Abstract
Simple SummaryBy analyzing a large German primary care provider database, we demonstrated that obesity represents a decisive risk factor for the development of colon, rectal, and liver cancer, partly in a sex-dependent manner. Thus, along with previous data, our study including >280,000 patients suggests that the clinical management of overweight patients should include a careful and structured risk assessment for the development of cancer in order to improve long-term outcomes in these patients.Cancer represents the second leading cause of death worldwide, implementing a major health care and socioeconomic burden. Overweight and obesity, both of which are dramatically on the rise in both highly and less developed regions worldwide, have been established as modifiable risk factors for the development of various tumor entities including gastrointestinal (GI) cancers such as colorectal or gastric cancer. However, systematic data on an association between excessive body fat and GI cancer development from Germany are missing. Methods: A total of 287,357 adult outpatients with an available BMI value between 2010 and 2019 were identified from the Disease Analyzer database (IQVIA). The main outcome was the association between pre-obesity (BMI 25–30 kg/m2) and obesity (BMI ≥ 30 kg/m2) compared to normal weight (BMI 18.5–25 kg/m2) and the incident of a GI cancer diagnoses (including colon, rectum, stomach, pancreas, and liver cancer). Results: Within the observation period, the proportion of colon cancer patients increased stepwise from 0.5% and 0.64% in normal weight to 0.71% and 0.91% in obese female and male patients, respectively, which was confirmed in multivariable regression models (ORfemale obesity: 1.23; 95% CI: 1.03–1.48; ORmale obesity: 1.43, 95% CI: 1.17–1.74). In contrast, multivariable regression models revealed that obesity was significantly associated with rectal cancer (OR: 1.36, 95% CI: 1.01–1.84) as well as liver cancer (OR: 1.79, 95% CI: 1.17–2.73) in men only. Conclusions: Our data suggest that obesity represents a decisive risk factor for the development of colon, rectal, and liver cancer, partly in a sex-dependent manner. Since overweight and obesity are modifiable risk factors, the current results may help to establish appropriate prevention and lifestyle programs to reduce both the incidence as well as the high morbidity and mortality of GI tumors in the future.
Highlights
With nearly 10 million deaths in 2020, cancer represents the second leading cause of death worldwide and represents a major health care and socioeconomic burden [1].Several gastrointestinal (GI) cancers such as colorectal, gastric, esophagus, and liver cancer are among the 10 most common tumor entities worldwide in both men and women [1].most GI cancer are associated with a high morbidity and mortality rate [1].The most sensible way to reduce the high number of cancer-associated deaths worldwide is certainly the primary prevention of cancer based on established cancer risk factors.Large-scale sequencing efforts have decisively improved the understanding of the genomic landscape of several malignancies in the last decades [2]
There is a growing body of evidence suggesting an association between excessive body fat and the incidence of GI cancers such as colorectal cancer [8], gastric cancer [9], liver cancer [10], and pancreatic cancer [11]
This study was based on data from the Disease Analyzer database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data obtained directly and in anonymous format from computer systems used in the practices of general practitioners and specialists in Germany [12]
Summary
With nearly 10 million deaths in 2020, cancer represents the second leading cause of death worldwide and represents a major health care and socioeconomic burden [1].Several gastrointestinal (GI) cancers such as colorectal, gastric, esophagus, and liver cancer are among the 10 most common tumor entities worldwide in both men and women [1].most GI cancer are associated with a high morbidity and mortality rate [1].The most sensible way to reduce the high number of cancer-associated deaths worldwide is certainly the primary prevention of cancer based on established cancer risk factors.Large-scale sequencing efforts have decisively improved the understanding of the genomic landscape of several malignancies in the last decades [2]. There is a growing body of evidence suggesting an association between excessive body fat and the incidence of GI cancers such as colorectal cancer [8], gastric cancer [9], liver cancer [10], and pancreatic cancer [11] Most of these GI cancers are among the most common tumor entities worldwide and are associated with a comparatively high mortality [1], corroborating their high global relevance. We used a large outpatient database from Germany [12] to further dissect the association between pre-obesity and obesity and the risk of GI cancer development in male and female patients
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