Metabolically healthy overweight/obesity and cancer risk: A representative cohort study in Taiwan

Metabolically healthy across body mass index categories in relation to serum Klotho levels: a population-based study

Background

Metabolic health status and body mass index (BMI) are both key predictors of aging-related diseases and premature mortality. However, the relationship between metabolically distinct phenotypes, classified by BMI categories, and serum Klotho levels-a biomarker of aging-remains poorly understood. This study aimed to investigate the association between metabolically healthy phenotypes and serum Klotho levels among middle and aged adults.

Methods

A total of 11,413 participants were included in this study. Participants were categorized into phenotypes according to metabolic disorders and BMI: metabolically healthy and normal weight (MH-NW), metabolically healthy and overweight (MH-OW), metabolically healthy and obesity (MHO), metabolically unhealthy and normal weight (MU-NW), metabolically unhealthy and overweight (MU-OW), and metabolically unhealthy and obesity (MUO). Weighted multivariate linear regression models were performed to estimate the association between metabolically healthy phenotypes and Klotho levels.

Results

After adjusting for potential confounders, participants in the MH-OW, MU-OW, and MUO groups had significantly lower Klotho levels compared to the MH-NW group, with estimated percentage changes (95%CIs) at -5.4% (-9.2% to -1.4%), -5.0% (-8.3% to -1.5%), and -5.7% (-8.7% to -2.5%), respectively. Additionally, reduced Klotho levels were more pronounced among females with MU-OW and MUO phenotypes, showing estimated percentage changes of -6.6% (-11.1% to -1.9) and -8.4% (-12.7% to -3.8%), respectively.

Conclusion

This large population-based study found that Klotho levels vary according to metabolically healthy status across BMI categories, with metabolically unhealthy phenotypes exhibiting notably lower levels. These findings highlight the influence of metabolic abnormalities and body fatness on the aging process.

Correlates of Overweight and Obesity in German Primary School Children

BACKGROUND/OBJECTIVES

Childhood obesity is a consistent public health issue, which often persists into adulthood. This study determined risk factors of childhood obesity and associated comorbidities in German school children.

METHODS

Data of 1956 primary school children (7.1 ± 0.6 years) were analysed. Anthropometrics were taken on site, other (health) parameters were assessed using a parental questionnaire. Binary logistic regression models were calculated, controlling for age, gender, family education level, and migration background.

RESULTS

Father's physical illness (OR 1.092 [1.177; 3.073], p = 0.009) and a child's chronic illness (OR 1.687 [1.077; 2.644], p = 0.022), maternal and paternal overweight (OR 2.180 [1.492; 3.185]; OR 2.494 [1.547; 4.022], p < 0.001, respectively), as well as maternal and paternal smoking (OR 1.942 [1.306; 2.889]; OR 1.972 [1.334; 2.917], p = 0.001, respectively) were significantly associated with the child being overweight. Also associated with the child being overweight were physical activity, regular screen media use (OR 0.605 [0.408, 0.896], p = 0.012; OR 2.029 [1.306; 3.152], p = 0.002, respectively), the mother and/or father thinking their child is too fat (OR 2.213 [1.504; 3.258], p < 0.001; OR 1.537 [1.048; 2.253], p = 0.028), the father's physical inactivity (OR 1.69 [1.133; 2.521], p = 0.010), and if the child has not been breastfed (OR 1.632 [1.056; 2.521], p = 0.027), the mother smoked during pregnancy (OR 1.992 [1.224; 3.246], p = 0.006) as well as if the mother and/or father admonished their child about their weight (OR 25.521 [14.578; 44.680]; OR 19.448 [11.865; 31.877], p < 0.001, respectively). Children of unemployed mothers and in low-income households had an increased risk of being overweight (OR 4.811 [1.642; 14.096], p = 0.004; OR 2.203 [1.360; 3.568], p = 0.001, respectively).

CONCLUSIONS

This study shows that parental health, lifestyle, and social behaviours matter in determining childhood obesity. Understanding those is essential to promoting a healthy lifestyle.

Association of metabolic obesity phenotypes with risk of overall and site-specific cancers: a systematic review and meta-analysis of cohort studies

BACKGROUND

Adiposity is a known risk factor for certain cancers; however, it is not clear whether the risk of cancer differs between individuals with high adiposity but different metabolic health status. The aim of this systematic literature review and meta-analysis of cohort studies was to evaluate associations between metabolic obesity phenotypes and overall and site-specific cancer risk.

METHODS

PubMed and Embase databases were used to identify relevant cohort studies up to the 6th of June 2023. Random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs) for the association between metabolic obesity phenotypes and cancer risk. Certainty of evidence was assessed using the Cochrane methods and the GRADE tool. This study is registered with PROSPERO, number CRD42024549511.

RESULTS

A total of 15,556 records were screened, and 31 publications covering 15 unique cohort studies were included in this analysis. Of these studies, 22 were evaluated as being at low risk of bias and 9 at moderate risk of bias. Compared to metabolically healthy normal-weight individuals (MHNW), metabolically unhealthy overweight/obese (MUOW/OB) individuals had a higher risk of overall (SRR = 1.21, 95% CI = 1.02-1.44, n = 3 studies, high certainty) and obesity-related cancers (SRR = 1.42, 95% CI = 1.15-1.74, n = 3, very low certainty). Specifically, MUOW/OB individuals were at higher risk of cancers of the postmenopausal breast (SRR = 1.32, 95% CI = 1.17-1.48, n = 7, low certainty), colorectum (SRR = 1.24, 95% CI = 1.16-1.31, n = 6, moderate certainty), endometrium (SRR = 2.31, 95% CI = 2.08-2.57, n = 4, high certainty), thyroid (SRR = 1.42, 95% CI = 1.29-1.57, n = 4, moderate certainty), kidney (SRR = 1.71, 95% CI = 1.40-2.10, n = 3, low certainty), pancreas (SRR = 1.35, 95% CI = 1.24-1.47, n = 3, high certainty), liver (SRR = 1.81, 95% CI = 1.36-2.42, n = 2, moderate certainty), gallbladder (SRR = 1.42, 95% CI = 1.17-1.73, n = 2, high certainty), bladder (SRR = 1.36, 95% CI = 1.19-1.56, n = 2, moderate certainty), and stomach (SRR = 1.50, 95% CI = 1.12-2.01, n = 2, high certainty). In addition, we found elevated risks of most of these cancers among individuals classified as MUNW and MHOW/OB phenotypes compared to those with MHNW phenotype. Our stratified analyses according to metabolic obesity phenotypes suggested that the elevated risks of some cancers were stronger in individuals with MUOW/OB versus those with MHOW/OB or MUNW phenotypes.

CONCLUSION

These findings suggest that both higher adiposity and metabolic dysfunction were independently associated with increased risk of several cancers, with the strongest associations generally observed among those with both metabolic dysfunction and obesity.

The Significance of Comprehensive Metabolic Phenotypes in Cancer Risk: A Japan Multi-Institutional Collaborative Cohort Study

SIGNIFICANCE

The prospective cohort study in a large Japanese population suggested that metabolic phenotypes are important risk factors for total and some site-specific cancers in Japanese adults. Moreover, the risk of each site-specific cancer may differ according to metabolic phenotypes.

Metabolic obesity phenotypes and thyroid cancer risk: A systematic exploration of the evidence

Background

Obesity is recognized as a risk factor for various cancers, including thyroid cancer. However, the association between different metabolic obesity phenotypes and thyroid cancer risk remains unclear. This systematic review aimed to comprehensively evaluate the existing literature to elucidate the association between metabolic obesity phenotypes and thyroid cancer risk.

Methods

This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched for relevant studies until April 2024. Studies examining the link between metabolic obesity phenotypes and thyroid cancer risk were included.

