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Obesity is the most prevalent and serious nutritional disease among western countries and is rapidly replacing undernutrition as the most common form of malnutrition in the world. Approximately 300,000 deaths a year are currently associated with overweight and obesity, second only to cigarette smoking as a leading cause of preventable death in the United States. Obesity effects 9 organ systems and is a risk factor for gastroesophageal reflux disease, nonalcoholic fatty liver disease, cholelithiasis, and colon cancer. Evidence-based guidelines on the identification, evaluation, and treatment of overweight and obesity have recently been developed by the National Institutes of Health to help practitioners effectively manage their patients. The body mass index is used to classify weight status and risk of disease. Treatment for obesity includes lifestyle management, consisting of diet therapy, physical activity, and behavioral modification, and may include pharmacotherapy or surgery based on level of risk. Currently only 2 medications, sibutramine and orlistat, are approved for long-term use. An initial weight loss of 10% of body weight achieved over 6 months is a recommended target. This article reviews the evaluation and management of the adult obese patient.
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PMID:Medical management of obesity. 1223 Mar 15

Errors in measuring dietary intake can threaten validity of data. Low-energy reporters (LER) are individuals who report lower levels of energy intake than deemed feasible given their basal metabolic rate and physical activity level (PAL). The purpose of this study was to determine whether LER differ by case/control status or by extent of disease of cases. Data from a large population-based case-control study of colon cancer were used to identify LER. Dietary data were collected using a diet history questionnaire. Age- and gender-specific basal metabolic rate was estimated, and Goldberg cut points were used to estimate plausible energy intake and adjusted for PAL. On the basis of standard methods that do not take PAL into account, 16.7% of male cases, 19.8% of male controls, 20.9% of female cases, and 22.2% of female controls were considered LER. There were no case-control differences in the proportion of LER in men or women when PAL-adjusted cut points were used, although more individuals were considered LER. Likewise, there were no differences in LER by colon cancer disease stage. Excluding LER from the population and assessing associations between energy intake and colon cancer yielded results similar to those observed for the total population. In this population, LER were significantly more likely to be older, never to have smoked cigarettes, to be more physically active, and to be overweight or obese. LER reported fewer total food items than non-LER. There does not appear to be differential reporting of low energy intake by cases and controls or by disease stage among cases. However, LER appear to differ depending on exposure characteristics that may be importantly associated with cancer.
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PMID:Low-energy reporters: evaluation of potential differential reporting in case-control studies. 1241 56

The prevalence of patients with cancer histories and types of cancers prevailing among a cohort of adults with end-stage hip osteoarthritis was established in order to determine if this group might require some form of enriched pre- and postoperative rehabilitation in view of their adverse medical history. Body weights and selected physical capacity indicators were specifically compared among hip surgical patients with and without cancer histories to specify characteristics that could direct potentially desirable and improved intervention efforts. The medical records of 1,000 hip osteoarthritis surgical candidates were scrutinized, and numbers with and without malignancy histories were recorded. Malignancy typologies and selected body mass and physical capacity indices were recorded. Specific subgroup comparisons among these variables were then made for 40 cancer survivors and an age- and gender-matched subgroup of 40 otherwise healthy osteoarthritis patients, and for selected breast, prostate, and colon cancer survivors. (1) Fourteen percent of the present patient group had a cancer history. (2) The most common malignancy noted was breast cancer, followed by prostate and then colon cancer. (3) Among subjects matched for age and gender, 85% with a cancer history were overweight or obese, compared with 60% of those with no comorbid disease history. (4) Patients with cancer histories were more impaired immediately before, and after, surgery than patients with no cancer history. (5) Patients with breast and colon cancer histories had significantly slower recovery rates after hip surgery than those with a prostate cancer history (p < 0.05). Thus, breast, prostate, and colon cancer survivors constitute a modest proportion of patients undergoing surgery for painful disabling hip osteoarthritis. As a subgroup, cancer survivors, especially breast cancer survivors, are overweight, and more impaired before and after surgery than adults of the same age without a cancer history undergoing hip surgery.
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PMID:Body mass and physical capacity indicators of hip osteoarthritis patients with and without malignancy histories: implications for prevention and rehabilitation. 1289 65

