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Excess body weight and obesity—the link with gastrointestinal and hepatobiliary cancer

Nature Reviews Gastroenterology & Hepatology volume 8, pages 224–238 (2011)Cite this article

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Abstract

Excess body weight (EBW) is an independent risk factor for many human malignancies, including cancers throughout the gastrointestinal and hepatobiliary tract from the esophagus to the colorectum. The relative risk of gastrointestinal cancer in obese individuals is approximately 1.5–2.0 times that for normal weight individuals, with organ-specific and gender-specific differences for specific cancers. The association between EBW and risk of premalignant stages of gastrointestinal carcinogenesis, such as colorectal adenoma and Barrett esophagus, is similar, implying a role for EBW during the early stages of carcinogenesis that could be relevant to preventative strategies. EBW also impacts negatively on gastrointestinal cancer outcomes. The mechanistic basis of the association between EBW and carcinogenesis remains incompletely understood. Postulated mechanisms include increased insulin and insulin-like growth factor signaling and chronic inflammation (both linked to the metabolic syndrome), as well as signaling via adipokines, such as leptin. The role of obesity-related changes in the intestinal microbiome in gastrointestinal carcinogenesis deserves further attention. Whether weight loss leads to reduced future gastrointestinal and liver cancer risk has yet to be fully explored. There is some support for the idea that weight loss negatively regulates colorectal carcinogenesis. In addition, data suggest a reduction in risk of several cancers in the first 10 years after bariatric surgery.

Key Points

  • Excess body weight (EBW) is a potentially preventable cause of several gastrointestinal and hepatobiliary malignancies, including colorectal, esophageal, liver and pancreatic cancer

  • A positive association between EBW and premalignant conditions, such as colorectal adenoma and Barrett esophagus, implies that EBW promotes the early stages of carcinogenesis (which could be relevant for prevention)

  • The mechanisms linking excess adiposity (particularly visceral or abdominal fat) and gastrointestinal carcinogenesis are unclear but may include insulin and insulin-like growth factor signaling, chronic inflammation, adipokine signaling and changes to the intestinal microbiome

  • Whether weight loss reduces future gastrointestinal and liver cancer risk has not been addressed fully and requires further study

  • EBW is also associated with worse outcomes from gastrointestinal cancer following diagnosis

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Figure 1: Mechanisms linking excess adiposity in overweight and obese states with gastrointestinal and hepatobiliary carcinogenesis.

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References

  1. Moghaddam, A. A., Woodward, M. & Huxley, R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol. Biomarkers Prev. 16, 2533–2547 (2007).

    PubMed  Google Scholar 

  2. Renehan, A. G., Tyson, M., Egger, M., Heller, R. F. & Zwahlen, M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371, 569–578 (2008).

    PubMed  Google Scholar 

  3. WHO. Obesity and overweight. Fact Sheet No 311. World Health Organization [online], (2006).

  4. World Cancer Research Fund. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective 2nd edn (American Institute for Cancer Research, Washington, 2007).

  5. Vainoio, H. & Bianchinin, F. (Eds) International Agency for Research in Cancer. Weight control and physical activity. (IARC Press, Lyon, 2002).

    Google Scholar 

  6. Renehan, A. G. et al. Incident cancer burden attributable to excess body mass index in 30 European countries. Int. J. Cancer 126, 692–702 (2010).

    CAS  PubMed  Google Scholar 

  7. Wolk, A. et al. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control 12, 13–21 (2001).

    Article  CAS  PubMed  Google Scholar 

  8. Siddiqui, A. et al. Obesity is associated with an increased prevalence of advanced adenomatous colon polyps in a male veteran population. Dig. Dis. Sci. 54, 1560–1564 (2009).

    PubMed  Google Scholar 

  9. Jacobson, B. C., Chan, A. T., Giovannucci, E. L. & Fuchs, C. S. Body mass index and Barrett's oesophagus in women. Gut 58, 1460–1466 (2009).

    CAS  PubMed  Google Scholar 

  10. Sato, Y., Nozaki, R., Yamada, K., Takano, M. & Haruma, K. Relation between obesity and adenomatous polyps of the large bowel. Dig. Endosc. 21, 154–157 (2009).

    PubMed  Google Scholar 

  11. Cook, M. B., Greenwood, D. C., Hardie, L. J., Wild, C. R. & Forman, D. A systematic review and meta-analysis of the risk of increasing adiposity on Barrett's esophagus. Am. J. Gastroenterol. 103, 292–300 (2008).

    PubMed  Google Scholar 

  12. Thygesen, L. C. et al. Prospective weight change and colon cancer risk in male US health professionals. Int. J. Cancer 123, 1160–1165 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  13. National Institutes for Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The evidence report. (NHLBI, 1998).

  14. Larsson, S. C. & Wolk, A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. Am. J. Clin. Nutr. 86, 556–565 (2007).

    CAS  PubMed  Google Scholar 

  15. Dai, Z., Xu, Y. C. & Niu, L. Obesity and colorectal cancer risk: a meta-analysis of cohort studies. World J. Gastroenterol. 13, 4199–4206 (2007).

    PubMed  PubMed Central  Google Scholar 

  16. Moore, L. L. et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int. J. Obes. 28, 559–567 (2004).

    CAS  Google Scholar 

  17. Wise, L. A., Rosenberg, L., Palmer, J. R. & Adams-Campbell, L. L. Anthropometric risk factors for colorectal polyps in African-American women. Obesity 16, 859–868 (2008).

    PubMed  Google Scholar 

  18. Sedjo, R. L. et al. Change in body size and the risk of colorectal adenomas. Cancer Epidemiol. Biomarkers Prev. 16, 526–531 (2007).

    PubMed  Google Scholar 

  19. Larsen, I. K., Grotmol, T., Almendingen, K. & Hoff, G. Lifestyle as a predictor for colonic neoplasia in asymptomatic individuals. BMC Gastroenterol. 6, 5 (2006).

    PubMed  PubMed Central  Google Scholar 

  20. Neugut, A. I. et al. Obesity and colorectal adenomatous polyps. J. Natl Cancer Inst. 83, 359–361 (1991).

    CAS  PubMed  Google Scholar 

  21. Morois, S., Mesrine, S., Josset, M., Clavel-Chapelon, F. & Boutron-Ruault, M.-C. Anthropometric factors in adulthood and risk of colorectal adenomas. Am. J. Epidemiol. 172, 1166–1180 (2010).

    PubMed  Google Scholar 

  22. Giovannucci, E. et al. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann. Intern. Med. 122, 327–334 (1995).

    CAS  PubMed  Google Scholar 

  23. Giovannucci, E., Colditz, G. A., Stampfer, M. J. & Willett, W. C. Physical activity obesity and risk of colorectal adenoma in women (United States). Cancer Causes Control 7, 253–263 (1996).

    CAS  PubMed  Google Scholar 

  24. Yamaji, Y. et al. The effect of body weight reduction on the incidence of colorectal adenoma. Am. J. Gastroenterol. 103, 2061–2067 (2008).

    PubMed  Google Scholar 

  25. Lieberman, D. A., Prindiville, S., Weiss, D. G. & Willett, W. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 290, 2959–2967 (2003).

    PubMed  Google Scholar 

  26. Anderson, J. C. et al. Body mass index: a marker for significant colorectal neoplasia in a screening population. J. Clin. Gastroenterol. 41, 285–290 (2007).

    PubMed  Google Scholar 

  27. Omata, F. et al. Modifiable risk factors for colorectal neoplasms and hyperplastic polyps. Intern. Med. 48, 123–128 (2009).

    PubMed  Google Scholar 

  28. Kim, Y. & Lee, S. An association between colonic adenoma and abdominal obesity: a cross-sectional study. BMC Gastroenterol. 9, 4 (2009).

    PubMed  PubMed Central  Google Scholar 

  29. Betes, M. et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am. J. Gastroenterol. 98, 2648–2654 (2003).

    PubMed  Google Scholar 

  30. Bird, C. L., Frankl, H. D., Lee, E. R. & Haile, R. W. Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum. Am. J. Epidemiol. 147, 670–680 (1998).

    CAS  PubMed  Google Scholar 

  31. Kono, S., Shinchi, K. & Imanishi, K. Body mass index and adenomas of the sigmoid colon in Japanese men. Eur. J. Epidemiol. 12, 425–426 (1996).

    CAS  PubMed  Google Scholar 

  32. Boutron-Ruault, M.-C., Senesse, P., Méance, S., Belghiti, C. & Faivre, J. Energy intake, body mass index, physical activity, and the colorectal adenoma-carcinoma sequence. Nutr. Cancer 39, 50–57 (2001).

    CAS  PubMed  Google Scholar 

  33. Wallace, K. et al. The association of physical activity and body mass index with the risk of large bowel polyps. Cancer Epidemiol. Biomarkers Prev. 14, 2082–2086 (2005).

    PubMed  Google Scholar 

  34. Terry, M. B. et al. Risk factors for advanced colorectal adenomas: a pooled analysis. Cancer Epidemiol. Biomarkers Prev. 11, 622–629 (2002).

    PubMed  Google Scholar 

  35. Wolf, L. A., Terry, P. D., Potter, J. D. & Bostick, R. M. Do factors related to endogenous and exogenous estrogens modify the relationship between obesity and risk of colorectal adenomas in women? Cancer Epidemiol. Biomarkers Prev. 16, 676–683 (2007).

    CAS  PubMed  Google Scholar 

  36. Almendingen, K., Hofstad, B. & Vatn, M. H. Does high body fatness increase the risk of presence and growth of colorectal adenomas followed up in situ for 3 years? Am. J. Gastroenterol. 96, 2238–2246 (2001).

    CAS  PubMed  Google Scholar 

  37. Bayerdörffer, E. et al. Increased risk of 'high-risk' colorectal adenomas in overweight men. Gastroenterology 104, 137–144 (1993).

    PubMed  Google Scholar 

  38. Kang, H. W. et al. Visceral obesity and insulin resistance as risk factors for colorectal adenoma: a cross-sectional, case-control study. Am. J. Gastroenterol. 105, 178–187 (2010).

    PubMed  Google Scholar 

  39. Kim, J. H. et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol. Biomarkers Prev. 16, 1543–1546 (2007).

    CAS  PubMed  Google Scholar 

  40. Kim, K. S. et al. The frequency and risk factors of colorectal adenoma in health-check-up subjects in South Korea: relationship to abdominal obesity and age. Gut Liver 4, 36–42 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Jacobs, E. T. et al. Association between body mass index and colorectal neoplasia at follow-up colonoscopy: a pooling study. Am. J. Epidemiol. 169, 657–666 (2009).

    PubMed  PubMed Central  Google Scholar 

  42. Sainsbury, A. et al. Increased colorectal epithelial cell proliferation and crypt fission associated with obesity and roux-en-Y gastric bypass. Cancer Epidemiol. Biomarkers Prev. 17, 1401–1410 (2008).

    CAS  PubMed  Google Scholar 

  43. Ferrante, J. M. et al. Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detect. Prev. 30, 459–465 (2006).

    PubMed  PubMed Central  Google Scholar 

  44. Rosen, A. B. & Schneider, E. C. Colorectal cancer screening disparities related to obesity and gender. J. Gen. Intern. Med. 19, 332–338 (2004).

    PubMed  PubMed Central  Google Scholar 

  45. Borg, B. B., Gupta, N. K., Zuckerman, G. R., Banerjee, B. & Gyawali, C. P. Impact of obesity on bowel preparation for colonoscopy. Clin. Gastroenterol. Hepatol. 7, 670–675 (2009).

    PubMed  PubMed Central  Google Scholar 

  46. Pera, M., Manterola, C., Vidal, O. & Grande, L. Epidemiology of esophageal adenocarcinoma. J. Surg. Onc. 92, 151–159 (2005).

    Google Scholar 

  47. Lagergren, J., Bergstrom, R., Lindgren, A. & Nyren, O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N. Engl. J. Med. 340, 825–831 (1999).

    CAS  PubMed  Google Scholar 

  48. Hampel, H., Abraham, N. S. & El-Serag, H. B. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann. Intern. Med. 143, 199–211 (2005).

    PubMed  Google Scholar 

  49. Corley, D. A. & Kubo, A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am. J. Gastroenterol. 101, 2619–2628 (2006).

    PubMed  Google Scholar 

  50. Corley, D. A., Kubo, A. & Zhao, W. Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut 56, 756–762 (2007).

    PubMed  Google Scholar 

  51. Whiteman, D. et al. The role of obesity, gastroesophageal reflux and smoking in adenocarcinomas of the esophagus and esophago-gastric junction [abstract]. Gastroenterology 132, A418 (2007).

    Google Scholar 

  52. Yousef, F. et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus: a systematic review and meta-analysis. Am. J. Epidemiol. 168, 237–249 (2008).

    PubMed  Google Scholar 

  53. Kamat, P., Wen, S. J., Morris, J. & Anandasabapathy, S. Exploring the association between elevated body mass index and Barrett's esophagus: a systematic review and meta-analysis. Ann. Thorac. Surg. 87, 655–662 (2009).

    PubMed  Google Scholar 

  54. Edelstein, Z. R., Farrow, D. C., Bronner, M. P., Rosen, S. N. & Vaughan, T. L. Central adiposity and risk of Barrett's esophagus. Gastroenterology 133, 403–411 (2007).

    PubMed  Google Scholar 

  55. Corley, D. A. et al. Abdominal obesity and body mass index as risk factors for Barrett's esophagus. Gastroenterology 133, 34–41 (2007).

    PubMed  Google Scholar 

  56. Oberg, S., Wenner, J., Johansson, J., Walther, B. & Willen, R. Barrett esophagus: risk factors for progression to dysplasia and adenocarcinoma. Ann. Surg. 242, 49–54 (2005).

    PubMed  PubMed Central  Google Scholar 

  57. Arslan, A. A. et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch. Intern. Med. 170, 791–802 (2010).

    PubMed  PubMed Central  Google Scholar 

  58. Larsson, S. C., Orsini, N. & Wolk, A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int. J. Cancer 120, 1993–1998 (2007).

    CAS  PubMed  Google Scholar 

  59. Li, D. et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 301, 2553–2562 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Huxley, R., Ansary-Moghaddam, A., de Gonzalez, A. B., Barzi, F. & Woodward, M. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br. J. Cancer 92, 2076–2083 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Permert, J. et al. Is profound peripheral insulin resistance in patients with pancreatic cancer caused by a tumor-associated factor? Am. J. Surg. 165, 61–66 (1993).

    CAS  PubMed  Google Scholar 

  62. Lowenfels, A. B. et al. Pancreatitis and the risk of pancreatic cancer. N. Engl. J. Med. 328, 1433–1437 (1993).

    CAS  PubMed  Google Scholar 

  63. Yang, P. et al. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur. J. Cancer 45, 2867–2873 (2009).

    PubMed  Google Scholar 

  64. Leung, W. K. et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol. 9, 279–287 (2008).

    PubMed  Google Scholar 

  65. Goldblum, J. R. et al. Helicobacter pylori infection, not gastroesophageal reflux, is the major cause of inflammation and intestinal metaplasia of gastric cardiac mucosa. Am. J. Gastroenterol. 97, 302–311 (2002).

    PubMed  Google Scholar 

  66. Kelley, J. R. & Duggan, J. M. Gastric cancer epidemiology and risk factors. J. Clin. Epidemiol. 56, 1–9 (2003).

    PubMed  Google Scholar 

  67. Wistuba, I. I. & Gazdar, A. F. Gallbladder cancer: Lessons from a rare tumour. Nat. Rev. Cancer 4, 695–706 (2004).

    CAS  PubMed  Google Scholar 

  68. Engeland, A., Tretli, S., Austad, G. & Bjorge, T. Height and body mass index in relation to colorectal and gallbladder cancer in two million Norwegian men and women. Cancer Causes Control 16, 987–996 (2005).

    PubMed  Google Scholar 

  69. Hsing, A. W. et al. Body size and the risk of biliary tract cancer: a population-based study in China. Br. J. Cancer 99, 811–815 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Stampfer, M. J., Maclure, K. M., Colditz, G. A., Manson, J. E. & Willett, W. C. Risk of symptomatic gallstones in women with severe obesity. Am. J. Clin. Nutr. 55, 652–658 (1992).

    CAS  PubMed  Google Scholar 

  71. Lazcano-Ponce, E. C. et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J. 51, 349–364 (2001).

    CAS  Google Scholar 

  72. Warren, B. L. & Marais, A. W. Carcinoma of the gallbladder: a possible regional predisposition in the western Cape and the northern Cape. S. Afr. J. Surg. 33, 161–164 (1995).

