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Dana N, Ferns GA, Nedaeinia R, Haghjooy Javanmard S. Leptin signaling in breast cancer and its crosstalk with peroxisome proliferator-activated receptors α and γ. Clin Transl Oncol 2023; 25:601-610. [PMID: 36348225 DOI: 10.1007/s12094-022-02988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
Obesity may create a mitogenic microenvironment that influences tumor initiation and progression. The obesity-associated adipokine, leptin regulates energy metabolism and has been implicated in cancer development. It has been shown that some cell types other than adipocytes can express leptin and leptin receptors in tumor microenvironments. It has been shown that peroxisome proliferator-activated receptors (PPAR) agonists can affect leptin levels and vice versa leptin can affect PPARs. Activation of PPARs affects the expression of several genes involved in aspects of lipid metabolism. In addition, PPARs regulate cancer cell progression through their action on the tumor cell proliferation, metabolism, and cellular environment. Some studies have shown an association between obesity and several types of cancer, including breast cancer. There is some evidence that suggests that there is crosstalk between PPARs and leptin during the development of breast cancer. Through a systematic review of previous studies, we have reviewed the published relevant articles regarding leptin signaling in breast cancer and its crosstalk with peroxisome proliferator-activated receptors α and γ.
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Affiliation(s)
- Nasim Dana
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PH, Sussex, UK
| | - Reza Nedaeinia
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Nutraceuticals as Supportive Therapeutic Agents in Diabetes and Pancreatic Ductal Adenocarcinoma: A Systematic Review. BIOLOGY 2023; 12:biology12020158. [PMID: 36829437 PMCID: PMC9953002 DOI: 10.3390/biology12020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
The correlation between pancreatic ductal adenocarcinoma (PDAC) and diabetes-related mechanisms support the hypothesis that early therapeutic strategies targeting diabetes can contribute to PDAC risk reduction and treatment improvement. A systematic review was conducted, using PubMed, Embase and Cochrane Library databases, to evaluate the current evidence from clinical studies qualitatively examining the efficacy of four natural products: Curcumin-Curcuma longa L.; Thymoquinone-Nigella sativa L.; Genistein-Glycine max L.; Ginkgo biloba L.; and a low-carbohydrate ketogenic diet in type 2 diabetes (T2D) and PDAC treatment. A total of 28 clinical studies were included, showing strong evidence of inter-study heterogeneity. Used as a monotherapy or in combination with chemo-radiotherapy, the studied substances did not significantly improve the treatment response of PDAC patients. However, pronounced therapeutic efficacy was confirmed in T2D. The natural products and low-carbohydrate ketogenic diet, combined with the standard drugs, have the potential to improve T2D treatment and thus potentially reduce the risk of cancer development and improve multiple biological parameters in PDAC patients.
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Pujia R, Tarsitano MG, Arturi F, De Lorenzo A, Lenzi A, Pujia A, Montalcini T. Advances in Phenotyping Obesity and in Its Dietary and Pharmacological Treatment: A Narrative Review. Front Nutr 2022; 9:804719. [PMID: 35242796 PMCID: PMC8885626 DOI: 10.3389/fnut.2022.804719] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022] Open
Abstract
In recent times, it has become evident that there are individuals who, from a metabolic point of view, are affected by obesity but have a normal body mass index. There are also metabolically healthy individuals with a high body mass index who are thus are considered as to be affected by obesity obese. Understanding that individuals with obesity are phenotypically heterogeneous is a relatively novel concept which, although present in the scientific literature, unfortunately has not yet had an impact in clinical practice. However, common dietary approaches are not effective in treating large numbers of obese patients with obesity. This narrative review, based on the material searched via PubMed and the Web of Science up to October 2021, proposes a downsizing of the role of the body mass index in identifying the individual with “true obesity” since it is only partially useful, and suggests a new approach which also integrates the body composition and assessment of metabolic parameters. This approach leads to personalized therapies that work best for each obesity phenotype in reducing the risk of non-communicable diseases.
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Affiliation(s)
- Roberta Pujia
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Antonino De Lorenzo
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, University La Sapienza, Rome, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
- *Correspondence: Tiziana Montalcini
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Fooken J, Vo LK. Exploring the macroeconomic and socioeconomic determinants of simultaneous over and undernutrition in Asia: An analysis of stunted child - overweight mother households. Soc Sci Med 2021; 269:113570. [DOI: 10.1016/j.socscimed.2020.113570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/24/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
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Sant'Anna MD, Carvalhal RF, Oliveira FDFBD, Zin WA, Lopes AJ, Lugon JR, Guimarães FS. Respiratory mechanics of patients with morbid obesity. ACTA ACUST UNITED AC 2019; 45:e20180311. [PMID: 31644708 PMCID: PMC8653979 DOI: 10.1590/1806-3713/e20180311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/16/2019] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the different components of the resistance of the respiratory system, respiratory muscle strength and to investigate the occurrence of expiratory flow limitation (EFL) in patients with morbid obesity (MO) when seated. METHODS The sample was composed of MO (BMI≥40 kg/m2) and non-obese individuals (NO) with a BMI between 18 and 30 kg/m2. The protocol consisted of the anthropometric assessment and the following measures of respiratory function: spirometry, maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and impulse oscillometry. The group comparison was performed using T-test for unpaired samples. The correlations were evaluated by the Pearson test with a significance level of 5%. RESULTS Fifty MO (age 40±10.4 years, 1.64±0.09 m, 138.8±33.6 kg and 50.7±8.9 kg/m2), and 30 NO (age 37.6±11.5 years, 1.67±0.09 m, 65.2±10.3 kg and 23.2±22 kg/m2) were evaluated. The MO showed higher values of total, peripheral, airways, tissue and central resistance when compared to the NO. No patient showed EFL. The waist circumference was associated with spirometric variables, MIP, and MEP. The waist-to-hip ratio was correlated to respiratory mechanics and spirometric variables, MIP, and MEP. CONCLUSION Morbidly obese patients with no obstructive spirometric pattern show increased total, airway, peripheral, and tissue respiratory system resistance when compared to nonobese. These individuals, however, do not present with expiratory flow limitation and reduced respiratory muscles strength.
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Affiliation(s)
- Mauricio de Sant'Anna
- Curso de Fisioterapia, Instituto Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Renata Ferreira Carvalhal
- Programa de cirurgia bariátrica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Walter Araújo Zin
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Agnaldo José Lopes
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro (RJ) Brasil
| | - Jocemir Ronaldo Lugon
- Departamento de Medicina Clínica/Nefrologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Fernando Silva Guimarães
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Mirzababaei A, Djafarian K, Mozafari H, Shab-Bidar S. The long-term prognosis of heart diseases for different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies. Endocrine 2019; 63:439-462. [PMID: 30671787 DOI: 10.1007/s12020-019-01840-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/03/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE This meta-analysis aimed to assess the association of different categories of weight and metabolic status with risk of heart diseases including myocardial infarction (MI), cardiovascular diseases (CVDs), and heart failure (HF). METHODS Data from relevant studies were identified systematically by searching PubMed and Scopus search engines up to 29 May 2018. Prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference. Pooled RRs and 95% CI were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity. RESULTS Overall, 21 studies (n = 778,401 participants) were eligible for the present meta-analysis. Generally, the risk of CVDs for all metabolic phenotypes in metabolically unhealthy obese increased compared with the MHNW group. A significant positive association between all metabolic phenotypes and the risk of HF was also observed expect for MHOW (RR = 1.10, 95% CI: 0.60-2.00, P = 0.76) and MHO phenotypes (RR = 0.96, 95% CI: 0.25-3.77, P = 0.95). Moreover, MUHO phenotype was associated with greater risk of MI compared with the MHNW phenotype (RR = 1.82, 95% CI: 1.50-2.22, P < 0.001, respectively). CONCLUSIONS Our findings showed that all metabolically unhealthy phenotypes in different categories of weight were associated with increased incident of CVDs/HF and MI. Furthermore, healthy overweight and obese subjects had increased risk of CVDs.
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Affiliation(s)
- Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Student's Scientific Research Center, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hadis Mozafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Bao B, Prasad AS. Targeting CSC in a Most Aggressive Subtype of Breast Cancer TNBC. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:311-334. [DOI: 10.1007/978-3-030-20301-6_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Eibl G, Cruz-Monserrate Z, Korc M, Petrov MS, Goodarzi MO, Fisher WE, Habtezion A, Lugea A, Pandol SJ, Hart PA, Andersen DK. Diabetes Mellitus and Obesity as Risk Factors for Pancreatic Cancer. J Acad Nutr Diet 2018; 118:555-567. [PMID: 28919082 PMCID: PMC5845842 DOI: 10.1016/j.jand.2017.07.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest types of cancer. The worldwide estimates of its incidence and mortality in the general population are eight cases per 100,000 person-years and seven deaths per 100,000 person-years, and they are significantly higher in the United States than in the rest of the world. The incidence of this disease in the United States is more than 50,000 new cases in 2017. Indeed, total deaths due to PDAC are projected to increase dramatically to become the second leading cause of cancer-related deaths before 2030. Considering the failure to date to efficiently treat existing PDAC, increased effort should be undertaken to prevent this disease. A better understanding of the risk factors leading to PDAC development is of utmost importance to identify and formulate preventive strategies. Large epidemiologic and cohort studies have identified risk factors for the development of PDAC, including obesity and type 2 diabetes mellitus. This review highlights the current knowledge of obesity and type 2 diabetes as risk factors for PDAC development and progression, their interplay and underlying mechanisms, and the relation to diet. Research gaps and opportunities to address this deadly disease are also outlined.
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Fu SP, Hong H, Lu SF, Hu CJ, Xu HX, Li Q, Yu ML, Ou C, Meng JZ, Wang TL, Hennighausen L, Zhu BM. Genome-wide regulation of electro-acupuncture on the neural Stat5-loss-induced obese mice. PLoS One 2017; 12:e0181948. [PMID: 28806763 PMCID: PMC5555711 DOI: 10.1371/journal.pone.0181948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 07/10/2017] [Indexed: 02/05/2023] Open
Abstract
Acupuncture is reported to be effective in treating obesity related illnesses, but its mechanism is still unclear. To investigate this mechanism we applied electro-acupuncture (EA) in a mouse model of obesity and used RNA-seq to identify molecular consequences. Deletion of the transcription factor STAT5 from neurons (Stat5NKO) led to obesity. Acupuncture, in turn, reduced body weight and the ratio of epididymal white adipose tissue (Epi-WAT) to body weight, and it also decreased plasma concentrations of glucose, triglyceride, and cholesterol. In addition, EA increased cold endurance of Stat5NKO obese mice. EA reversed altered gene expressions in the hypothalamus and Epi-WAT, especially in the hypothalamus in Stat5NKO obese mice. This study provides, for the first time, insight into genomic networks of obesity and their modulation by electro-acupuncture, which in turn reveals potential mechanisms that explain acupuncture-induced weight-loss.
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Affiliation(s)
- Shu-Ping Fu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Hong
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Sheng-Feng Lu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen-Jun Hu
- School of Information Technology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hou-Xi Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian Li
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mei-Ling Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Ou
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian-Zhong Meng
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tian-Lin Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lothar Hennighausen
- Laboratory of Genetics and Physiology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Bing-Mei Zhu
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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Frič P, Šedo A, Škrha J, Bušek P, Laclav M, Škrha P, Zavoral M. Early detection of sporadic pancreatic cancer: time for change. Eur J Gastroenterol Hepatol 2017; 29:885-891. [PMID: 28471824 DOI: 10.1097/meg.0000000000000904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Sporadic pancreatic cancer amounts to ∼90% of all pancreatic cancers. It is a gloomy depressive disease and the most recalcitrant malignancy, with a very low 5-year survival (3-6%). At present, diagnostic methods are commonly applied, as used half a century ago, after the appearance of local and systemic symptoms (abdominal and back pain, cholestasis, painless jaundice, fatigue, anorexia, weight loss, anemia, peripheral phlebitis, and cachexia). Unfortunately, these symptoms are harbingers of an advanced disease. The subsequent imaging methods may offer additional information on the location, size, and morphology of the lesion, but they do not influence the prognosis. Radical surgery may be offered to 15-20% of patients. The relapses after surgery are frequent and chemotherapy may be palliative. Preventive programs represent the only possibility of improvement. We propose the first multistep and multidisciplinary preventive program for early detection of sporadic pancreatic cancer for the differential identification of average-risk patients who probably have the disease from those who do not.
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Affiliation(s)
- Přemysl Frič
- aDepartment of Medicine/Gastroenterology, Military University Hospital bInstitute of Biochemistry and Experimental Oncology cLaboratory of Endocrinology and Metabolism, General University Hospital, First Faculty of Medicine dSecond Department of Medicine, University Hospital, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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12
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Gathirua-Mwangi WG, Monahan PO, Murage MJ, Zhang J. Metabolic syndrome and total cancer mortality in the Third National Health and Nutrition Examination Survey. Cancer Causes Control 2017; 28:127-136. [PMID: 28097473 DOI: 10.1007/s10552-016-0843-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/20/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Although metabolic syndrome incidence has substantially increased during the last few decades, it largely remains unclear whether this metabolic disorder is associated with total cancer mortality. The present study was carried out to investigate this important question. METHODS A total of 687 cancer deaths were identified from 14,916 participants in the third National Health and Nutrition Examination Survey by linking them to the National Death Index database through December 31, 2006. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to metabolic syndrome and its individual components. RESULTS After adjustment for confounders, a diagnosis of metabolic syndrome was associated with 33% elevated total cancer mortality. Compared with individuals without metabolic syndrome, those with 3, 4 and 5 abnormal components had HRs (95% CIs) of 1.28 (1.03-1.59), 1.24 (0.96-1.60), and 1.87 (1.34-2.63), respectively (p-trend = 0.0003). Systolic blood pressure and serum glucose were associated with an increased risk of death from total cancer [HR (95% CI) for highest vs. lowest quartiles: 1.67 (1.19-2.33), p-trend = 0.002 and 1.34 (1.04-1.74), p-trend = 0.003, respectively]. Overall null results were obtained for lung cancer mortality. The effects of metabolic syndrome and its components on non-lung cancer mortality were generally similar to, but somewhat larger than, those for total cancer mortality. CONCLUSION Our study is among the first to reveal that metabolic syndrome is associated with increased total cancer mortality.
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Affiliation(s)
- Wambui G Gathirua-Mwangi
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA
| | - Patrick O Monahan
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mwangi J Murage
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA
| | - Jianjun Zhang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA. .,Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
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Early pancreatic carcinogenesis - risk factors, early symptoms, and the impact of antidiabetic drugs. Eur J Gastroenterol Hepatol 2016; 28:e19-25. [PMID: 27120389 DOI: 10.1097/meg.0000000000000646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Risk factors (long-term diabetes, obesity) and early symptoms (new-onset diabetes, loss of weight, or persistent low body mass) are the initial symptoms of pancreatic carcinogenesis. They may be influenced by antidiabetic drugs and their correct evaluation is a prerequisite for early diagnosis of pancreatic cancer (PC). We review the risk factors, early symptoms, and the impact of antidiabetic drugs on early pancreatic carcinogenesis. The main source of data was the database Medline/PubMed and abstracts of international congresses (DDW, UEGW). The risk factors and early symptoms are integral components of the familial PC surveillance and sporadic PC screening. Preventive programs should always be include multistep and multidisciplinary procedures. The correct evaluation of antidiabetic drugs and their interactions with other components of pancreatic carcinogenesis may influence the early diagnosis of PC.
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Hossin MZ. From habitual sleep hours to morbidity and mortality: existing evidence, potential mechanisms, and future agenda. Sleep Health 2016; 2:146-153. [PMID: 28923258 DOI: 10.1016/j.sleh.2016.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
Epidemiological studies consistently show a strong U-shaped association between sleep duration and health outcomes. That is, both short and long sleepers are exposed to greater risks of death and diseases than normal length sleepers. Moreover, long sleep is often demonstrated as a stronger predictor of mortality than short sleep. While there is some experimental evidence in favor of a causal connection between short sleep and health, no such evidence exists to explain why excessive sleep might be associated with poor health. One possible explanation is that long duration sleep, instead of being a real cause of illness, is merely a marker of poor sleep quality or some unmeasured risk factor that confounds the association of long habitual sleep with mortality and other health outcomes. As for short sleep, the effect is said to be mediated via the hormones that alters glucose metabolism and appetite regulation as well as via an overactivity of the stress systems that causes increased heart rate and blood pressure. The mechanisms, however, are still poorly understood and future investigations should take into account sleep quality, objective and longitudinal sleep measures, more confounding biases, and the broad social context that influences the length and quality of sleep.
