Andrea M Stroud1, Elizabeth N Dewey2, Farah A Husain2, Jared M Fischer3, Anita P Courcoulas4, David R Flum5, James E Mitchell6, Walter J Pories7, Jonathan Q Purnell8, Bruce M Wolfe2. 1. Department of Surgery, Oregon Health & Science University, Portland, Oregon. Electronic address: strouda@ohsu.edu. 2. Department of Surgery, Oregon Health & Science University, Portland, Oregon. 3. Knight Cancer Institute, Center for Cancer Early Detection Advanced Research Center, and Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon. 4. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 5. Department of Surgery, University of Washington, Seattle, Washington. 6. Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. 7. Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina. 8. Knight Cardiovascular Institute and the Division of Endocrinology, Oregon Health and Science University, Portland, Oregon.
Abstract
BACKGROUND: Bariatric surgery reduces cancer risk in populations with obesity. It is unclear if weight loss alone or metabolic changes related to bariatric surgery cause this effect. OBJECTIVE: We evaluated the relationship between surgical weight loss and serum biomarker changes with incident cancer in a bariatric surgery cohort. SETTING: Ten U.S. clinical facilities. METHODS: The Longitudinal Assessment of Bariatric Surgery 2 (LABS-2) is a prospective multicenter cohort (n = 2458, 79% female, mean age = 46). We evaluated weight and serum biomarkers, measured preoperatively and 1 year postoperatively, as predictors for incident cancer. Associations were determined using Cox proportional hazards models adjusting for weight loss, age, sex, education, and smoking history. RESULTS: Over 8759 person-years of follow-up, 82 patients reported new cancer diagnosis (936 per 100,000 person-years, 95% confidence interval [CI]: 749-1156). Cancer risk was decreased by approximately 50% in participants with 20% to 34.9% total weight loss (TWL) compared with <20% TWL (hazard ratio [HR] = .49, 95%CI: .29-.83). Reduced cancer risk was observed with percent decrease from baseline for glucose (per 10%, HR = .94, 95%CI: .90-.99), proinsulin (per 20%, HR = .95, 95%CI: .93-.98), insulin (per 30%, HR = .97, 95%CI: .96-.99), and leptin (per 20%, HR = .81, 95%CI: .68-.97), and per 15% percent increase in ghrelin (HR = .94, 95%CI: .29-.83). CONCLUSIONS: After bariatric surgery, cancer risk is reduced >50% when weight loss exceeds 20% TWL compared with patients with <20% TWL. Weight loss alone may not explain the observed risk reduction, as improvements in diabetes, leptin, and ghrelin were associated with decreased cancer risk.
BACKGROUND: Bariatric surgery reduces cancer risk in populations with obesity. It is unclear if weight loss alone or metabolic changes related to bariatric surgery cause this effect. OBJECTIVE: We evaluated the relationship between surgical weight loss and serum biomarker changes with incident cancer in a bariatric surgery cohort. SETTING: Ten U.S. clinical facilities. METHODS: The Longitudinal Assessment of Bariatric Surgery 2 (LABS-2) is a prospective multicenter cohort (n = 2458, 79% female, mean age = 46). We evaluated weight and serum biomarkers, measured preoperatively and 1 year postoperatively, as predictors for incident cancer. Associations were determined using Cox proportional hazards models adjusting for weight loss, age, sex, education, and smoking history. RESULTS: Over 8759 person-years of follow-up, 82 patients reported new cancer diagnosis (936 per 100,000 person-years, 95% confidence interval [CI]: 749-1156). Cancer risk was decreased by approximately 50% in participants with 20% to 34.9% total weight loss (TWL) compared with <20% TWL (hazard ratio [HR] = .49, 95%CI: .29-.83). Reduced cancer risk was observed with percent decrease from baseline for glucose (per 10%, HR = .94, 95%CI: .90-.99), proinsulin (per 20%, HR = .95, 95%CI: .93-.98), insulin (per 30%, HR = .97, 95%CI: .96-.99), and leptin (per 20%, HR = .81, 95%CI: .68-.97), and per 15% percent increase in ghrelin (HR = .94, 95%CI: .29-.83). CONCLUSIONS: After bariatric surgery, cancer risk is reduced >50% when weight loss exceeds 20% TWL compared with patients with <20% TWL. Weight loss alone may not explain the observed risk reduction, as improvements in diabetes, leptin, and ghrelin were associated with decreased cancer risk.
Authors: Kajsa Sjöholm; Lena M S Carlsson; Per-Arne Svensson; Johanna C Andersson-Assarsson; Felipe Kristensson; Peter Jacobson; Markku Peltonen; Magdalena Taube Journal: Diabetes Care Date: 2022-02-01 Impact factor: 19.112
Authors: Ali Aminian; Rickesha Wilson; Abbas Al-Kurd; Chao Tu; Alex Milinovich; Matthew Kroh; Raul J Rosenthal; Stacy A Brethauer; Philip R Schauer; Michael W Kattan; Justin C Brown; Nathan A Berger; Jame Abraham; Steven E Nissen Journal: JAMA Date: 2022-06-28 Impact factor: 157.335