Results

Five cohort studies involving 831,510 participants met the inclusion criteria. Metabolically unhealthy obesity was consistently associated with an increased risk of thyroid cancer in both men and women. Central adiposity emerged as a significant predictor of thyroid cancer risk. Mechanistically, chronic inflammation, dysregulated adipokine secretion, hormonal imbalances, and altered signaling pathways may contribute to thyroid carcinogenesis. There is an ongoing debate regarding the risk associated with metabolically healthy obesity, with some suggesting potential protective effects due to favorable metabolic profiles.

Conclusion

This systematic review highlights the complex relationship between metabolic obesity phenotypes and thyroid cancer risk. The findings highlighted the importance of considering metabolic status alongside obesity in thyroid cancer risk assessment and intervention strategies.

Metabolic obesity phenotypes and obesity-related cancer risk in the National Health and Nutrition Examination Survey

INTRODUCTION

Body mass index (BMI) fails to identify up to one-third of normal weight individuals with metabolic dysfunction who may be at increased risk of obesity-related cancer (ORC). Metabolic obesity phenotypes, an alternate metric to assess metabolic dysfunction with or without obesity, were evaluated for association with ORC risk.

METHODS

National Health and Nutrition Examination Survey participants from 1999 to 2018 (N = 19,500) were categorized into phenotypes according to the metabolic syndrome (MetS) criteria and BMI: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Adjusted multivariable logistic regression models were used to evaluate associations with ORC.

RESULTS

With metabolic dysfunction defined as ≥1 MetS criteria, ORC cases (n = 528) had higher proportions of MUNW (28.2% vs. 17.4%) and MUO (62.6% vs. 60.9%) phenotypes than cancer-free individuals (n = 18,972). Compared with MHNW participants, MUNW participants had a 2.2-times higher ORC risk [OR (95%CI) = 2.21 (1.27-3.85)]. MHO and MUO participants demonstrated a 43% and 56% increased ORC risk, respectively, compared to MHNW, but these did not reach statistical significance [OR (95% CI) = 1.43 (0.46-4.42), 1.56 (0.91-2.67), respectively]. Hyperglycaemia, hypertension and central obesity were all independently associated with higher ORC risk compared to MHNW.

CONCLUSIONS

MUNW participants have a higher risk of ORC than other abnormal phenotypes, compared with MHNW participants. Incorporating metabolic health measures in addition to assessing BMI may improve ORC risk stratification. Further research on the relationship between metabolic dysfunction and ORC is warranted.

Visfatin upregulates VEGF-C expression and lymphangiogenesis in esophageal cancer by activating MEK1/2-ERK and NF-κB signaling

Lymph node metastasis is a recognized prognostic factor in esophageal cancer. Adipokines, including visfatin, and the molecule vascular endothelial growth factor (VEGF)-C, are implicated in lymphangiogenesis, but whether any association exists between esophageal cancer, adipokines and VEGF-C is unknown. We examined the relevance of adipokines and VEGF-C in esophageal squamous cell carcinoma (ESCC) in the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. We found significantly higher levels of visfatin and VEGF-C expression in esophageal cancer tissue than in normal tissue. Immunohistochemistry (IHC) staining identified that higher levels of visfatin and VEGF-C expression were correlated with advanced stage ESCC. Visfatin treatment of ESCC cell lines upregulated VEGF-C expression and VEGF-C-dependent lymphangiogenesis in lymphatic endothelial cells. Visfatin induced increases in VEGF-C expression by activating the mitogen-activated protein kinase kinases1/2-extracellular signal-regulated kinase (MEK1/2-ERK) and Nuclear Factor Kappa B (NF-κB) signaling cascades. Transfecting ESCC cells with MEK1/2-ERK and NF-κB inhibitors (PD98059, FR180204, PDTC, and TPCK) and siRNAs inhibited visfatin-induced increases in VEGF-C expression. It appears that visfatin and VEGF-C are promising therapeutic targets in the inhibition of lymphangiogenesis in esophageal cancer.

Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine

In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.