TY - JOUR
T1 - Association between weight loss and serum biomarkers with risk of incident cancer in the Longitudinal Assessment of Bariatric Surgery cohort
AU - Stroud, Andrea M.
AU - Dewey, Elizabeth N.
AU - Husain, Farah A.
AU - Fischer, Jared M.
AU - Courcoulas, Anita P.
AU - Flum, David R.
AU - Mitchell, James E.
AU - Pories, Walter J.
AU - Purnell, Jonathan Q.
AU - Wolfe, Bruce
N1 - Funding Information:
We would like to acknowledge the extensive contributions of Carrie Nielson, Ph.D. She consulted on project development, study design, and data analysis and interpretation, while she was Associate Professor of Epidemiology in the OHSU-PSU School of Public Health. The Longitudinal Assessment of Bariatric Surgery-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: Data Coordinating Center – U01 DK066557; Columbia-Presbyterian - U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, Grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University – U01-DK66526; University of Pittsburgh Medical Center – U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health & Science University – U01-DK66555. No additional funding was obtained for this study.
Funding Information:
We would like to acknowledge the extensive contributions of Carrie Nielson, Ph.D. She consulted on project development, study design, and data analysis and interpretation, while she was Associate Professor of Epidemiology in the OHSU-PSU School of Public Health. The Longitudinal Assessment of Bariatric Surgery-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: Data Coordinating Center ? U01 DK066557; Columbia-Presbyterian - U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, Grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University ? U01-DK66526; University of Pittsburgh Medical Center ? U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health & Science University ? U01-DK66555. No additional funding was obtained for this study. The authors have no commercial associations that might be a conflict of interest in relation to this article.
Publisher Copyright:
© 2020 American Society for Bariatric Surgery
PY - 2020/8
Y1 - 2020/8
N2 - 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.
AB - 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.
KW - Bariatric surgery
KW - Cancer
KW - Diabetes
KW - Weight loss
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U2 - 10.1016/j.soard.2020.04.012
DO - 10.1016/j.soard.2020.04.012
M3 - Article
C2 - 32471725
AN - SCOPUS:85085516613
SN - 1550-7289
VL - 16
SP - 1086
EP - 1094
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 8
ER -