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Sant Anna Junior MD, Carneiro JRI, Carvalhal RF, Torres DDFM, Cruz GGD, Quaresma JCDV, Lugon JR, Guimarães FS. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity. Arq Bras Cardiol 2015; 105:580-7. [PMID: 26536979 PMCID: PMC4693662 DOI: 10.5935/abc.20150125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022] Open
Abstract
Background Morbid obesity is directly related to deterioration in cardiorespiratory capacity,
including changes in cardiovascular autonomic modulation. Objective This study aimed to assess the cardiovascular autonomic function in morbidly obese
individuals. Methods Cross-sectional study, including two groups of participants: Group I, composed by
50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The
autonomic function was assessed by heart rate variability in the time domain
(standard deviation of all normal RR intervals [SDNN]; standard deviation of the
normal R-R intervals [SDNN]; square root of the mean squared differences of
successive R-R intervals [RMSSD]; and the percentage of interval differences of
successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent
interval), and in the frequency domain (high frequency [HF]; low frequency [LF]:
integration of power spectral density function in high frequency and low frequency
ranges respectively). Between-group comparisons were performed by the Student’s
t-test, with a level of significance of 5%. Results Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ±
27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p =
0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF
(30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean
LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p =
0.0189), indicating changes in the sympathovagal balance. No statistical
difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz
vs. 40.9 ± 23.9 Hz; p = 0.9013). Conclusion morbidly obese individuals have increased sympathetic activity and reduced
parasympathetic activity, featuring cardiovascular autonomic dysfunction.
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Affiliation(s)
- Maurício de Sant Anna Junior
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - João Regis Ivar Carneiro
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renata Ferreira Carvalhal
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diego de Faria Magalhães Torres
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Gustavo Gavina da Cruz
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Carlos do Vale Quaresma
- Programa de Tratamento Multidisciplinar da Obesidade, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jocemir Ronaldo Lugon
- Divisão de Nefrologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Fernando Silva Guimarães
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Klingberg S, Mehlig K, Lanfer A, Björkelund C, Heitmann BL, Lissner L. Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women. Obesity (Silver Spring) 2015; 23:2123-30. [PMID: 26337249 DOI: 10.1002/oby.21203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/03/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Despite solid evidence of an association between centralized body fatness and subsequent disease risk, little is known about the consequences of changes in body fat distribution. Recently it was shown that large hip circumference (HC), measured once, was protective against total and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample. METHODS Baseline WC and 6-year change in WC as predictors of mortality and CVD were analyzed in 2,492 women from the Danish MONICA study and the Prospective Population Study of Women in Gothenburg, Sweden. RESULTS Increase in WC was significantly associated with increased subsequent mortality and CVD adjusting for BMI and other covariates, with some evidence of a J-shaped association. Associations between increase in WC and outcomes were restricted to women with normal weight at baseline and to ever-smokers. CONCLUSIONS In contrast to changes in HC which did not predict mortality and CVD, a 6-year increase in WC is strongly predictive, particularly among initially lean women and ever-smokers. This implies the importance of developing strategies to prevent central fat deposition.
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Affiliation(s)
- Sofia Klingberg
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lanfer
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine, Section for Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Berit L Heitmann
- Research Unit for Dietary Studies, the Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Fredriksberg Hospitals, the Capital Region, Denmark
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Fowler SPG, Williams K, Hazuda HP. Diet soda intake is associated with long-term increases in waist circumference in a biethnic cohort of older adults: the San Antonio Longitudinal Study of Aging. J Am Geriatr Soc 2015; 63:708-15. [PMID: 25780952 DOI: 10.1111/jgs.13376] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the relationship between diet soda (DS) intake (DSI) and long-term waist circumference (WC) change (ΔWC) in the biethnic San Antonio Longitudinal Study of Aging (SALSA). DESIGN Prospective cohort study. SETTING San Antonio, Texas, neighborhoods. PARTICIPANTS SALSA examined 749 Mexican-American and European-American individuals aged 65 and older at baseline (baseline, 1992-96); 474 (79.1%) survivors completed follow-up 1 (FU1, 2000-01), 413 (73.4%) completed FU2 (2001-03), and 375 (71.0%) completed FU3 (2003-04). Participants completed a mean of 2.64 follow-up intervals, for 9.4 total follow-up years. MEASUREMENTS DSI, WC, height, and weight were measured at outset and at the conclusion of each interval: baseline, FU1, FU2, and FU3. RESULTS Adjusted for initial WC, demographic characteristics, physical activity, diabetes mellitus, and smoking, mean interval ΔWC of DS users (2.11 cm, 95% confidence interval (CI) = 1.45-2.76 cm) was almost triple that of nonusers (0.77 cm, 95% CI = 0.29-1.23 cm) (P < .001). Adjusted interval ΔWCs were 0.77 cm (95% CI = 0.29-1.23 cm) for nonusers, 1.76 cm (95% CI = 0.96-2.57 cm) for occasional users, and 3.04 cm (95% CI = 1.82-4.26 cm) for daily users (P = .002 for trend). This translates to ΔWCs of 0.80 inches for nonusers, 1.83 inches for occasional users, and 3.16 for daily users over the total SALSA follow-up. In subanalyses stratified for selected covariates, ΔWC point estimates were consistently higher in DS users. CONCLUSION In a striking dose-response relationship, increasing DSI was associated with escalating abdominal obesity, a potential pathway for cardiometabolic risk in this aging population.
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Affiliation(s)
- Sharon P G Fowler
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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18
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The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women. Br J Nutr 2015; 113:849-58. [PMID: 25690300 DOI: 10.1017/s0007114515000070] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population.
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Karvinen KH, Carr LJ, Stevinson C. Resources for physical activity in cancer centers in the United States. Clin J Oncol Nurs 2015; 17:E71-6. [PMID: 24305494 DOI: 10.1188/13.cjon.e71-e76] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physical activity (PA) has many benefits for cancer survivors. However, the available PA resources for survivors at cancer centers throughout the United States are undocumented. The current study surveyed major cancer centers concerning the availability and types (e.g., facilities, programs, counseling, information resources) of PA resources available. Of supportive care services, PA resources were the least commonly reported. Significant correlations were found among availability of PA resources and other supportive care services. Although many cancer centers reported offering PA programming, formal and informal PA guidance and support seem to fall on oncology nurses and other clinicians. Oncology nurses should be reminded that they may be one of the only sources of PA guidance available to survivors at cancer centers.
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Affiliation(s)
- Kristina H Karvinen
- School of Physical and Health Education, Nipissing University in North Bay, Ontario, Canada
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20
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Sun W, Huang Y, Wang Z, Yu Y, Lau A, Ali G, Huang P, Geng Y, Xu T, Shan G. Sleep duration associated with body mass index among Chinese adults. Sleep Med 2015; 16:612-6. [PMID: 25862120 DOI: 10.1016/j.sleep.2014.12.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/14/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the relationship between sleep duration and obesity among Chinese adults. METHODS A community-based cross-sectional study was conducted among Chinese adults in 2008. In total, 3225 participants were selected by a multistage cluster sampling method. Self-reported sleep duration was measured by a standardized questionnaire. Logistic regression models were used to estimate the odds ratios (ORs) (95% confidence intervals, CIs) of obesity with sleep duration, separated by gender, and adjusted for age, education, occupation, marriage, smoking, drinking, body pain, and health status. RESULTS The mean sleep duration was 7.8 h. Among the 2962 participants, 7.2% had short sleep duration (≤6 h/day). There were 171 obese participants (5.7%) in this population. After adjustment for age, short sleep duration (<6 h) was significantly associated with obesity among men (OR: 2.15; 95% CI: 1.193.90), but not among women; additional adjustment for potential confounders did not attenuate the association among men. Increasing sleep duration (a continuous variable) was significantly and negatively associated with obesity in women after adjustment for education level, occupation, marital status, smoking, drinking, body pain, and health status. The adjusted OR per-hour increase in sleep duration was 0.74 (0.56-0.97) for obesity, suggesting that for a 1-h increase in sleep duration among women, obesity risk decreased by 26%. CONCLUSION Short sleep duration was associated with increasing obesity in Chinese men, and sleep duration was associated with obesity in Chinese women, although the underlying mechanism is unclear. This possible gender difference warrants further studies.
