52.

    Article  PubMed  Google Scholar 

  47. Kim N, Lee SW, Cho SI, Park CG, Yang CH, Kim HS, et al. The prevalence of and risk factors for erosive oesophagitis and non-erosive reflux disease: a nationwide multicentre prospective study in Korea. Aliment Pharmacol Ther. 2008;27:173–85.

    Article  CAS  PubMed  Google Scholar 

  48. Kim YS, Kim N, Kim GH. Sex and gender differences in gastroesophageal reflux disease. J Neurogastroenterol Motil. 2016;22:575–88.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Cossentino MJ, Wong RK. Barrett’s esophagus and risk of esophageal adenocarcinoma. Semin Gastrointest Dis. 2003;14:128–35.

    PubMed  Google Scholar 

  50. Kim SY, Jung HK, Lim J, Kim TO, Choe AR, Tae CH, et al. Gender specific differences in prevalence and risk factors for gastro-esophageal reflux disease. J Korean Med Sci. 2019;34:e158.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Grishina I, Fenton A, Sankaran-Walters S. Gender differences, aging and hormonal status in mucosal injury and repair. Aging Dis. 2014;5:160–9.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kendall BJ, Macdonald GA, Hayward NK, Prins JB, Brown I, Walker N, et al. Leptin and the risk of Barrett’s oesophagus. Gut. 2008;57:448–54.

    Article  CAS  PubMed  Google Scholar 

  53. Bhaskaran K, Douglas I, Forbes H, dos -Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014;384:755–65.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Steffen A, Huerta JM, Weiderpass E, Bueno-de-Mesquita HB, May AM, Siersema PD, et al. General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2015;137:646–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Ravindran RD, Vashist P, Gupta SK, Young IS, Maraini G, Camparini M, et al. Prevalence and risk factors for vitamin C deficiency in north and south India: a two centre population based study in people aged 60 years and over. PLoS One. 2011;6:e28588.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Kong P, Cai Q, Geng Q, Wang J, Lan Y, Zhan Y, et al. Vitamin intake reduce the risk of gastric cancer: meta-analysis and systematic review of randomized and observational studies. PLoS One. 2014;9:e116060.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis. 2008;46:1582–8.

    Article  PubMed  Google Scholar 

  58. Nishida T, Sakakibara H. Association between underweight and low lymphocyte count as an indicator of malnutrition in Japanese women. J Women’s Health. 2010;19:1377–83.

    Article  Google Scholar 

  59. Ziomkiewicz A, Ellison PT, Lipson SF, Thune I, Jasienska G. Body fat, energy balance and estradiol levels: a study based on hormonal profiles from complete menstrual cycles. Hum Reprod. 2008;23:2555–63.

    Article  CAS  PubMed  Google Scholar 

  60. Key TJ, Appleby PN, Reeves GK, Roddam A, Dorgan JF, Longcope C, et al. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst. 2003;95:1218–26.

    Article  CAS  PubMed  Google Scholar 

  61. Lindblad M, Ye W, Rubio C, Lagergren J. Estrogen and risk of gastric cancer: a protective effect in a nationwide cohort study of patients with prostate cancer in Sweden. Cancer Epidemiol Biomark Prev. 2004;13:2203–7.

    CAS  Google Scholar 

  62. Yi JH, Do IG, Jang J, Kim ST, Kim KM, Park SH, et al. Anti-tumor efficacy of fulvestrant in estrogen receptor positive gastric cancer. Sci Rep. 2014;4:7592.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Sheh A, Ge Z, Parry NM, Muthupalani S, Rager JE, Raczynski AR, et al. 17beta-estradiol and tamoxifen prevent gastric cancer by modulating leukocyte recruitment and oncogenic pathways in Helicobacter pylori-infected INS-GAS male mice. Cancer Prev Res (Phila). 2011;4:1426–35.

    Article  CAS  Google Scholar 

  64. Messa C, Pricci M, Linsalata M, Russo F, Di Leo A. Inhibitory effect of 17beta-estradiol on growth and the polyamine metabolism of a human gastric carcinoma cell line (HGC-27). Scand J Gastroenterol. 1999;34:79–84.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gyeongnam Center for Infectious Disease Control and Prevention, Gyeongnam Provincial Government, Changwon, Republic of Korea

    Jieun Jang

  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)

    Nayoung Kim

Authors
  1. Jieun Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nayoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nayoung Kim .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Republic of)

    Nayoung Kim

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jang, J., Kim, N. (2022). Sex/Gender-Specific Medicine for Impact of Overweight, Obese, and Underweight on Gastric Cancer. In: Kim, N. (eds) Sex/Gender-Specific Medicine in the Gastrointestinal Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-19-0120-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-0120-1_11

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-0119-5

  • Online ISBN: 978-981-19-0120-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation