Obesity, metabolic syndrome and esophageal adenocarcinoma: epidemiology, etiology and new targets.
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Authors
Ryan, Aoife MDuong, Michelle
Healy, Laura
Ryan, Stephen A
Parekh, Niyati
Reynolds, John V
Power, Derek G
Affiliation
Department of Nutrition, Food Studies & Public Health, New York University, New York, NY 10044, USA. aoife.ryan1@gmail.comIssue Date
2011-08
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Obesity, metabolic syndrome and esophageal adenocarcinoma: epidemiology, etiology and new targets. 2011, 35 (4):309-19 Cancer EpidemiolJournal
Cancer epidemiologyDOI
10.1016/j.canep.2011.03.001PubMed ID
21470937Abstract
Rates of distal and junctional adenocarcinomas are increasing in Western countries.Systematic review of epidemiological evidence linking obesity to esophageal adenocarcinoma (EA) was performed for studies published from 2005 to 2010. The current understanding of obesity's role in the etiology and potential dysplastic progression of Barrett's esophagus (BE) to EA is reviewed.
Accumulating epidemiological studies provide evidence of obesity's role as a driving force behind the increasing rates of EA. The simplest construct is that obesity promotes reflux, causing chronic inflammation and BE, predisposing to adenocarcinoma. However, as obesity is positively associated with the prevalence of many cancers, other mechanisms are important. A link may exist between fat distribution patterns and the risk of BE and EA. Altered metabolic profiles in the metabolic syndrome (MetS) may be a key factor in cell cycle/genetic abnormalities that mark the progression of BE towards cancer. Research highlighting a unique role of MetS in the length of BE, and its association with systemic inflammation and insulin resistance is discussed, as well as adipokine receptor expression in both BE and esophageal epithelium, and how MetS and the systemic response impacts on key regulators of inflammation and tumorigenesis. CONCLUSIONS/IMPACT: Obesity is positively associated with EA. The systemic inflammatory state consequent on the altered metabolism of obese patients, and the associated impact of adipocytokines and pro-coagulant factors released by adipocytes in central fat, may underlie obesity's relationship to this cancer. Novel therapeutic agents that may antagonize adipo-cytokines and potentially offer a promising role in cancer therapy are discussed.
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ArticleLanguage
enISSN
1877-783Xae974a485f413a2113503eed53cd6c53
10.1016/j.canep.2011.03.001
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