    CAS  PubMed  Google Scholar 

  73. Shrikhande, S. V., Barreto, S. G., Singh, S., Udwadia, T. E. & Agarwal, A. K. Cholelithiasis in gallbladder cancer: coincidence, cofactor, or cause! Eur. J. Surg. Oncol. 36, 514–519 (2010).

    CAS  PubMed  Google Scholar 

  74. Randi, G., Franceschi, S. & La Vecchia, C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int. J. Cancer 118, 1591–1602 (2006).

    CAS  PubMed  Google Scholar 

  75. Mohandas, K. M. & Patil, P. S. Cholecystectomy for asymptomatic gallstones can reduce gall bladder cancer mortality in northern Indian women. Ind. J. Gastroenterol. 25, 147–151 (2006).

    CAS  Google Scholar 

  76. Duarte, I., Llanos, O., Domke, H., Harz, C. & Valdivieso, V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 72, 1878–1884 (1993).

    CAS  PubMed  Google Scholar 

  77. Lim, S. H. et al. Is metabolic syndrome one of the risk factors for gallbladder polyps Found by ultrasonography during health screening? Gut Liver 1, 138–144 (2007).

    PubMed  PubMed Central  Google Scholar 

  78. Segawa, K. et al. Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am. J. Gastroenterol. 87, 630–633 (1992).

    CAS  PubMed  Google Scholar 

  79. Liew, P. L. et al. Gallbladder disease among obese patients in Taiwan. Obes. Surg. 17, 383–390 (2007).

    PubMed  Google Scholar 

  80. Patel, T. Worldwide trends in mortality from biliary tract malignancies. BMC Cancer 2, 10 (2002).

    PubMed  PubMed Central  Google Scholar 

  81. Grainge, M. J., West, J., Solaymani-Dodaran, M., Aithal, G. P. & Card, T. R. The antecedents of biliary cancer: a primary care case-control study in the United Kingdom. Br. J. Cancer 100, 178–180 (2008).

    PubMed  PubMed Central  Google Scholar 

  82. Welzel, T. M. et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin. Gastroenterol. Hepatol. 5, 1221–1228 (2007).

    PubMed  PubMed Central  Google Scholar 

  83. Welzel, T. M. et al. Risk factors for intrahepatic cholangiocarcinoma in a low-risk population: a nationwide case-control study. Int. J. Cancer 120, 638–641 (2007).

    CAS  PubMed  Google Scholar 

  84. Starley, B. Q., Calcagno, C. J. & Harrison, S. A. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 51, 1820–1832 (2010).

    PubMed  Google Scholar 

  85. Liu, B., Balkwill, A., Reeves, G. & Beral, V. Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study. BMJ 340, c912 (2010).

    PubMed  PubMed Central  Google Scholar 

  86. Omagari, K. et al. Fatty liver in non-alcoholic non-overweight Japanese adults: incidence and clinical characteristics. J. Gastroenterol. Hepatol. 17, 1098–1105 (2002).

    PubMed  Google Scholar 

  87. Browning, J. D. et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40, 1387–1395 (2004).

    PubMed  Google Scholar 

  88. Machado, M., Marques-Vidal, P. & Cortez-Pinto, H. Hepatic histology in obese patients undergoing bariatric surgery. J. Hepatol. 45, 600–606 (2006).

    PubMed  Google Scholar 

  89. Saunders, D., Seidel, D., Allison, M. & Lyratzopoulos, G. Systematic review: the association between obesity and hepatocellular carcinoma—epidemiological evidence. Aliment. Pharmacol. Ther. 31, 1051–1063 (2010).

    CAS  PubMed  Google Scholar 

  90. Larsson, S. C. & Wolk, A. Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies. Br. J. Cancer 97, 1005–1008 (2007).

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Oh, S. W., Yoon, Y. S. & Shin, S. A. Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J. Clin. Oncol. 23, 4742–4754 (2005).

    PubMed  Google Scholar 

  92. Nair, S., Mason, A., Eason, J., Loss, G. & Perrillo, R. P. Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis? Hepatology 36, 150–155 (2002).

    PubMed  Google Scholar 

  93. Ohki, T. et al. Obesity is an independent risk factor for hepatocellular carcinoma development in chronic hepatitis C patients. Clin. Gastroenterol. Hepatol. 6, 459–464 (2008).

    PubMed  Google Scholar 

  94. Park, E. J. et al. Dietary and genetic obesity promote liver inflammation and tumorigenesis by enhancing IL-6 and TNF expression. Cell 140, 197–208 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  95. Ichikawa, T. et al. Two cases of non-alcoholic steatohepatitis with development of hepatocellular carcinoma without cirrhosis. J. Gastroenterol. Hepatol. 21, 1865–1866 (2006).

    PubMed  Google Scholar 

  96. Kawada, N. et al. Hepatocellular carcinoma arising from non-cirrhotic nonalcoholic steatohepatitis. J. Gastroenterol. 44, 1190–1194 (2009).

    PubMed  Google Scholar 

  97. Wellen, K. E. & Hotamisligil, G. S. Inflammation, stress, and diabetes. J. Clin. Invest. 115, 1111–1119 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  98. Roberts, D. L., Dive, C. & Renehan, A. G. Biological mechanisms linking obesity and cancer risk: new perspectives. Ann. Rev. Med. 61, 301–316 (2010).

    CAS  PubMed  Google Scholar 

  99. Lin, J. H. & Giovannucci, E. Sex hormones and colorectal cancer: what have we learned so far? J. Natl Cancer Inst. 102, 1746–1747 (2010).

    PubMed  PubMed Central  Google Scholar 

  100. Ley, R. E., Turnbaugh, P. J., Klein, S. & Gordon, J. I. Microbial ecology: human gut microbes associated with obesity. Nature 444, 1022–1023 (2006).

    CAS  PubMed  Google Scholar 

  101. Caesar, R., Fåk, F. & Bäckhed, F. Effects of gut microbiota on obesity and atherosclerosis via modulation of inflammation and lipid metabolism. J. Int. Med. 268, 320–328 (2010).

    CAS  Google Scholar 

  102. Cowey, S. & Hardy, R. W. The metabolic syndrome: a high-risk state for cancer? Am. J. Pathol. 169, 1505–1522 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Donohoe, C. L., Pidgeon, G. P., Lysaght, J. & Reynolds, J. V. Obesity and gastrointestinal cancer. Br. J. Surg. 97, 628–642 (2010).

    CAS  PubMed  Google Scholar 

  104. Renehan, A. G., Frystyk, J. & Flyvbjerg, A. Obesity and cancer risk: the role of the insulin-IGF axis. Trends Endocrinol. Metab. 17, 328–336 (2006).

    CAS  PubMed  Google Scholar 

  105. Larsson, S. C., Giovannucci, E. & Wolk, A. Diabetes and colorectal cancer incidence in the cohort of Swedish men. Diabetes Care 28, 1805–1807 (2005).

    PubMed  Google Scholar 

  106. Clayton, P. E., Banerjee, I., Murray, P. G. & Renehan, A. G. Growth hormone, the insulin-like growth factor axis, insulin and cancer risk. Nat. Rev. Endocrinol. 7, 11–24 (2011).

    CAS  PubMed  Google Scholar 

  107. Giovannucci, E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J. Nutr. 131, 3109S–3120S (2001).

    CAS  PubMed  Google Scholar 

  108. Corpet, D. E., Jacquinet, C., Peiffer, G. & Tache, S. Insulin injections promote the growth of aberrant crypt foci in the colon of rats. Nutr. Cancer 27, 316–320 (1997).

    CAS  PubMed  PubMed Central  Google Scholar 

  109. Samani, A. A., Yakar, S., LeRoith, D. & Brodt, P. The role of the IGF system in cancer growth and metastasis: overview and recent insights. Endocr. Rev. 28, 20–47 (2007).

    CAS  PubMed  Google Scholar 

  110. Sears, R. et al. Multiple Ras-dependent phosphorylation pathways regulate Myc protein stability. Genes Dev. 14, 2501–2514 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  111. Hursting, S. D. et al. Reducing the weight of cancer: mechanistic targets for breaking the obesity-carcinogenesis link. Best Pract. Res. Clin. Endocrinol. Metab. 22, 659–669 (2008).

    CAS  PubMed  Google Scholar 

  112. Hosono, K. et al. Metformin suppresses colorectal aberrant crypt foci in a short-term clinical trial. Cancer Prev. Res. 3, 1077–1083 (2010).

    CAS  Google Scholar 

  113. Tomimoto, A. et al. Metformin suppresses intestinal polyp growth in ApcMin/+ mice. Cancer Sci. 99, 2136–2141 (2008).

    CAS  PubMed  Google Scholar 

  114. Renehan, A. G. et al. Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet 363, 1346–1353 (2004).

    CAS  PubMed  Google Scholar 

  115. Schoen, R. E. et al. Insulin-like growth factor-I and insulin are associated with the presence and advancement of adenomatous polyps. Gastroenterology 129, 464–475 (2005).

    PubMed  Google Scholar 

  116. Renehan, A. G. et al. High-risk colorectal adenomas and serum insulin-like growth factors. Br. J. Surg. 88, 107–113 (2001).

    CAS  PubMed  Google Scholar 

  117. Flood, A. et al. Serum concentrations of insulin-like growth factor and insulin-like growth factor binding protein 3 and recurrent colorectal adenomas. Cancer Epidemiol. Biomarkers Prev. 17, 1493–1498 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  118. Wolpin, B. M. et al. Circulating insulin-like growth factor binding protein-1 and the risk of pancreatic cancer. Cancer Res. 67, 7923–7928 (2007).

    CAS  PubMed  Google Scholar 

  119. Bergmann, U., Funatomi, H., Yokoyama, M., Beger, H. G. & Korc, M. Insulin-like growth factor I overexpression in human pancreatic cancer: evidence for autocrine and paracrine roles. Cancer Res. 55, 2007–2011 (1995).

    CAS  PubMed  Google Scholar 

  120. Zhao, R., Macdonald, K. & Casson, A. G. Insulin-like growth factor type I receptor gene expression and obesity in esophageal adenocarcinoma. Mol. Carcinog. 48, 982–988 (2009).

    CAS  PubMed  Google Scholar 

  121. Hoyo, C. et al. IGF2R polymorphisms and risk of esophageal and gastric adenocarcinomas. Int. J. Cancer 125, 2673–2678 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  122. McElholm, A. R. et al. A population-based study of IGF axis polymorphisms and the esophageal inflammation, metaplasia, adenocarcinoma sequence. Gastroenterology 139, 204–212.e3 (2010).

    CAS  PubMed  Google Scholar 

  123. Park, H. S., Park, J. Y. & Yu, R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-[alpha] and IL-6. Diab. Res. Clin. Pract. 69, 29–35 (2005).

    CAS  Google Scholar 

  124. Nishimura, S. et al. CD8+ effector T cells contribute to macrophage recruitment and adipose tissue inflammation in obesity. Nat. Med. 15, 914–920 (2009).

    CAS  PubMed  Google Scholar 

  125. Feuerer, M. et al. Lean, but not obese, fat is enriched for a unique population of regulatory T cells that affect metabolic parameters. Nat. Med. 15, 930–939 (2009).

    CAS  PubMed  PubMed Central  Google Scholar 

  126. Balistreri, C. R., Caruso, C. & Candore, G. The role of adipose tissue and adipokines in obesity-related inflammatory diseases. Mediators Inflamm. 2010, 802078 (2010).

    PubMed  PubMed Central  Google Scholar 

  127. Song, M. J., Kim, K. H., Yoon, J. M. & Kim, J. B. Activation of Toll-like receptor 4 is associated with insulin resistance in adipocytes. Biochem. Biophys. Res. Commun. 346, 739–745 (2006).

    CAS  PubMed  Google Scholar 

  128. Balkwill, F., Charles, K. A. & Mantovani, A. Smoldering and polarized inflammation in the initiation and promotion of malignant disease. Cancer Cell 7, 211–217 (2005).

    CAS  PubMed  Google Scholar 

  129. Poullis, A. Bowel inflammation as measured by faecal calprotectin: a link between lifestyle factors and colorectal cancer risk. Cancer Epidemiol. Biomarkers Prev. 13, 279–284 (2004).

    CAS  PubMed  Google Scholar 

  130. Pendyala, S., Neff, L. M., Suárez-Fariñas, M. & Holt, P. R. Diet-induced weight loss reduces colorectal inflammation: implications for colorectal carcinogenesis. Am. J. Clin. Nutr. 93, 234–242 (2011).

    CAS  PubMed  Google Scholar 

  131. Martínez, M. E. et al. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucosa. J. Natl Cancer Inst. 91, 950–953 (1999).

    PubMed  Google Scholar 

  132. Hotamisligil, G. S. Inflammation and metabolic disorders. Nature 444, 860–867 (2006).

    CAS  PubMed  Google Scholar 

  133. Tsilidis, K. K. et al. C-reactive protein and colorectal cancer risk: a systematic review of prospective studies. Int. J. Cancer 123, 1133–1140 (2008).

    CAS  PubMed  Google Scholar 

  134. Tsilidis, K. K. et al. C-reactive protein and colorectal adenoma in the CLUE II cohort. Cancer Causes Control 19, 559–567 (2008).

    PubMed  Google Scholar 

  135. Kim, S. et al. Circulating levels of inflammatory cytokines and risk of colorectal adenomas. Cancer Res. 68, 323–328 (2008).

    CAS  PubMed  PubMed Central  Google Scholar 

  136. Considine, R. V. et al. Serum immunoreactive leptin concentrations in normal-weight and obese humans. N. Engl. J. Med. 334, 292–295 (1996).

    CAS  PubMed  Google Scholar 

  137. Aloulou, N. et al. Involvement of the leptin receptor in the immune response in intestinal cancer. Cancer Res. 68, 9413–9422 (2008).

    CAS  PubMed  Google Scholar 

  138. Liu, Z. H., Uesaka, T., Watanabe, H. & Kato, N. High fat diet enhances colonic cell proliferation and carcinogenesis in rats by elevating serum leptin. Int. J. Oncol. 19, 1009–1014 (2001).

    CAS  PubMed  Google Scholar 

  139. Rouet-Benzineb, P. et al. Leptin counteracts sodium butyrate-induced apoptosis in human colon cancer HT-29 cells via NF-kappaB signaling. J. Biol. Chem. 279, 16495–16502 (2004).

    CAS  PubMed  Google Scholar 

  140. Hirose, Y. et al. Enhancement of development of azoxymethane-induced colonic premalignant lesions in C57BL/KsJ-db/db mice. Carcinogenesis 25, 821–825 (2004).

    CAS  PubMed  Google Scholar 

  141. Ogunwobi, O., Mutungi, G. & Beales, I. L. P. Leptin stimulates proliferation and inhibits apoptosis in Barrett's esophageal adenocarcinoma cells by cyclooxygenase-2-dependent, prostaglandin-E2-mediated transactivation of the epidermal growth factor receptor and c-Jun NH2-terminal kinase activation. Endocrinology 147, 4505–4516 (2006).

    CAS  PubMed  Google Scholar 

  142. Chia, V. M. et al. Leptin concentrations, leptin receptor polymorphisms, and colorectal adenoma risk. Cancer Epidemiol. Biomarkers Prev. 16, 2697–2703 (2007).

    CAS  PubMed  Google Scholar 

  143. Stattin, P. et al. Plasma leptin and colorectal cancer risk: a prospective study in Northern Sweden. Oncol. Rep. 10, 2015–2021 (2003).

    PubMed  Google Scholar 

  144. Stattin, P. et al. Obesity and colon cancer: does leptin provide a link? Int. J. Cancer 109, 149–152 (2004).

    CAS  PubMed  Google Scholar 

  145. Kendall, B. J. et al. Leptin and the risk of Barrett's oesophagus. Gut 57, 448–454 (2008).

    CAS  PubMed  Google Scholar 

  146. Wang, S. N., Lee, K. T. & Ker, C. G. Leptin in hepatocellular carcinoma. World J. Gastroenterol. 16, 5801–5809 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  147. Arita, Y. et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem. Biophys. Res. Commun. 257, 79–83 (1999).

    CAS  PubMed  Google Scholar 

  148. Sugiyama, M. et al. Adiponectin inhibits colorectal cancer cell growth through the AMPK/mTOR pathway. Int. J. Oncol. 34, 339–344 (2009).

