文章：

超重、肥胖和癌症：流行病学证据和提出的机制

Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms

原文发布日期：2004-08-01

DOI: 10.1038/nrc1408

类型: Review Article

开放获取: 否

要点：

1. The International Agency for Research on Cancer has determined that, based on results from epidemiological studies, people who are overweight or obese are at increased risk of developing several cancer types, including adenocarcinoma of the oesophagus, colon cancer, breast cancer (in postmenopausal women), endometrial cancer and kidney (renal-cell) cancer.
2. Epidemiological evidence also indicates that cancers of the liver, gallbladder and pancreas are obesity related, and that obesity might also increase risk for haematopoietic cancers and for aggressive prostate cancer. No association is seen between obesity and lung cancer. Results for other cancers have been inconsistent.
3. Insulin resistance develops as a metabolic adaptation to increased levels of circulating free fatty acids released from adipose tissue, especially intra-abdominal adipose. Insulin resistance is generally compensated by increased pancreatic insulin secretion. There is mounting epidemiological and experimental evidence to indicate that chronic hyperinsulinaemia increases risk of cancers of the colon and endometrium, and probably other tumours (for example, of the pancreas and kidney).
4. Serum levels of insulin-like growth factor 1 (IGF1) are also associated with different forms of cancer. However, there is no simple, direct relationship between circulating levels of IGF1 and the degree of adiposity.
5. Circulating levels of oestrogens are strongly related to adiposity. For cancers of the breast (in postmenopausal women) and endometrium, the effects of overweight and obesity on cancer risk are largely mediated by increased oestrogen levels.
6. In 4–8% of premenopausal women, obesity and ensuing insulin resistance can either cause or aggravate syndromes of ovarian androgen excess (polycystic ovary syndrome) and chronic progesterone deficiency. There is strong evidence that such syndromes, along with reduced progesterone production, increase the risk of endometrial cancer.
7. Successful intervention strategies for weight loss and maintenance at the individual and community level are needed to reduce cancer risk.

要点翻译：

1. 国际癌症研究机构已根据流行病学研究结果确认，超重或肥胖人群罹患多种癌症的风险增加，包括食管腺癌、结肠癌、乳腺癌（绝经后女性）、子宫内膜癌及肾细胞癌。
2. 流行病学证据还表明，肝癌、胆囊癌和胰腺癌与肥胖相关，且肥胖可能增加造血系统癌症和侵袭性前列腺癌的风险。未发现肥胖与肺癌存在关联。其他癌症的相关性研究结果尚不一致。
3. 胰岛素抵抗是机体对脂肪组织（尤其是腹腔内脂肪）释放的循环游离脂肪酸水平升高的代谢适应。这种抵抗通常通过胰腺增加胰岛素分泌来代偿。越来越多的流行病学和实验证据表明，慢性高胰岛素血症会增加结肠癌和子宫内膜癌的风险，可能还包括其他肿瘤（如胰腺癌和肾癌）。
4. 血清胰岛素样生长因子1（IGF1）水平也与多种癌症相关。但循环IGF1水平与肥胖程度之间不存在简单的直接关联。
5. 循环雌激素水平与肥胖程度密切相关。对于乳腺癌（绝经后女性）和子宫内膜癌，超重和肥胖对癌症风险的影响主要通过雌激素水平升高介导。
6. 在4%-8%的育龄女性中，肥胖及随之产生的胰岛素抵抗可引发或加重卵巢雄激素过多症（多囊卵巢综合征）和慢性孕酮缺乏综合征。有力证据表明，此类综合征伴随孕酮分泌减少会增加子宫内膜癌风险。
7. 为降低癌症风险，需要在个体和社区层面建立有效的减重及体重维持干预策略。

英文摘要：

The prevalence of obesity is rapidly increasing globally. Epidemiological studies have associated obesity with a range of cancer types, although the mechanisms by which obesity induces or promotes tumorigenesis vary by cancer site. These include insulin resistance and resultant chronic hyperinsulinaemia, increased bioavailability of steroid hormones and localized inflammation. Gaining a better understanding of the relationship between obesity and cancer can provide new insight into mechanisms of cancer pathogenesis.

摘要翻译： 

肥胖症的患病率在全球范围内迅速上升。流行病学研究已将肥胖与多种癌症类型联系起来，尽管肥胖诱发或促进肿瘤发生的机制因癌症部位而异。这些机制包括胰岛素抵抗及其导致的慢性高胰岛素血症、类固醇激素生物利用度的增加以及局部炎症。更深入地理解肥胖与癌症之间的关系，可为癌症发病机制提供新的见解。

原文链接：

Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms