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Cancer prevention through weight control—where are we in 2020?

Abstract

Growing data from epidemiological studies highlight the association between excess body fat and cancer incidence, but good indicative evidence demonstrates that intentional weight loss, as well as increasing physical activity, offers much promise as a cost-effective approach for reducing the cancer burden. However, clear gaps remain in our understanding of how changes in body fat or levels of physical activity are mechanistically linked to cancer, and the magnitude of their impact on cancer risk. It is important to investigate the causal link between programmes that successfully achieve short-term modest weight loss followed by weight-loss maintenance and cancer incidence. The longer-term impact of weight loss and duration of overweight and obesity on risk reduction also need to be fully considered in trial design. These gaps in knowledge need to be urgently addressed to expedite the development and implementation of future cancer-control strategies. Comprehensive approaches to trial design, Mendelian randomisation studies and data-linkage opportunities offer real possibilities to tackle current research gaps. In this paper, we set out the case for why non-pharmacological weight-management trials are urgently needed to support cancer-risk reduction and help control the growing global burden of cancer.

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Fig. 1: Expected effects of lowering BMI on cancer risk—how Mendelian Randomisation can guide research.

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Acknowledgements

The authors thank to Ms Jill Hampton and Mrs Mary Burke for the paper co-ordination and preparation and Ms Fiona Davies for organisation of meetings and discussion sessions.

the UK NIHR Cancer and Nutrition Collaboration (Population Health Stream)

Annie Anderson10, Rebecca Beeken11, Janet Cade12, Amanda Cross13, Angela King14, Richard Martin15, Giota Mitrou16, Elio Riboli17, John Saxton18, Andrew Renehan19

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A.S.A. led the paper drafting, original concept, paper structure and drafting. A.G.R., J.M.S., J.B., J.C., A.J.C., A.K., E.R., F.S., S.T. and R.M.M. were involved in the original concept, paper structure and drafting. All authors approved the final version of the paper.

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Correspondence to Annie S. Anderson.

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R.M.M. reports grants from CRUK, during the conduct of the study, S.T. reports grants from the Scottish Government, during the conduct of the study and J.C. reports and she is the Director of Dietary Assessment Ltd. A.S.A., A.K., F.S., A.G.R., A.J.C., J.S., J.B. and E.R. declare no competing interest.

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This work was supported by the NIHR Cancer and Nutrition Collaboration. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. R.M.M. is supported by a Cancer Research UK programme grant (C18281/A19169) and by the National Institute for Health Research (NIHR) Bristol Biomedical Research Centre. The National Institute for Health Research (NIHR) Bristol Biomedical Research Centre is funded by the National Institute for Health Research and is a partnership between University Hospitals Bristol NHS Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. He is also part of the Medical Research Council Integrative Epidemiology Unit at the University of Bristol supported by the Medical Research Council (MC_UU_12013/1, MC_UU_12013/2 and MC_UU_12013/3) and the University of Bristol. A.G.R. is supported by the Manchester NIHR Biomedical Research Centre (IS-BRC-1215-20007).

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Note This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

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Additional Information Expected effects of lowering BMI on cancer risk—how Mendelian Randomisation can guide research (Fig. 1).

Note This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

These members were involved in work stream discussions but were not involved with the drafting of the publication: Rebecca Beeken, Giota Mitrou.

The Population Health Cancer Stream exists to promote research on key nutrition-related factors in the prevention of cancer. These are; diet and nutrition, alcohol, physical activity and obesity. In calling for more research, the group is addressing an urgent need for more effective cancer prevention strategies and interventions. We do not assign any judgement or stigma to any groups or individuals on the basis of their lifestyle.

Members of the UK NIHR Cancer and Nutrition Collaboration (Population Health Stream) are listed above Acknowledgements.

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Anderson, A.S., Renehan, A.G., Saxton, J.M. et al. Cancer prevention through weight control—where are we in 2020?. Br J Cancer 124, 1049–1056 (2021). https://doi.org/10.1038/s41416-020-01154-3

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