    CAS  PubMed  Google Scholar 

  149. Otani, K. et al. Adiponectin suppresses tumorigenesis in Apc(Min/+) mice. Cancer Lett. 288, 177–182 (2010).

    CAS  PubMed  Google Scholar 

  150. Takahashi, H. et al. Association of visceral fat accumulation and plasma adiponectin with rectal dysplastic aberrant crypt foci in a clinical population. Cancer Sci. 100, 29–32 (2009).

    CAS  PubMed  Google Scholar 

  151. Wei, E. K., Giovannucci, E., Fuchs, C. S., Willett, W. C. & Mantzoros, C. S. Low plasma adiponectin levels and risk of colorectal cancer in men: A prospective study. J. Natl Cancer Inst. 97, 1688–1694 (2005).

    CAS  PubMed  Google Scholar 

  152. Nakajima, T. E. et al. Adipocytokines as new promising markers of colorectal tumors: adiponectin for colorectal adenoma, and resistin and visfatin for colorectal cancer. Cancer Sci. 101, 1286–1291 (2010).

    CAS  PubMed  Google Scholar 

  153. Yamaji, T., Iwasaki, M., Sasazuki, S. & Tsugane, S. Interaction between adiponectin and leptin Influences the risk of colorectal adenoma. Cancer Res. 70, 5430–5437 (2010).

    CAS  PubMed  Google Scholar 

  154. Otake, S. et al. Decreased levels of plasma adiponectin associated with increased risk of colorectal cancer. World J. Gastroenterol. 16, 1252–1257 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  155. Ishikawa, M. et al. Plasma adiponectin and gastric cancer. Clin. Cancer Res. 11, 466–472 (2005).

    CAS  PubMed  Google Scholar 

  156. Otani, K. et al. Adiponectin receptors are downregulated in human gastric cancer. J. Gastroenterol. 45, 918–927 (2010).

    CAS  PubMed  Google Scholar 

  157. Konturek, P. C., Burnat, G., Rau, T., Hahn, E. G. & Konturek, S. Effect of adiponectin and ghrelin on apoptosis of barrett adenocarcinoma cell line. Dig. Dis. Sci. 53, 597–605 (2008).

    CAS  PubMed  Google Scholar 

  158. Sharma, D. et al. Adiponectin antagonizes the oncogenic actions of leptin in hepatocellular carcinogenesis. Hepatology 52, 1713–1722 (2010).

    CAS  PubMed  Google Scholar 

  159. Backhed, F. et al. The gut microbiota as an environmental factor that regulates fat storage. Proc. Natl Acad. Sci. USA 101, 15718–15723 (2004).

    PubMed  PubMed Central  Google Scholar 

  160. Backhed, F., Manchester, J. K., Semenkovich, C. F. & Gordon, J. I. Mechanisms underlying the resistance to diet-induced obesity in germ-free mice. Proc. Natl Acad. Sci. USA 104, 979–984 (2007).

    CAS  PubMed  PubMed Central  Google Scholar 

  161. Furet, J. P. et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes 59, 3049–3057 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  162. Shen, X. J. et al. Molecular characterization of mucosal adherent bacteria and associations with colorectal adenomas. Gut Microbes 1, 138–147 (2010).

    PubMed  PubMed Central  Google Scholar 

  163. Vannucci, L. et al. Colorectal carcinogenesis in germ-free and conventionally reared rats: different intestinal environments affect the systemic immunity. Int. J. Oncol. 32, 609–617 (2008).

    PubMed  Google Scholar 

  164. Martin, H. M. et al. Enhanced Escherichia coli adherence and invasion in Crohn's disease and colon cancer. Gastroenterology 127, 80–93 (2004).

    CAS  PubMed  Google Scholar 

  165. Swidsinski, A. et al. Association between intraepithelial Escherichia coli and colorectal cancer. Gastroenterology 115, 281–286 (1998).

    CAS  PubMed  Google Scholar 

  166. Cani, P. D. et al. Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes 56, 1761–1772 (2007).

    CAS  PubMed  Google Scholar 

  167. Parker, E. D. & Folsom, A. R. Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study. Int. J. Obes. Relat. Metab. Disord. 27, 1447–1452 (2003).

    CAS  PubMed  Google Scholar 

  168. Rapp, K. et al. Weight change and cancer risk in a cohort of more than 65 000 adults in Austria. Ann. Oncol. 19, 641–648 (2008).

    CAS  PubMed  Google Scholar 

  169. St. George, A. et al. Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors. J. Gastroenterol. Hepatol. 24, 399–407 (2009).

    CAS  PubMed  Google Scholar 

  170. Stewart, L. K. et al. The influence of exercise training on inflammatory cytokines and C-reactive protein. Med. Sci. Sports Exerc. 39, 1714–1719 (2007).

    CAS  PubMed  Google Scholar 

  171. Rankin, J. W. & Turpyn, A. D. Low carbohydrate, high fat diet increases C-reactive protein during weight loss. J. Am. Coll. Nutr. 26, 163–169 (2007).

    CAS  PubMed  Google Scholar 

  172. Tammariello, A. E. & Milner, J. A. Mouse models for unraveling the importance of diet in colon cancer prevention. J. Nutr. Biochem. 21, 77–88 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  173. Johnson, N. A. et al. Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology 50, 1105–1112 (2009).

    CAS  PubMed  Google Scholar 

  174. Kirkegaard, H. et al. Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study. BMJ 341, c5504 (2010).

    PubMed  PubMed Central  Google Scholar 

  175. Sjöström, L. et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 10, 653–662 (2009).

    PubMed  Google Scholar 

  176. Adams, T. D. et al. Cancer incidence and mortality after gastric bypass surgery. Obesity 17, 796–802 (2009).

    PubMed  Google Scholar 

  177. Christou, N. V., Lieberman, M., Sampalis, F. & Sampalis, J. S. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg. Obes. Relat. Dis. 4, 691–695 (2008).

