Abstract
Simple SummaryMetabolic (bariatric) surgery (MBS) provides the greatest maximum and sustained weight loss among individuals who are morbidly obese. It is more effective than lifestyle interventions in improving or eliminating type 2 diabetes mellitus (T2DM) and in decreasing cardiovascular (CV) risk. Preclinical studies have been conducted to investigate the mechanisms by which MBS leads to the benefits in T2DM and CV risk. In this review, we describe the emerging evidence that MBS may also impact cancer risk and mortality, and whom may benefit most. We describe the long term involvement and commitment of the National Institutes of Health in obesity research in general and MBS in particular. We outline the need for additional research to understand the mechanism(s) by which MBS may influence cancer, since these mechanism(s) are currently unknown.Metabolic (bariatric) surgery (MBS) is recommended for individuals with a BMI > 40 kg/m2 or those with a BMI 35–40 kg/m2 who have one or more obesity related comorbidities. MBS leads to greater initial and sustained weight loss than nonsurgical weight loss approaches. MBS provides dramatic improvement in metabolic function, associated with a reduction in type 2 diabetes mellitus and cardiovascular risk. While the number of MBS procedures performed in the U.S. and worldwide continues to increase, they are still only performed on one percent of the affected population. MBS also appears to reduce the risk of certain obesity related cancers, although which cancers are favorably impacted vary by study, who benefits most is uncertain, and the mechanism(s) driving this risk reduction are mostly speculative. The goal of this manuscript is to highlight (1) emerging evidence that MBS influences cancer risk, and that the potential benefit appears to vary based on cancer, gender, surgical procedure, and likely other variables; (2) the role of the NIH in MBS research in T2DM and CV risk for many years, and more recently in cancer; and (3) the opportunity for research to understand the mechanism(s) by which MBS influences cancer. There is evidence that women benefit more from MBS than men, that MBS may actually increase the risk of colorectal cancer in both women and men, and there is speculation that the benefit in cancer risk reduction may vary according to which MBS procedure an individual undergoes. Herein, we review what is currently known, the historical role of government, especially the National Institutes of Health (NIH), in driving this research, and provide suggestions that we believe could lead to a better understanding of whether and how MBS impacts cancer risk, which cancers are impacted either favorably or unfavorably, the role of the NIH and other research agencies, and key questions to address that will help us to move the science forward.
Highlights
This text is not meant to be an exhaustive review of metabolic surgery (MBS) procedures, nor its impact on disease in animal or human studies
The two most commonly performed Metabolic (bariatric) surgery (MBS) procedures today are the Roux-en-Y gastric bypass (RYGB) and the sleeve gastrectomy (SG), comprising 78% of all MBS procedures performed in the U.S in 2018 [2]
The expert panel found no reason to alter the 1991 consensus panel recommendations and confirmed the recommendation that MBS is an option for carefully selected patients with body mass index (BMI) ≥ 40 kg/m2 (There has some variability over time as to whether morbid obesity is a BMI ≥ 40 kg/m2 or > 40 kg/m2.) or 35 kg/m2 with comorbid conditions when less invasive methods of weight loss have failed and the patient is at high risk for obesity related morbidity or mortality [19]
Summary
This text is not meant to be an exhaustive review of metabolic (bariatric) surgery (MBS) procedures, nor its impact on disease in animal or human studies. There are clear changes in gut peptides and bile acids [4], adipose tissue function (with changes in adipokine production and decreased adipose tissue inflammation) [8], gut-brain signals (which lead to satiety despite decreased food consumption) [9], intestinal gluconeogenesis (an improvement in which has protective effects against diabetes and obesity by positively regulating glucose homeostasis and hepatic glucose production) [10], and an improved CV metabolic profile, including improvements in total cholesterol, triglycerides, and high and low density lipoproteins [11] These observations provide convincing evidence that MBS consistently improves and often eliminates T2DM and lowers CV risk
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