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease with multiple extrarenal manifestations. It accounts for 7% to 11% of patients receiving dialysis or renal transplantation (RT) for end-stage renal disease (ESRD) in Europe. We analyzed retrospectively the causes of death, the prevalence of cardiovascular risk factors (CVRF) and the patient and graft survivals in 62 consecutive ADPKD patients who received 63 cadaveric grafts (29 men and 34 women), of the 600 RTs performed between 1980-2001. The diagnosis of ADPKD was established by family history and ultrasound techniques. At present, 50 patients (79.4%) have functioning grafts, with a mean follow-up of 84.7 months (range, 12-255), and 13 patients have lost their grafts. The main cause of failure was patient death with a functioning graft (9 cases). Malignancies occurred in 5 patients, including 2 lymphomas, 1 renal carcinoma, 1 pancreas sarcoma, and 1 lung cancer associated with infection. Three patients died of cardiocerebrovascular events, and 1 patient of pneumonia. One patient lost the graft after decreasing the immunosuppression for an obstructing colon cancer. Three additional patients now on dialysis lost their grafts due to chronic rejection in 2 cases and primary nonfunction in 1 case. The prevalence of cardiovascular risk factors among the 50 patients with functional grafts were: hypertension, 70%; hypercholesterolemia, 62%; hyperhomocysteinemia, 30%; hyperfibrinogenemia, 68%; increased lipoprotein (a), 18%; microalbuminuria, 22%; hyperuricemia, 48%; hyperparathyroidism, 24%; overweight status, 24%; and nonlethal myocardial infarction, 10%. We conclude that ADPKD patients have good graft and patient survivals, and that the presence of malignancy is the main cause of death and graft failure at our center.
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PMID:Autosomal-dominant polycystic kidney disease: high prevalence of graft loss for death-related malignancies and cardiovascular risk factors. 1296 69

Glycaemic index is a measure of blood glucose increase two hours after intake of food containing 50 g of carbohydrate. The reference is measurements after intake of 50 g glucose or white bread containing 50 g carbohydrate, which is set to the value of 100. The glycaemic index was developed to help persons with diabetes improve their blood glucose control in order to avoid long-term complications. Apple can have an index of approximately 40, while a baguette has 95 and pumpernickel bread 41. Some observational studies suggest that a carbohydrate diet with low glycaemic index may reduce the risk of overweight, diabetes type 2 and colon cancer. There are at present few published controlled clinical trials supporting this conclusion. The food industry and some people working with weight reduction have shown interest in using the glycaemic index. The system may easily cause confusion and leave the impression that important and nutritious carbohydrate-containing foods should be avoided. The glycaemic index could be a tool for dieticians and physicians counselling persons with metabolic syndrome, overweight, diabetes type 1 or 2.
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PMID:[Glycaemic index]. 1471 13

Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.
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PMID:Obesity and nutrition in women throughout adulthood. 1556 71

Inadequate vegetable intake appears to increase colon cancer risk. Since genetic variation in taste influences vegetable preference, we tested associations between bitterness of 6-n-propylthiouracil (PROP), a measure of taste genetics, and number of colonic polyps, a measure of colon cancer risk, in 251 men who underwent screening lower endoscopy. Patients used the general Labeled Magnitude Scale to rate bitterness of 1.6 mg PROP delivered via filter paper. A subset of 86 patients reported weekly vegetable intakes, excluding salad or potatoes. PROP bitterness correlated significantly with polyp number, an effect separate from age-associated increases in polyp number. The PROP-polyp relationship was strongest in men over 66 years, and older men with polyps were most likely to be overweight or obese. In the subset reporting vegetable intake, men who tasted PROP as more bitter consumed fewer vegetables. These preliminary findings suggest that taste genetics may influence colon cancer risk, possibly through intake of vegetables.
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PMID:Association between 6-n-propylthiouracil (PROP) bitterness and colonic neoplasms. 1581 Jun 30

Excess weight has been associated with increased risk of cancer. The effect of body mass index (BMI, kg/m(2)) on overall cancer risk and on risk of developing several common cancer types was examined in a population-based cohort study. Height and weight measurements were available for 35,362 women and 33,424 men recruited in the Northern Sweden Health and Disease Cohort between 1985 and 2003. Among cohort members, 2,691 incident cancer cases were identified. The association of BMI with cancer risk was examined using Poisson regression. Women with BMI > 27.1 (top quartile) had a 29% higher risk of developing any malignancy compared to women with BMI of 18.5-22.2 (lowest quartile), which increased to 47% in analysis limited to nonsmokers. Analyses according to WHO cut-off points showed that obese women (BMI > or = 30) had a 36% higher risk of cancer than women with BMI in the normal range (18.5-25). Individual cancer sites most strongly related to obesity were endometrium (risk for top quartile = 3.53, 95% confidence interval 1.86-7.43), ovary (2.09, 1.13-4.13) and colon (2.05, 1.04-4.41). BMI was inversely related to breast cancer occurring before age 49 (0.58, 0.29-1.11, p(trend) < 0.04). In men, there was no association of BMI with overall cancer risk. Obese men (BMI > or = 30), however, were at increased risk of developing kidney cancer (3.63, 1.23-10.7) and, after exclusion of cases diagnosed within 1 year of recruitment, colon cancer (1.77, 1.04-2.95). Our study provides further evidence that BMI is positively associated with cancer risk. In women from northern Sweden, up to 7% of all cancers were attributable to overweight and obesity and could be avoided by keeping BMI within the recommended range.
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PMID:Body mass index and cancer: results from the Northern Sweden Health and Disease Cohort. 1604 63

Overweight and obesity increase the risk of developing several cancers. Once cancer develops, individuals may be at increased risk of recurrence and poorer survival if they are overweight or obese. A statistically significant association between overweight or obesity and breast cancer recurrence or survival has been observed in the majority of population-based case series; however, adiposity has been shown to have less of an effect on prognosis in the clinical trial setting. Weight gain after breast cancer diagnosis may also be associated with decreased prognosis. New evidence suggests that overweight/obesity vs normal weight may increase the risk of poor prognosis among resected colon cancer patients and the risk of chemical recurrence inprostate cancer patients. Furthermore, obese cancer patients are at increased risk for developing problems following surgery, including wound complication, lymphedema, second cancers, and the chronic diseases affecting obese individuals without cancer such as cardiovascular disease and diabetes. Mechanisms proposed to explain the association between obesity and reduced prognosis include adipose tissue-induced increased concentrations of estrogens and testosterone, insulin, bioavailable insulin-like growth factors, leptin, and cytokines. Additional proposed mechanisms include reduced immune functioning, chemotherapy dosing, and differences in diet and physical activity in obese and nonobese patients. There have been no randomized clinical trials testing the effect of weight loss on recurrence or survival in overweight or obese cancer patients, however. In the absence of clinical trial data, normal weight, overweight, and obese patients should be advised to avoid weight gain through the cancer treatment process. In addition, weight loss is probably safe, and perhaps helpful, for overweight and obese cancer survivors who are otherwise healthy.
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PMID:Obesity and cancer: the risks, science, and potential management strategies. 1605 36

We investigated the relation of overweight and obesity with cancer in a population-based cohort of more than 145 000 Austrian adults over an average of 9.9 years. Incident cancers (n=6241) were identified through the state cancer registry. Using Cox proportional-hazards models adjusted for smoking and occupation, increases in relative body weight in men were associated with colon cancer (hazard rate (HR) ratio 2.48; 95% confidence interval (CI): 1.15, 5.39 for body mass index (BMI) > or =35 kg m(-2)) and pancreatic cancer (HR 2.34, 95% CI: 1.17, 4.66 for BMI>30 kg m(-2)) compared to participants with normal weight (BMI 18.5-24.9 kg m(-2)). In women, there was a weak positive association between increasing BMI and all cancers combined, and strong associations with non-Hodgkin's lymphomas (HR 2.86, 95% CI: 1.49, 5.49 for BMI> or =30 kg m(-2)) and cancers of the uterine corpus (HR 3.93, 95% CI: 2.35, 6.56 for BMI> or =35 kg m(-2)). Incidence of breast cancer was positively associated with high BMI only after age 65 years. These findings provide further evidence that overweight is associated with the incidence of several types of cancer.
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PMID:Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. 1623 22


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