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Affiliation(s)
- Wenjie Sun
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, Guangdong, China; Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yuee Huang
- Department of Preventive Medicine, School of Public Health, Wannan Medical College, Wu Hu, Anhui, China; Laboratory for Environment and Health, School of Earth and Environment, Anhui University of Science and Technology, Huainan, Anhui, China
| | - Zengzhen Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqin Yu
- Department of Epidemiology, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Abby Lau
- Department of Infectious Diseases, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Gholam Ali
- Heart and Vascular Institute, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Ping Huang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yunlong Geng
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
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21
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Jiang N, Sun R, Sun Q. Leptin signaling molecular actions and drug target in hepatocellular carcinoma. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2295-302. [PMID: 25484575 PMCID: PMC4238752 DOI: 10.2147/dddt.s69004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Previous reports indicate that over 13 different tumors, including hepatocellular carcinoma (HCC), are related to obesity. Obesity-associated inflammatory, metabolic, and endocrine mediators, as well as the functioning of the gut microbiota, are suspected to contribute to tumorigenesis. In obese people, proinflammatory cytokines/chemokines including tumor necrosis factor-alpha, interleukin (IL)-1 and IL-6, insulin and insulin-like growth factors, adipokines, plasminogen activator inhibitor-1, adiponectin, and leptin are found to play crucial roles in the initiation and development of cancer. The cytokines induced by leptin in adipose tissue or tumor cells have been intensely studied. Leptin-induced signaling pathways are critical for biological functions such as adiposity, energy balance, endocrine function, immune reaction, and angiogenesis as well as oncogenesis. Leptin is an activator of cell proliferation and anti-apoptosis in several cell types, and an inducer of cancer stem cells; its critical roles in tumorigenesis are based on its oncogenic, mitogenic, proinflammatory, and pro-angiogenic actions. This review provides an update of the pathological effects of leptin signaling with special emphasis on potential molecular mechanisms and therapeutic targeting, which could potentially be used in future clinical settings. In addition, leptin-induced angiogenic ability and molecular mechanisms in HCC are discussed. The stringent binding affinity of leptin and its receptor Ob-R, as well as the highly upregulated expression of both leptin and Ob-R in cancer cells compared to normal cells, makes leptin an ideal drug target for the prevention and treatment of HCC, especially in obese patients.
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Affiliation(s)
- Nan Jiang
- Shandong University School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Rongtong Sun
- Weihai Municipal Hospital, Weihai, Shandong Province, People's Republic of China
| | - Qing Sun
- Department of Pathology, QianFoShan Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China
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22
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Zhou W, Tian Y, Gong H, Guo S, Luo C. Oncogenic role and therapeutic target of leptin signaling in colorectal cancer. Expert Opin Ther Targets 2014; 18:961-71. [PMID: 24946986 DOI: 10.1517/14728222.2014.926889] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Obesity is characterized by high secretion of several cytokines from adipose tissue and is a recognized risk factor for many cancers. Among these cytokines, leptin mainly produced by adipose tissue and cancer cells is the most studied adipokine. Leptin is an activator of cell proliferation, an antiapoptotic molecule and inducer of cancer stem cells in many cell types, and its critical roles in obesity-related tumorigenesis are based on its oncogenic, mitogenic, pro-inflammatory and pro-angiogenic actions. AREAS COVERED These leptin-induced signals and action are critical for their biological effects on energy balance, adiposity, endocrine systems, immunity, angiogenesis as well as oncogenesis. This review focuses on the up-to-date knowledge on the oncogenic role of leptin signaling, clinical significance and specific drug target development in colorectal cancer (CRC). Additionally, leptin-induced angiogenic ability and molecular mechanisms in CRC cells are discussed. EXPERT OPINION Stringent binding affinity of leptin/Ob-R and overexpression of leptin/Ob-R and their targets in cancer cells make it a unique drug target for prevention and treatment of CRC, particularly in obesity colorectal patients.
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Affiliation(s)
- Weiqiang Zhou
- Shenyang Medical College, Key Laboratory of Environmental Pollution and Microecology of Liaoning Province , No.146 North Huanghe St, Huanggu Dis, Shenyang City, Liaoning Pro 110034 , PR China
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23
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Stanstrup J, Schou SS, Holmer-Jensen J, Hermansen K, Dragsted LO. Whey protein delays gastric emptying and suppresses plasma fatty acids and their metabolites compared to casein, gluten, and fish protein. J Proteome Res 2014; 13:2396-408. [PMID: 24708224 DOI: 10.1021/pr401214w] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Whey protein has been demonstrated to improve fasting lipid and insulin response in overweight and obese individuals. To establish new hypotheses for this effect and to investigate the impact of stomach emptying, we compared plasma profiles after intake of whey isolate (WI), casein, gluten (GLU), and cod (COD). Obese, nondiabetic subjects were included in the randomized, blinded, crossover meal study. Subjects ingested a high fat meal containing one of the four protein sources. Plasma samples were collected at five time points and metabolites analyzed using LC-Q-TOF-MS. In contrast to previous studies, the WI meal caused a decreased rate of gastric emptying compared to the other test meals. The WI meal also caused elevated levels of a number of amino acids, possibly stimulating insulin release leading to reduced plasma glucose. The WI meal also caused decreased levels of a number of fatty acids, while the GLU meal caused elevated levels of a number of unidentified hydroxy fatty acids and dicarboxylic fatty acids. Also reported are a number of markers of fish intake unique to the COD meal.
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Affiliation(s)
- Jan Stanstrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen , Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark
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24
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Ghaem Maralani H, Tai BC, Wong TY, Tai ES, Li J, Wang JJ, Mitchell P. The prognostic role of body mass index on mortality amongst the middle-aged and elderly: a competing risk analysis. Diabetes Res Clin Pract 2014; 103:42-50. [PMID: 24382466 DOI: 10.1016/j.diabres.2013.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/25/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
AIMS To determine the relationship between body mass index (BMI) including its 5-year changes and mortality, and compare the results obtained using Cox and competing risks models. METHODS Our study subjects included 2216 persons aged ≥49 years who participated in the Blue Mountains Eye Study, Australia between 1992 and 1994, and returned for further follow-up examinations between 1997 and 1999. We examined the relationship between BMI and mortality using cubic spline. The Cox and competing risks models were used to assess the associations between baseline BMI and its 5-year changes with all-cause and cause-specific mortality. RESULTS Amongst subjects aged ≤70 years, the relationship between BMI and all-cause mortality was U-shaped. For those aged >70 years, an L-shaped relationship was seen with no elevation in risk amongst the overweight/obese. Based on the competing risks model, obesity at baseline was associated with increased risk of cardiovascular death and reduction in BMI at 5-year was linked to an increase risk of cancer death amongst those aged ≤70 years. The cause-specific Cox model showed that reduction in BMI at 5-year was associated with cancer-death regardless of age, and with cardiovascular deaths among subjects aged ≤70 years. Cox regression model showed larger magnitude of effect with wider confidence interval as compared with competing risks model. CONCLUSIONS Conditions associated with obesity are more likely to affect mortality among subjects aged ≤70 years, but not among those aged over 70 years. Cox model shows larger magnitude of effect in comparison with competing risks model.
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Affiliation(s)
- Haleh Ghaem Maralani
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jialiang Li
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Jie Jin Wang
- Centre for Vision Research, University of Sydney, Sydney, Australia; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Paul Mitchell
- Centre for Vision Research, University of Sydney, Sydney, Australia
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25
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Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML. Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative. Cancer Prev Res (Phila) 2014; 7:42-53. [PMID: 24403289 PMCID: PMC4090781 DOI: 10.1158/1940-6207.capr-13-0258] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0-8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75-0.92], 22% lower risk of breast cancer (HR, 0.78; 95% CI, 0.67-0.92), 52% lower risk of colorectal cancer (HR, 0.48; 95% CI, 0.32-0.73), 27% lower risk of all-cause mortality, and 20% lower risk of cancer-specific mortality (HR, 0.80; 95% CI, 0.71-0.90). Associations with lower cancer incidence and mortality were generally strongest among Asian, black, and Hispanic women and weakest among non-Hispanic whites. Behaviors concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women.
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Affiliation(s)
- Cynthia A Thomson
- Health Promotion Sciences, Canyon Ranch Center for Prevention & Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Street, Tucson, AZ 85721.
