Cancer: Does 'Type' of Obesity Matter?

Highlights:

Metabolically healthy obesity is the lack of any metabolic abnormality or cardiovascular disease in an obese person
People with metabolically unhealthy obesity are at higher risk of multiple cancers, both men and women
Overweight men regardless of the type of obesity had an increased risk of blood cancer

Recent studies show that both metabolically healthy and unhealthy 'forms' of obesity are associated with a higher risk of various cancers related to obesity, with the association being stronger in metabolically unhealthy obesity.

The studies were released in the Journal of the National Cancer Institute. The investigation was carried out by Dr. Ming Sun and associates from Lund University in Malmö, Sweden ().

Research on the association of cancer with obesity with metabolic complications (commonly known as metabolically unhealthy obesity) or without such complications (healthy obesity) is few.

The current study analyzed body mass index (BMI, normal weight/overweight/obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk among 797,193 European individuals.

The metabolically healthy and unhealthy status was determined using a metabolic score made up of blood pressure, plasma glucose, and triglycerides (blood fats), and statistical modeling was employed to estimate any link.

The participants were thus put into six different categories – metabolically unhealthy obesity (6.8% of participants); metabolically healthy obesity (3.4%), metabolically unhealthy overweight (15.4%), metabolically healthy overweight (19.8%), metabolically unhealthy normal weight (12.5%), metabolically healthy normal weight (42.0%).

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‘Regardless of whether obesity is metabolically ‘healthy’ or ‘unhealthy’, both can increase the chances of cancer.’

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Metabolically Healthy vs. Metabolically Unhealthy Obesity and the Risk of Cancer

Metabolically unhealthy obesity when compared to metabolically healthy obesity was associated with an increased relative risk of any obesity-related cancer and colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer, with endometrial, liver, and renal cell cancer having the highest risk estimates (2.5 to 3.0 times increased risk).

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The Risk of Cancer for Metabolically Healthy and Metabolically Unhealthy Obese Women

When seen in women, metabolically unhealthy women with obesity had a 21% increased risk of colon cancer, a 3-fold increased risk of endometrial cancer, and 2.5 times increased risk of kidney cancer when compared to metabolically healthy women with obesity.

Obese metabolically healthy women had a 2.4-fold greater risk of endometrial cancer and an 80% increased risk of kidney cancer, but the link with colon cancer was no longer statistically significant.

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Men: The Relationship Between Metabolically Healthy and Metabolically Unhealthy Obesity and Cancer

In males, metabolically unhealthy individuals with obesity had a 2.6-fold greater risk of kidney cancer, an 85% increased risk of colon cancer, and a 32% increased risk of both pancreatic and rectal cancer when compared to metabolically healthy men of normal weight.

Obese males who were metabolically healthy had a 67% risk of kidney cancer and a 42% risk of colon cancer, but the link with pancreatic and rectal cancer was no longer statistically significant.

In a surprising finding, both metabolically healthy and unhealthy men who were overweight (but not obese) had a 50% greater risk of the blood cancer multiple myeloma - but neither metabolically healthy nor unhealthy men who were obese had an elevated risk.

According to the study's authors, the data implies that obesity combined with metabolic problems increases the risk of these obesity-related cancers more than the sum of either risk factor alone.

They say: “This has important public health implications, suggesting that a significant number of cancer cases could potentially be prevented by targeting the co-existence of metabolic problems and obesity, particularly for obesity-related cancers among men.”

The authors conclude: “This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, being metabolically unhealthy further increased the obesity-related cancer risk, suggesting that both obesity and metabolic conditions are useful targets for the prevention of obesity-related cancers.”

Reference:

Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study - (https://pubmed.ncbi.nlm.nih.gov/36647199/)

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