Adiposity and gastrointestinal cancers: epidemiology, mechanisms and future directions

Excess adiposity is a risk factor for several cancers of the gastrointestinal system, specifically oesophageal adenocarcinoma and colorectal, small intestine, pancreatic, liver, gallbladder and stomach cancers. With the increasing prevalence of obesity in nearly all regions of the world, this relati...

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Published in:	Nature reviews. Gastroenterology & hepatology 2018-11, Vol.15 (11), p.659-670
Main Authors:	Murphy, Neil, Jenab, Mazda, Gunter, Marc J
Format:	Article
Language:	eng
Subjects:	Adenocarcinoma Adipose tissue Adipose tissues Adiposity - physiology Biomedical Research Cancer Complications and side effects Development and progression Digestive system Digestive tract Epidemiology Esophageal cancer Esophagus Fatty liver Forecasting Gallbladder Gastrointestinal cancer Gastrointestinal Neoplasms - epidemiology Gastrointestinal Neoplasms - etiology Gastrointestinal system Genetics Health aspects Health risk assessment Hormones Host-bacteria relationships Humans Insulin Intestinal microflora Liver Liver diseases Magnetic resonance imaging Medical prognosis Microbiomes Microbiota (Symbiotic organisms) Obesity Obesity - complications Obesity - epidemiology Obesity - physiopathology Oncology, Experimental Pancreas Risk factors Signal transduction Small intestine Stomach Stomach cancer
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Summary:	Excess adiposity is a risk factor for several cancers of the gastrointestinal system, specifically oesophageal adenocarcinoma and colorectal, small intestine, pancreatic, liver, gallbladder and stomach cancers. With the increasing prevalence of obesity in nearly all regions of the world, this relationship could represent a growing source of cancers of the digestive system. Experimental and molecular epidemiological studies indicate important roles for alterations in insulin signalling, adipose tissue-derived inflammation and sex hormone pathways in mediating the association between adiposity and gastrointestinal cancer. The intestinal microbiome, gut hormones and non alcoholic fatty liver disease (NAFLD) also have possible roles. However, important gaps remain in our knowledge. For instance, our understanding of how adiposity throughout the life course is related to the risk of gastrointestinal cancer development and of how obesity influences gastrointestinal cancer prognosis and survival is limited. Nonetheless, the increasing use of state-of-the-art analytical methods (such as omics technologies, Mendelian randomization and MRI) in large-scale epidemiological studies offers exciting opportunities to advance our understanding of the complex relationship between adiposity and gastrointestinal cancers. Here, we examine the epidemiology of associations between obesity and gastrointestinal cancer, explore potential mechanisms underlying these relationships and highlight important unanswered research questions.
ISSN:	1759-5045 1759-5053