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26
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Shao F, Li J, Ma S, Lee MLT. Semiparametric varying-coefficient model for interval censored data with a cured proportion. Stat Med 2013; 33:1700-12. [DOI: 10.1002/sim.6054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 10/27/2013] [Accepted: 11/06/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Fang Shao
- National University of Singapore; Lower Kent Ridge Road Singapore
| | - Jialiang Li
- National University of Singapore; Lower Kent Ridge Road Singapore
- Duke-NUS Graduate Medical School; 8 College Road Singapore
- Singapore Eye Research Institute; 11 Third Hospital Avenue Singapore
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Abstract
PURPOSE OF REVIEW The association of diabetes and cancer has received increased attention as data have emerged to indicate that the type of diabetes treatment may influence the risk of cancer, and that the risk of cancer among diabetic individuals can be reduced by intervention. The association of diabetes and pancreatic cancer is particularly strong, but often misunderstood. Long-standing type 1 diabetes and type 2 diabetes increase the risk for this malignancy, but the cancer can also induce pancreatogenic, or type 3c, diabetes as well. RECENT FINDINGS This review covers the recent findings which help to clarify these relationships, and offers guidance for prevention, early detection, and treatment. Obesity and, separately, diabetes increase the risk of several common malignancies by about two-fold. This risk is reduced by successful treatments. Type 3c diabetes is more common than previously realized, and strategies to differentiate type 3c diabetes from type 2 diabetes, to identify those candidates who will benefit from screening studies, are discussed. SUMMARY The death rate because of pancreatic and other cancers can be reduced by an aggressive approach to reversing obesity and hyperinsulinemia, achieving good glycemic control in diabetic patients, and identifying at an early timepoint those patients with pancreatogenic diabetes.
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MESH Headings
- Blood Glucose/metabolism
- Carcinoma, Pancreatic Ductal/blood
- Carcinoma, Pancreatic Ductal/etiology
- Carcinoma, Pancreatic Ductal/pathology
- Cell Transformation, Neoplastic
- Diabetes Complications/blood
- Diabetes Complications/pathology
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/pathology
- Early Detection of Cancer
- Female
- Humans
- Hyperinsulinism/blood
- Hyperinsulinism/complications
- Hypoglycemic Agents/adverse effects
- Male
- Metformin/administration & dosage
- Metformin/adverse effects
- Obesity/blood
- Obesity/complications
- Obesity/pathology
- Pancreatic Neoplasms/blood
- Pancreatic Neoplasms/etiology
- Pancreatic Neoplasms/pathology
- Peptides/blood
- Risk Factors
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Affiliation(s)
- Dana K Andersen
- Clinical Studies Program, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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Fagherazzi G, Vilier A, Balkau B, Clavel-Chapelon F, Magliano DJ. Anthropometrics, body shape over 12 years and risk of cancer events in pre- and post-menopausal women. Int J Cancer 2013; 133:740-8. [PMID: 23364907 DOI: 10.1002/ijc.28069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/14/2013] [Indexed: 01/04/2023]
Abstract
Studies of anthropometry and cancer have focused on body mass index (BMI). Relations between weight, waist (WC) and hip circumferences (HC), birth length and adult height with cancer are less well studied. Women from the French E3N study, born between 1925 and 1950, were followed biennially from 1995 until 2008. Body shape was classed into four groups based on median WC and HC at baseline. Hazard ratios (HRs) were estimated by Cox proportional hazards regression models. Over the 12 years of follow-up, 7,247 of 63,798 women developed cancer. As WC increased, we found a trend for decreasing cancer risk in pre-menopausal women, which reversed to an increasing risk in post-menopausal women. This remained unchanged after further adjustment for HC /or height [HR: 0.72 (0.52-1.00) before menopause and 1.17 (1.04-1.31) in the 5th vs. 1st quintile of HC], and were similar after exclusion of breast cancer. We showed that large body shape decreased cancer risk before menopause and increased it after [HR: 0.87 (0.73-1.02) and 1.11 (1.04-1.17), respectively, in women with large waist and hips compared to small waist and hips]. Adult height was associated with an non-significant increase in cancer in pre-menopause and a significant cancer risk in menopause, independent of other anthropometric characteristics [5th vs. 1st quintile [HR: 1.24 (0.98-1.56) and 1.20 (1.10-1.30)], respectively as was long birth length in post-menopausal women [HR: 1.18 (1.07-1.30) compared to medium birth length]. These results suggest independent roles of height and WC on cancer risk, through different pathways.
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Affiliation(s)
- Guy Fagherazzi
- Inserm, Centre for research in Epidemiology and Population Health (CESP), CESP U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France
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Menez S, Cheskin L, Geller G. Perspectives on obesity and its treatment: health care providers and the general public in rural West Virginia and urban Baltimore. HEALTH EDUCATION & BEHAVIOR 2013; 40:663-72. [PMID: 23341478 DOI: 10.1177/1090198112473101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine and compare the perspectives of the general public and health care providers (HCPs) on obesity and its treatment in rural West Virginia (WV) and Baltimore, MD. METHOD Surveys were completed in both locations by the general public (WV: n = 200; Baltimore: n = 171) and HCPs (WV: n = 25; Baltimore: n = 15). RESULTS BMI (body mass index) ≥ 30 (WV: n = 94; Baltimore: n = 58) was associated with a stronger belief in the heritability of obesity and with the ability to control obesity by controlling food cost, compared with those with normal BMI (WV: n = 42; Baltimore: n = 57). Those with a high school education (WV: n = 112; Baltimore: n = 113) were less likely to agree that obesity is a problem in the community and that proper diet and exercise are realistic expectations, compared with those with at least some higher education. Perspectives of HCPs differed significantly from the general public in both locations. CONCLUSION Many differences in perspective on obesity exist between WV and Baltimore, within both populations, and between HCPs and the general public in both settings. A better understanding of patient views is important for effective obesity management. HCPs must consider each patient's level of understanding when discussing management and consequences of obesity. More time spent with patients who have less insight into their obesity may improve patient adherence with treatment and overall patient outcomes.
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Affiliation(s)
- Steven Menez
- 1Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Anthropometric characteristics and risk of lymphoid and myeloid leukemia in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 2013; 24:427-38. [PMID: 23288400 DOI: 10.1007/s10552-012-0128-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Holmer-Jensen J, Mortensen LS, Astrup A, de Vrese M, Holst JJ, Thomsen C, Hermansen K. Acute differential effects of dietary protein quality on postprandial lipemia in obese non-diabetic subjects. Nutr Res 2013; 33:34-40. [DOI: 10.1016/j.nutres.2012.11.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/28/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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Abstract
Epidemiological studies clearly indicate that the risk of pancreatic cancer (PC) is increased in diabetic patients, but most studies focus on overall diabetes or type 2 diabetes mellitus (T2DM), and there are few studies on the risks of type 1 and type 3c (secondary) diabetes. Possible mechanisms for increased cancer risk in diabetes include cellular proliferative effects of hyperglycemia, hyperinsulinemia, and abnormalities in insulin/IGF receptor pathways. Recently, insulin and insulin secretagogues have been observed to increase the PC risk, while metformin treatment reduces the cancer risk in diabetic subjects. In addition, anticancer drugs used to treat PC may either cause diabetes or worsen coexisting diabetes. T3cDM has emerged as a major subset of diabetes and may have the highest risk of pancreatic carcinoma especially in patients with chronic pancreatitis. T3cDM is also a consequence of PC in at least 30% of patients. Distinguishing T3cDM from the more prevalent T2DM among new-onset diabetic patients can be aided by an assessment of clinical features and confirmed by finding a deficiency in postprandial pancreatic polypeptide release. In conclusion, diabetes and PC have a complex relationship that requires more clinical attention. The risk of developing PC can be reduced by aggressive prevention and treatment of T2DM and obesity and the prompt diagnosis of T3cDM may allow detection of a tumor at a potentially curable stage.
