Adipositas und Krebs

Adipositas erhöht nicht nur das Risiko für Typ-2-Diabetes und Herz-Kreislauf-Komplikationen, auch Tumorerkrankungen sind eine mögliche Folge von Adipositas. Adipositas ist mit einem erhöhten Risiko assoziiert, an bestimmten Krebsarten zu erkranken, wobei das Krebsspektrum geschlechtsspezifische Unterschiede aufweist. Die Tatsache, dass in Deutschland zwei Drittel der Männer und die Hälfte der Frauen adipös sind, unterstreicht die gesundheitspolitische, ökonomische und gesellschaftliche Relevanz des Volksleidens Adipositas.

Abstract

The incidence of obesity in the western world has grown dramatically during the recent decades. Epidemiological data suggest that obesity is associated with an increased risk of several, but not all types of cancer, with marked gender-specific differences. The underlying mechanisms are still a matter of debate. This review focuses on the potential factors linking obesity to cancer. Current experimental evidence suggests that insulin resistance and a chronic, subclinical inflammation in the visceral fat are the major metabolic events causing alterations in the levels of insulin, glucose, free fatty acids, insulin-like growth factors, adipose tissue-derived proinflammatory cytokines and other bioactive molecules such as adipokines, vascular endothelial growth factor (VEGF), sex hormones, gut microbiota, and secondary bile acids. All these factors may act directly or indirectly on the tumor microenvironment to drive tumor progression via stimulation of cell survival/antiapoptosis, cell proliferation, angiogenesis, and invasion/metastasis of the cancer cells. A therapeutic strategy that targets dysfunctional and/or inflamed fat and that has been shown to benefit patients is mainly represented by bariatric surgery, while other cell or hormone-directed interventions such as the pharmacological modulation of serum adipokine levels are still theoretical and need to be evaluated for their ability to successfully treat or prevent obesity-related cancers.

Kernaussagen

• Adipositas erhöht das Risiko für Typ-2-Diabetes und Herz-Kreislauf-Komplikationen, auch Tumorerkrankungen können eine Langzeitfolge von Adipositas sein; darüber hinaus chronische Niereninsuffizienz, Erkrankungen des Bewegungsapparates, neuropsychiatrische und psychosoziale Folgen.

• Adipositas ist mit einem erhöhten Risiko assoziiert, an bestimmten (aber nicht allen) Krebsarten zu erkranken.

• Das Spektrum der Krebserkrankungen, die durch Adipositas beeinflusst sind, weist geschlechtsspezifische Unterschiede auf.

• Neben anthropometrischen Parametern wie Body-Mass-Index, Gewichtszunahme, dem Anteil an viszeralem Fettgewebe sowie Lifestyle-Faktoren wie Ernährung und körperliche Aktivität haben biologische Mechanismen Einfluss auf das Krebsrisiko von adipösen Menschen:

  • Hyperinsulinämie

  • Insulinresistenz

  • Insulin-ähnliche Wachstumsfaktoren und ihre Bindungsproteine

  • Sexualhormone

  • viszerales Fettgewebe

  • Adipokine

  • chronische Low-Grade-inflammatorische Prozesse

  • Störungen der intestinalen Mikrobiota

  • Gallensäuren

• Adipositas wirkt sich primär auf das Erkrankungsrisiko, nicht aber die Überlebenswahrscheinlichkeit für bestimmte Krebsarten aus.

• Während die bariatrische Chirurgie einen therapeutischen Nutzen in Hinblick auf die Krebsinzidenz zu bringen scheint, müssen pharmakologische Interventionen noch auf ihre Eignung evaluiert werden.

Schlüsselwörter

Krebs - Adipositas - Entzündung - Adipokine - viszerales Fettgewebe

Keywords

cancer - obesity - inflammation - adipokines - visceral fat

Publication History

Article published online:
04 April 2022

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