    PubMed  Google Scholar 

  178. Plecka-Ostlund, M. Risk of obesity-related cancer after obesity surgery in a population-based cohort study. Ann. Surg. 252, 972–976 (2010).

    Google Scholar 

  179. Prizment, A. E., Flood, A., Anderson, K. E. & Folsom, A. R. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women's Health Study. Cancer Epidemiol. Biomarkers Prev. 19, 2229–2237 (2010).

    PubMed  PubMed Central  Google Scholar 

  180. Haydon, A. M. M., MacInnis, R. J., English, D. R. & Giles, G. G. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55, 62–67 (2006).

    CAS  PubMed  PubMed Central  Google Scholar 

  181. Wu, Y. J. et al. Insulin-like growth factor-I regulates the liver microenvironment in obese mice and promotes liver metastasis. Cancer Res. 70, 57–67 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  182. Earl, T. M. et al. Silencing of TLR4 decreases liver tumor burden in a murine model of colorectal metastasis and hepatic steatosis. Ann. Surg. Oncol. 16, 1043–1050 (2009).

    CAS  PubMed  Google Scholar 

  183. Benoist, S., Panis, Y., Alves, A. & Valleur, P. Impact of obesity on surgical outcomes after colorectal resection. Am. J. Surg. 179, 275–281 (2000).

    CAS  PubMed  Google Scholar 

  184. Meyerhardt, J. A. et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from intergroup trial 0114. J. Clin. Oncol. 22, 648–657 (2004).

    PubMed  Google Scholar 

  185. Moon, H. G. et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann. Surg. Oncol. 15, 1918–1922 (2008).

    PubMed  Google Scholar 

  186. Meyerhardt, J. A. et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98, 484–495 (2003).

    PubMed  Google Scholar 

  187. Dignam, J. J. et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J. Natl Cancer Inst. 98, 1647–1654 (2006).

    PubMed  Google Scholar 

  188. Guiu, B. et al. Visceral fat area is an independent predictive biomarker of outcome after first-line bevacizumab-based treatment in metastatic colorectal cancer. Gut 59, 341–347 (2010).

    CAS  PubMed  Google Scholar 

  189. Grotenhuis, B. A. et al. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World J. Surg. 34, 2621–2627 (2010).

    CAS  PubMed  PubMed Central  Google Scholar 

  190. Healy, L. A. et al. Impact of obesity on outcomes in the management of localized adenocarcinoma of the esophagus and esophagogastric junction. J. Thorac. Cardiovasc. Surg. 134, 1284–1291 (2007).

    PubMed  Google Scholar 

  191. Scipione, C. N., Chang, A. C., Pickens, A., Lau, C. L. & Orringer, M. B. Transhiatal esophagectomy in the profoundly obese: implications and experience. Ann. Thorac. Surg. 84, 376–383 (2007).

    PubMed  Google Scholar 

  192. Melis, M. et al. An elevated body mass index does not reduce survival after esophagectomy for cancer. Ann. Surg. Oncol. doi:10.1245/s10434-010-1336-1.

    PubMed  PubMed Central  Google Scholar 

  193. Oh, S. J. et al. Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J. Gastroenterol. Hepatol. 24, 475–479 (2009).

    PubMed  Google Scholar 

  194. Tokunaga, M. et al. Better 5-year survival rate following curative gastrectomy in overweight patients. Ann. Surg. Oncol. 16, 3245–3251 (2009).

    PubMed  Google Scholar 

  195. Zyromski, N. J. et al. Obesity potentiates the growth and dissemination of pancreatic cancer. Surgery 146, 258–263 (2009).

    PubMed  Google Scholar 

  196. Noun, R. et al. The impact of obesity on surgical outcome after pancreaticoduodenectomy. JOP 9, 468–476 (2008).

    PubMed  Google Scholar 

  197. Rosso, E. et al. The role of “fatty pancreas” and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J. Gastrointest. Surg. 13, 1845–1851 (2009).

    PubMed  Google Scholar 

  198. Lermite, E. et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J. Am. Coll. Surg. 204, 588–596 (2007).

    PubMed  Google Scholar 

  199. Fleming, J. B. et al. Influence of obesity on cancer-related outcomes after pancreatectomy to treat pancreatic adenocarcinoma. Arch. Surg. 144, 216–221 (2009).

    PubMed  Google Scholar 

  200. Tsai, S. et al. Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: a large single-institution study. J. Gastrointest. Surg. 14, 1143–1150 (2010).

    PubMed  Google Scholar 

  201. de Vries, E. et al. Lifestyle changes and reduction of colon cancer incidence in Europe: a scenario study of physical activity promotion and weight reduction. Eur. J. Cancer 46, 2605–2616 (2010).

    CAS  PubMed  Google Scholar 

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Acknowledgements

Work on the link between obesity, weight loss and cancer risk in the authors' laboratory is funded by the Medical Research Council (UK) Medical Research Foundation.

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  1. Leeds Institute of Molecular Medicine, University of Leeds, Wellcome Trust Brenner Building, St. James's University Hospital, Beckett Street, LS9 7TF, Leeds, UK

    Prashant Kant & Mark A. Hull

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Kant, P., Hull, M. Excess body weight and obesity—the link with gastrointestinal and hepatobiliary cancer. Nat Rev Gastroenterol Hepatol 8, 224–238 (2011). https://doi.org/10.1038/nrgastro.2011.23

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