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Affiliation(s)
- YunFeng Cui
- Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tseng CH. Obesity paradox: differential effects on cancer and noncancer mortality in patients with type 2 diabetes mellitus. Atherosclerosis 2012; 226:186-92. [PMID: 23040832 DOI: 10.1016/j.atherosclerosis.2012.09.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/19/2012] [Accepted: 09/05/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate associations between body mass index (BMI) and cause-specific mortality in patients with type 2 diabetes mellitus (T2DM). METHODS Prospective follow-up of a nationally representative cohort of 89,056 Taiwanese patients with T2DM recruited since 1995. Vital status was matched with the National Death Certificate Database until the end of 2006. Self-reported body weight and height were used to calculate BMI, which was treated either as a continuous or categorical variable (underweight, <18.5; normal, 18.5-22.9; overweight, 23.0-24.9; obesity I, 25.0-29.9; and obesity II, ≥30.0 kg/m(2)). Causes of death were classified as all-cause, cancer, diabetes complications (macrovascular and microvascular), and other. Cox regression was used to estimate the hazard ratios. RESULTS A total of 26,951 patients (30.3% of the cohort) died during follow-up (cancer 5.4%, diabetes complications 17.4%, and other causes 7.5%). As a continuous variable, BMI was inversely associated with mortality from all-cause, cancer, diabetes complications, and other causes, with respective adjusted hazard ratios (95% confidence intervals) of 0.942 (0.939-0.946), 0.966 (0.958-0.975), 0.935 (0.930-0.939), and 0.942 (0.935-0.949). Compared to normal weight, underweight was significantly predictive for any of causes of death, while overweight, obesity I, and obesity II were all significantly associated with mortality in an inverse pattern. After excluding patients with a follow-up duration <2 years, most BMI categories were not significantly predictive of mortality from cancer, suggesting a potential bias of cancer-induced weight loss. CONCLUSIONS The obesity paradox, mainly observed in noncancer mortality, exists in patients with T2DM, suggesting a survival advantage in obese diabetic patients.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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Shay CM, Van Horn L, Stamler J, Dyer AR, Brown IJ, Chan Q, Miura K, Zhao L, Okuda N, Daviglus ML, Elliott P. Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Am J Clin Nutr 2012; 96:483-91. [PMID: 22854407 PMCID: PMC3417211 DOI: 10.3945/ajcn.111.025056] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Clinical trial data show that reduction in total energy intake enhances weight loss regardless of the macronutrient composition of the diet. Few studies have documented dietary patterns or nutrient intakes that favor leanness [BMI (in kg/m²) ≤25] in free-living populations. OBJECTIVE This investigation examined associations of usual energy, food, and nutrient intakes with BMI among US participants of the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). DESIGN The INTERMAP is an international cross-sectional study of dietary factors and blood pressure in men and women (ages 40-59 y) that includes 8 US population samples. The present study included data from 1794 Americans who were not consuming a special diet and who provided four 24-h dietary recalls and 2 timed 24-h urine collections. Multivariable linear regression with the residual method was used to adjust for energy intake; sex-specific associations were assessed for dietary intakes and urinary excretions with BMI adjusted for potential confounders including physical activity. RESULTS Lower energy intake was associated with lower BMI in both sexes. Univariately, higher intakes of fresh fruit, pasta, and rice and lower intakes of meat were associated with lower BMI; these associations were attenuated in multivariable analyses. Lower urinary sodium and intakes of total and animal protein, dietary cholesterol, saturated fats, and heme iron and higher urinary potassium and intakes of carbohydrates, dietary fiber, and magnesium were associated with lower BMI in both sexes. CONCLUSION The consumption of foods higher in nutrient-dense carbohydrate and lower in animal protein and saturated fat is associated with lower total energy intakes, more favorable micronutrient intakes, and lower BMI.
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Affiliation(s)
- Christina M Shay
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Soriano R, Ponce de León Rosales S, García R, García-García E, Méndez JP. High knowledge about obesity and its health risks, with the exception of cancer, among Mexican individuals. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:306-311. [PMID: 22160851 DOI: 10.1007/s13187-011-0298-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mexico has the second biggest prevalence in the world of obese adults (30%). We conducted a survey to determine knowledge concerning obesity co-morbidities. Three groups were surveyed with a questionnaire divided into three sections: demographic characteristics; knowledge and awareness in relation to obesity being a disease; causes of obesity and the health risks it represents; weight auto-perception and the subject's personal experiences regarding weight. In all groups we found high knowledge regarding that obesity is a disease and the causes of its development, as well as that it greatly increases the risk of presenting type 2 diabetes, high blood pressure and knee osteoarthritis. However, in all groups, there was a gap in knowledge regarding the risk obesity poses for the development of breast and colon cancer. Aggressive health promotion campaigns concerning obesity, which have been implemented recently in Mexico, must emphasize cancer as a potential outcome for obese patients.
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Affiliation(s)
- Ruth Soriano
- Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Lee SW, Jo HH, Kim MR, You YO, Kim JH. Association between metabolic syndrome and serum leptin levels in postmenopausal women. J OBSTET GYNAECOL 2012; 32:73-7. [PMID: 22185543 DOI: 10.3109/01443615.2011.618893] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Menopausal status is associated with weight gain, increased central fat mass, abnormal lipid metabolism, insulin resistance and susceptibility to metabolic syndrome (MetS). Leptin is synthesised and secreted by adipocytes. Serum leptin levels are highly correlated with fat mass. We determined the association between MetS and serum leptin levels in 153 postmenopausal women. The difference in serum leptin level between MetS and non-MetS groups showed a statistical significance after adjusting for body mass index (BMI; 19.9 ± 9.5 vs 12.1 ± 5.9 ng/ml, p = 0.013). The indicator of abdominal obesity, waist-to-hip ratio (WHR) and visceral fat area (VFA), had a positive correlation with serum leptin level in non-obese subjects after adjusting for BMI (p = 0.017, p < 0.001, respectively). Of the components of MetS, abdominal obesity and the number of MetS components had a positive correlation with serum leptin level (p < 0.05, p < 0.001, respectively).
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Affiliation(s)
- S W Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea, St. Vincent Hospital, Suwon, Korea
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Apostolopoulou M, Michalakis K, Miras A, Hatzitolios A, Savopoulos C. Nutrition in the primary and secondary prevention of stroke. Maturitas 2012; 72:29-34. [PMID: 22406461 DOI: 10.1016/j.maturitas.2012.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 12/20/2022]
Abstract
Stroke is a worldwide major health issue. As some of the risk factors are modifiable, it is of high importance to understand how we can minimize the risk for stroke. Multifactorial interventions should be provided to patients in the frame of primary and secondary prevention. Obesity is a well-established modifiable factor as well as the dietary pattern that mostly depends on the social environment, the lifestyle and the habits of each individual. So, dietary changes should be part of the holistic approach which includes improvements in the regulation of hypertension, hyperlipidaemia and hyperglycaemia. In the present review, we try to provide a global approach on how diet can influence the risk of stroke and especially the nutritional influence on lipid profile and vessel disease and the role of dietary modification in the secondary stroke prevention. The importance of salt restriction, DASH and Mediterranean diet low in saturated and high in polyunsaturated fats, and the management of obesity seem to be the most important dietary priorities.
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Alexander E, Rosenthal S, Evans C. Achieving consensus on recommendations for the clinical management of overweight and obese adults for canadian physiotherapy practice. Physiother Can 2012; 64:42-52. [PMID: 23277684 PMCID: PMC3280708 DOI: 10.3138/ptc.2010-39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults. METHODS We used a modified Delphi method to achieve consensus. Participants rated the importance and feasibility of recommendations using a nine-point scale in two rounds of electronic surveys and a conference call. The mean and distribution of ratings were analyzed to determine consensus. RESULTS Twenty-one physiotherapists experienced in the management of patients with obesity and representing diverse regions of Canada and areas of practice participated. Seventeen (81.0%) completed survey 1. Ten (47.6%) participated in the conference call and survey 2. Eight of 34 strategies received mean ratings of 7.00 or more for both importance and feasibility from at least two-thirds of participants. These strategies were related to physical activity prescription and assessment. CONCLUSIONS A sample of physiotherapists in Canada agreed that obesity-related CPGs contain recommendations that are important to physiotherapy practice. These findings, along with the Canadian Physiotherapy Association's position statement on obesity, provide support for the argument that physiotherapists, as direct-access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight.
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Affiliation(s)
| | | | - Cathy Evans
- Eramosa Physiotherapy Associates, Guelph, Ont. (at time of study)
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Guo S, Liu M, Wang G, Torroella-Kouri M, Gonzalez-Perez RR. Oncogenic role and therapeutic target of leptin signaling in breast cancer and cancer stem cells. Biochim Biophys Acta Rev Cancer 2012; 1825:207-22. [PMID: 22289780 DOI: 10.1016/j.bbcan.2012.01.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/12/2012] [Accepted: 01/15/2012] [Indexed: 12/17/2022]
Abstract
Significant correlations between obesity and incidence of various cancers have been reported. Obesity, considered a mild inflammatory process, is characterized by a high level of secretion of several cytokines from adipose tissue. These molecules have disparate effects, which could be relevant to cancer development. Among the inflammatory molecules, leptin, mainly produced by adipose tissue and overexpressed with its receptor (Ob-R) in cancer cells is the most studied adipokine. Mutations of leptin or Ob-R genes associated with obesity or cancer are rarely found. However, leptin is an anti-apoptotic molecule in many cell types, and its central roles in obesity-related cancers are based on its pro-angiogenic, pro-inflammatory and mitogenic actions. Notably, these leptin actions are commonly reinforced through entangled crosstalk with multiple oncogenes, cytokines and growth factors. Leptin-induced signals comprise several pathways commonly triggered by many cytokines (i.e., canonical: JAK2/STAT; MAPK/ERK1/2 and PI-3K/AKT1 and, non-canonical signaling pathways: PKC, JNK and p38 MAP kinase). Each of these leptin-induced signals is essential to its biological effects on food intake, energy balance, adiposity, immune and endocrine systems, as well as oncogenesis. This review is mainly focused on the current knowledge of the oncogenic role of leptin in breast cancer. Additionally, leptin pro-angiogenic molecular mechanisms and its potential role in breast cancer stem cells will be reviewed. Strict biunivocal binding-affinity and activation of leptin/Ob-R complex makes it a unique molecular target for prevention and treatment of breast cancer, particularly in obesity contexts.
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Affiliation(s)
- Shanchun Guo
- Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
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Oncogenic role and therapeutic target of leptin signaling in breast cancer and cancer stem cells. BIOCHIMICA ET BIOPHYSICA ACTA 2012. [PMID: 22289780 DOI: 10.1016/j.bbcan.2012.01.002.oncogenic] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Significant correlations between obesity and incidence of various cancers have been reported. Obesity, considered a mild inflammatory process, is characterized by a high level of secretion of several cytokines from adipose tissue. These molecules have disparate effects, which could be relevant to cancer development. Among the inflammatory molecules, leptin, mainly produced by adipose tissue and overexpressed with its receptor (Ob-R) in cancer cells is the most studied adipokine. Mutations of leptin or Ob-R genes associated with obesity or cancer are rarely found. However, leptin is an anti-apoptotic molecule in many cell types, and its central roles in obesity-related cancers are based on its pro-angiogenic, pro-inflammatory and mitogenic actions. Notably, these leptin actions are commonly reinforced through entangled crosstalk with multiple oncogenes, cytokines and growth factors. Leptin-induced signals comprise several pathways commonly triggered by many cytokines (i.e., canonical: JAK2/STAT; MAPK/ERK1/2 and PI-3K/AKT1 and, non-canonical signaling pathways: PKC, JNK and p38 MAP kinase). Each of these leptin-induced signals is essential to its biological effects on food intake, energy balance, adiposity, immune and endocrine systems, as well as oncogenesis. This review is mainly focused on the current knowledge of the oncogenic role of leptin in breast cancer. Additionally, leptin pro-angiogenic molecular mechanisms and its potential role in breast cancer stem cells will be reviewed. Strict biunivocal binding-affinity and activation of leptin/Ob-R complex makes it a unique molecular target for prevention and treatment of breast cancer, particularly in obesity contexts.
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Coin A, Ruggiero E, Giannini S, Pedrazzoni M, Minisola S, Rossini M, Del Puente A, Inelmen EM, Manzato E, Sergi G. Trunk and Lower Limb Fat Mass Evaluated by Dual-Energy X-Ray Absorptiometry in a 20- to 80-Year-Old Healthy Italian Population. ANNALS OF NUTRITION AND METABOLISM 2012; 61:151-9. [DOI: 10.1159/000342086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/16/2012] [Indexed: 12/25/2022]
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Fischer L, Clemens G, Gehrig T, Kenngott H, Becker K, Bruckner T, Gutt CN, Büchler MW, Müller-Stich B. Challenges and pitfalls of experimental bariatric procedures in rats. Obes Facts 2012; 5:359-71. [PMID: 22722345 DOI: 10.1159/000339531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on obesity and obesity-related diseases is unquestionable. Up to now, the technical descriptions of these techniques in animals/rats have not been very comprehensive. METHODS For SG and RYGB, operating time, learning curve, and intraoperative mortality in relation to weight of the rat and type of anesthesia were recorded. Furthermore, a review of the literature on experimental approaches towards SG and RYGB in rats was carried out, merging in a detailed technical description for both procedures. RESULTS The data presented here revealed that the mean operating time for SG (69.4 ± 22.2 min (SD)) was shorter than for RYGB (123.0 ± 20.7 min). There is a learning curve for both procedures, resulting in a reduced operating time of up to 60% in SG and 35% in RYGB (p < 0.05; t-test). However, with increased weight, operating time increases to about 80 min for SG and about 120 min for RYGB. Obese rats have an increased intraoperative mortality rate of up to 50%. After gaseous anesthesia the mortality can be even higher. The literature search revealed 40 papers dealing with SG and RYGB in rats. 18 articles (45%) contained neither photographs nor illustrations; 14 articles (35%) did not mention the applied type of anesthesia. The mortality rate was described in 15 papers (37.5%). CONCLUSION Experimental obesity surgery in rats is challenging. Because of the high mortality in obese rats operated under gaseous anesthesia, exercises to establish the techniques should be performed in small rats using intraperitoneal anesthesia.
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Affiliation(s)
- Lars Fischer
- Department of Surgery, University of Heidelberg, Heidelberg, Germany.
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Zivkovic TB, Vuksanovic M, Jelic MA, Stojanovic J, Buric B, Jojic B, Milic N, Vujovic S. Obesity and metabolic syndrome during the menopause transition in Serbian women. Climacteric 2011; 14:643-8. [PMID: 21878054 DOI: 10.3109/13697137.2011.569595] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Abdominal obesity and metabolic syndrome are known to increase in prevalence from premenopause to postmenopause. Both are well recognized predictors of cardiovascular disease and diabetes in women. Aims The primary objective of this study was to assess the presence of obesity and metabolic syndrome during the menopause transition in Serbian women who attended health-care centers. The secondary objective was to evaluate the prevalence of ischemic heart disease, stroke and diabetes in this group. METHODS Our results present a part of the national epidemiological cross-sectional study assessing prevalence of metabolic syndrome and obesity in Serbia. In all, 1076 women attending 20 health-care centers were assessed. Women were divided into five groups: premenopausal, perimenopausal, early and late postmenopausal and geripausal. Medical history, waist circumference, blood glucose, lipids, and blood pressure were recorded. RESULTS The mean body mass index of all women was 28.5 ± 4.9 kg/m(2). The mean waist circumference of all women was 92 ± 12.5 cm. Both were significantly lower in premenopausal women than in other women. Metabolic syndrome was present in 72% of women, with a significant difference in prevalence between premenopausal women and other groups. High triglyceride levels and hypertension were the most commonly present components of metabolic syndrome. Ischemic heart disease, stroke and diabetes occurred significantly more often in postmenopausal and geripausal women. CONCLUSION The majority of Serbian women attending health-care centers have abdominal obesity and metabolic syndrome which significantly increase in prevalence in the perimenopausal years. This indicates that preventive measures should be focused on diabetes and cardiovascular disease in the perimenopause.
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Acute differential effects of milk-derived dietary proteins on postprandial lipaemia in obese non-diabetic subjects. Eur J Clin Nutr 2011; 66:32-8. [PMID: 21792215 DOI: 10.1038/ejcn.2011.142] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Postprandial lipaemia is an established risk factor for atherosclerosis. To investigate the acute effect of four milk-derived dietary proteins (alpha-lactalbumin, whey isolate, caseinoglycomacropeptide and whey hydrolysate) on postprandial lipaemia, we have conducted a randomized, acute, single-blinded clinical intervention study with crossover design. SUBJECTS/METHODS A total of 11 obese non-diabetic subjects (age: 44-74, BMI: 30-41.4 kg m(-2)) were included. On 4 different days the subjects ingested a high-fat meal with the following energy distribution: 66% energy from fat (100 g of butter), 15% of energy from carbohydrate (90 g of white wheat bread) and 19% of energy from protein (45 g of pure protein). Our primary variable was plasma triglyceride measured in the 8-h postprandial period. Secondarily, retinyl palmitate, non-esterified free fatty acids, glucose, insulin, glucagon, GLP-1 and GIP, active and total grehlin and cholecystokinin were measured. RESULTS We observed no statistically significant (P=0.8) differences between meals on our primary variable that is, triglycerides. Whey hydrolysate was associated with a significantly (P=0.02) smaller postprandial suppression of non-esterified free fatty acids compared with the other dietary proteins. CONCLUSION We did not observe significant differences in postprandial lipaemia to the four milk-derived dietary proteins. Whey hydrolysate caused less postprandial suppression of free fatty acids.
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Adams MKM, Simpson JA, Aung KZ, Makeyeva GA, Giles GG, English DR, Hopper J, Guymer RH, Baird PN, Robman LD. Abdominal obesity and age-related macular degeneration. Am J Epidemiol 2011; 173:1246-55. [PMID: 21422060 DOI: 10.1093/aje/kwr005] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Evidence for an association between age-related macular degeneration (AMD) and obesity is inconsistent. The authors examined associations between adiposity and AMD prevalence using 21,287 participants from the Melbourne Collaborative Cohort Study aged 40-69 years at baseline (1990-1994). For men, each increase of 0.1 in waist/hip ratio (~1 standard deviation) was associated with a 13% increase in the odds of early AMD (odds ratio = 1.13, 95% confidence interval: 1.01, 1.26; P = 0.03) and a 75% increase in the odds of late AMD (odds ratio = 1.75, 95% confidence interval: 1.11, 2.76; P = 0.02). No other adiposity measure was associated with early AMD for men. Smoking status modified the relation between waist/hip ratio and early AMD (P = 0.05), with no association for former smokers. For women, there were inverse associations with early AMD for all adiposity measures (odds ratios = 0.89-0.93; P = 0.002-0.02), but no associations were observed for late AMD. This study confirms abdominal obesity as an AMD risk factor for men despite a survivorship effect from competing risks in morbidity and mortality. The inverse associations for women may reflect weaker true positive associations with AMD that are insufficient to overcome the survivorship effect. New data are provided on complex interactions between environmental exposures and AMD risk.
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Affiliation(s)
- Madeleine K M Adams
- Centre for Eye Research Australia, University of Melbourne/Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia.
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Abstract
The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. Medical treatments of obesity include primary prevention, dietary intervention, increased physical activity, behavior modification, and pharmacotherapy. Surgical treatment for obesity is based on the extensive neural-hormonal effects of weight loss surgery on metabolism, and as such is better termed Metabolic Surgery. Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity.
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Affiliation(s)
- Nicole A Kissane
- Harvard Medical School, Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, WACC 460, 15 Parkman Street, Boston, MA 02114, USA
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Bao B, Wang Z, Li Y, Kong D, Ali S, Banerjee S, Ahmad A, Sarkar FH. The complexities of obesity and diabetes with the development and progression of pancreatic cancer. BIOCHIMICA ET BIOPHYSICA ACTA 2011; 1815:135-46. [PMID: 21129444 PMCID: PMC3056906 DOI: 10.1016/j.bbcan.2010.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 11/19/2010] [Accepted: 11/20/2010] [Indexed: 12/12/2022]
Abstract
Pancreatic cancer (PC) is one of the most lethal malignant diseases with the worst prognosis. It is ranked as the fourth leading cause of cancer-related deaths in the United States. Many risk factors have been associated with PC. Interestingly, large numbers of epidemiological studies suggest that obesity and diabetes, especially type-2 diabetes, are positively associated with increased risk of PC. Similarly, these chronic diseases (obesity, diabetes, and cancer) are also a major public health concern. In the U.S. population, 50 percent are overweight, 30 percent are medically obese, and 10 percent have diabetes mellitus (DM). Therefore, obesity and DM have been considered as potential risk factors for cancers; however, the focus of this article is restricted to PC. Although the mechanisms responsible for the development of these chronic diseases leading to the development of PC are not fully understood, the biological importance of the activation of insulin, insulin like growth factor-1 (IGF-1) and its receptor (IGF-1R) signaling pathways in insulin resistance mechanism and subsequent induction of compensatory hyperinsulinemia has been proposed. Therefore, targeting insulin/IGF-1 signaling with anti-diabetic drugs for lowering blood insulin levels and reversal of insulin resistance could be useful strategy for the prevention and/or treatment of PC. A large number of studies have demonstrated that the administration of anti-diabetic drugs such as metformin and thiazolidinediones (TZD) class of PPAR-γ agonists decreases the risk of cancers, suggesting that these agents might be useful anti-tumor agents for the treatment of PC. In this review article, we will discuss the potential roles of metformin and TZD anti-diabetic drugs as anti-tumor agents in the context of PC and will further discuss the complexities and the possible roles of microRNAs (miRNAs) in the pathogenesis of obesity, diabetes, and PC.
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Affiliation(s)
- Bin Bao
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Zhiwei Wang
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Yiwei Li
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Dejuan Kong
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Shadan Ali
- Division of Hematology/Oncology Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Sanjeev Banerjee
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Aamir Ahmad
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Fazlul H. Sarkar
- Department of Pathology, Wayne State University, Detroit, Michigan
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Hosseinpanah F, Barzin M, Sheikholeslami F, Azizi F. Effect of different obesity phenotypes on cardiovascular events in Tehran Lipid and Glucose Study (TLGS). Am J Cardiol 2011; 107:412-6. [PMID: 21257007 DOI: 10.1016/j.amjcard.2010.09.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 12/19/2022]
Abstract
In this community-based study, 6,215 subjects aged ≥30 years (43% men, mean age 47 years) free of cardiovascular disease (CVD) at baseline were followed for a mean of 8.1 years to assess risk for CVD stratified by body mass index and dysmetabolic status. Participants were stratified by body mass index categories (18.5 to 24.9 kg/m² = normal, 25 to 29.9 kg/m² = overweight, and ≥30 kg/m² = obese) and dysmetabolic status. Dysmetabolic status was defined as having metabolic syndrome according to the International Diabetes Federation's definition or diabetes. First CVD events occurred in 446 subjects. Multivariate-adjusted hazard ratios for CVD events in normal-weight, overweight, and obese subjects without dysmetabolic status were 1.00 (reference), 1.10 (95% confidence interval [CI] 0.76 to 1.61), and 1.07 (95% CI 0.59 to 1.96), respectively, and for normal-weight, overweight and obese subjects with dysmetabolic status were 2.10 (95% CI 1.36 to 3.26), 2.35 (95% CI 1.71 to 3.22), and 2.35 (95% CI 1.71 to 3.22), respectively. There was an interaction between body mass index and metabolic abnormalities in predicting CVD. In conclusion, normal-weight subjects with dysmetabolic status had higher risk for future CVD compared to healthy obese subjects.
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Abstract
Obesity is a result of excess body fat accumulation. This excess is associated with adverse health effects such as CVD, type 2 diabetes, and cancer. The development of obesity has an evident environmental contribution, but as shown by heritability estimates of 40% to 70%, a genetic susceptibility component is also needed. Progress in understanding the etiology has been slow, with findings largely restricted to monogenic, severe forms of obesity. However, technological and analytical advances have enabled detection of more than 20 obesity susceptibility loci. These contain genes suggested to be involved in the regulation of food intake through action in the central nervous system as well as in adipocyte function. These results provide plausible biological pathways that may, in the future, be targeted as part of treatment or prevention strategies. Although the proportion of heritability explained by these genes is small, their detection heralds a new phase in understanding the etiology of common obesity.
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Affiliation(s)
- Blanca M. Herrera
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN UK
| | - Cecilia M. Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN UK
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50
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Role of obesity-associated dysfunctional adipose tissue in cancer: a molecular nutrition approach. BIOCHIMICA ET BIOPHYSICA ACTA-BIOENERGETICS 2010; 1807:664-78. [PMID: 21111705 DOI: 10.1016/j.bbabio.2010.11.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/09/2010] [Accepted: 11/09/2010] [Indexed: 02/08/2023]
Abstract
Obesity is a complex disease caused by the interaction of a myriad of genetic, dietary, lifestyle and environmental factors, which favors a chronic positive energy balance, leading to increased body fat mass. There is emerging evidence of a strong association between obesity and an increased risk of cancer. However, the mechanisms linking both diseases are not fully understood. Here, we analyze the current knowledge about the potential contribution that expanding adipose tissue in obesity could make to the development of cancer via dysregulated secretion of pro-inflammatory cytokines, chemokines and adipokines such as TNF-α, IL-6, leptin, adiponectin, visfatin and PAI-1. Dietary factors play an important role in the risk of suffering obesity and cancer. The identification of bioactive dietary factors or substances that affect some of the components of energy balance to prevent/reduce weight gain as well as cancer is a promising avenue of research. This article reviews the beneficial effects of some bioactive food molecules (n-3 PUFA, CLA, resveratrol and lipoic acid) in energy metabolism and cancer, focusing on the molecular mechanisms involved, which may provide new therapeutic targets in obesity and cancer.
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