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By Dr. Priyom Bose, Ph.D. Nov 23 2023 Reviewed by Lily Ramsey, LLM

It is unclear whether the risk of cancer associated with a higher body mass index (BMI) varies across individuals with and without type 2 diabetes (T2D) and cardiovascular diseases (CVD).

A recent BMC Medicine study analyzed the joint and individual correlations of CVD/T2D and BMI with cancer risk. 

Study:  Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies . Image Credit: urbans/Shutterstock.com Background

The problem of being overweight and obese has risen sharply globally in recent decades. This has increased the chances of non-communicable diseases (NCDs), such as T2D, CVD, and cancer. The BMI is a commonly accepted measure of body fatness, which raises the risk of several types of cancer.  

Recent research has shown that CVD could independently drive certain cancers despite accounting for shared risk factors, such as BMI. Cancer, CVD, and T2D biological pathways, e.g., oxidative stress and inflammation, are common.

Taken together, it may be hypothesized that cardio-metabolic diseases (CMDs) could worsen the adverse effects of obesity and being overweight in the development of cancer. However, it must be highlighted that this linkage is not completely clear. 

Prior studies gave little attention to CMD and solely focussed on the cancer-BMI correlation in the general population. Additionally, joint associations between CMD and overweight/obesity with cancer have not been widely studied. About the study

The present study is a meta-analysis of two cohort studies. These are the European Prospective Investigation into Cancer and Nutrition (EPIC) and the UK Biobank (UKB). The sample comprised 577,343 adults free of CVD, T2D, and cancer at the time of recruitment.  Related StoriesStatins may reduce breast cancer mortality ratesAI tools show promise in personalized cancer treatment, but lag behind human expertsAI model predicts patient outcomes across multiple cancer types

Cox proportional hazard regressions were used to estimate multivariable-adjusted hazard ratios (HRs). HRs and 95% CIs for joint and separate correlations between overweight/obesity and CMD status were also estimated.

The relative excess risk due to interaction (RERI) was used to quantify an additive interaction. As a secondary outcome, total cancer or all cancers combined was also studied.  Key findings

It was noted that the sum of separate associations of obesity and CVD with cancer risk was lower than their joint association. Overall, this finding was consistent across the EPIC and UKB for all types of cancer.

However, this association is held only in the UKB for obesity-related cancer risk. This result implies that reducing obesity could lead to a reduction in cancer risk among individuals with CVD. 

The variability in cancer risk among patients with CMD is not well understood. Targeting this knowledge gap, it was shown that high BMI and cancer risk were equally associated in individuals with and without CMDs. It should be noted that no association between cancer risk and BMI was noted in the population group with T2D only. 

This study provided new evidence of an additive interaction between CVD and obesity/overweight, with respect to obesity-related and overall cancers. It is imperative to understand why certain diseases cluster and how the clustering affects the disease burdens in different groups of individuals. 

A common risk factor for CMD and cancer is excessive body weight. This could be one reason why these diseases tend to cluster. Mechanisms underlying the fat-cancer link could be increased insulin levels, altered sex hormone metabolism, and adipokine pathophysiology.

These mechanisms could also potentially explain the T2D-cancer link. On the contrary, the CVD-cancer link is less well-understood.  Conclusions

In sum, this study showed that higher BMI was associated with a greater risk of cancer, irrespective of the CMD status. The results indicate that prevention of obesity could lead to a higher reduction in cancer risk in individuals with CVD compared to the general population.

The key strength of the study is its use of two large prospective cohorts across multiple European countries and validated assessments of T2D, cancer, and CVD. The time-varying modeling of associations and sensitivity analyses to reduce biases also strengthen the analysis. 

One limitation of the study was around the inability to consider changes in modifiable habits at the follow-up stage. Metformin, used to treat T2D, can lead to weight loss and reduce obesity.

The use of metformin could not be accounted for in the EPIC data. The results could also have been influenced by selection bias, owing to including only participants without CMD. A key limitation of the UKB should also be highlighted here regarding its very low response rate. 

The generalizability of the findings could also be a cause for concern because the UKB sample was less socioeconomically deprived, showed a lower presence of long-term conditions, and fewer risk factors compared to the general UK population.

Furthermore, BMI may not be an ideal measure of fat because it neither captures fat distribution nor distinguishes between fat and lean mass. Future studies should improve upon this by using detailed body composition assessments. Journal reference:

Fontvieille, E. et al. (2023) Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies. BMC Medicine. 21(418). doi: https://doi.org/10.1186/s12916-023-03114-z. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03114-z

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Under siege in Ukraine, schools go underground to keep life as normal as possible for children

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Under siege in Ukraine, schools go underground to keep life as normal as possible for children

If you know a teacher, or you are a teacher, you’ll understand that many in the profession consider their jobs one of the best in the world, while also acknowledging it can be one of the most stressful.

Teaching in a war zone takes it to another level on both fronts.

But imagine teaching in a war zone in say the London Underground or the Paris or New York metros?

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Students learning in lessons

Well, that’s exactly what is happening in Kharkiv, Ukraine’s second largest city – a city attacked by Russia on a constant basis.

In 2023, the authorities banned children from being taught in regular school buildings here because of the threat they were under from missile strikes.

So Kharkiv city and its education department started working on a plan.

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That plan has concluded with the construction of six schools in six metro stations, teaching 4,800 children daily whose families haven’t fled the war.

Intrigued by this new educational experiment, as it’s still considered, we were told to meet at the University metro station in the centre of the city and wait to be taken to the school.

Soviet-era metro stations, and particularly the platforms, are universally grand and ornate, although Ukraine’s are slightly more modest.

A young child at school in Kharkiv's underground system
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A young child at his desk in the underground school

The school (left) and the metro system (right)
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The school (left) and the metro system (right)

Pedestrian walkways though are always crammed with florists, newspaper stands, mobile phone shops and cafes, and Kharkiv’s are no different.

What is different though is that next to the main platform entrance, an adjacent passageway has been sealed off by a white wall with three doors built into it.

We were ushered inside, past a guard and into a concourse with two desks.

Inside the classrooms in a city under siege
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Inside the classrooms in a city under siege

The classrooms are brightly decorated to try and maintain morale for the children
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The classrooms are brightly decorated to try and maintain morale for the children

In front of us, we could see a wide staircase leading to a long corridor. Above us, large, shiny silver metal tubes stretched into the distance, pumping in air from above ground.

Lining the corridor, we could see a series of white interconnecting cabins, all brightly lit, and from them, we could hear the sounds of children laughing, music, and teachers conducting class in this strange subterranean school.

Perhaps the only school in the world with one corridor.

A door to one of the classes opened, and in pairs, a class of six and seven-year-olds emerged – their teacher at the front and an assistant at the rear.

They’re heading to the bathroom for a toilet break, the staff must keep an eye on them.

If any of the children were to make it out of the school, they could easily get lost in the underground system.

The pupils are spread across seven classrooms with a mix of yellow and green desks and chairs, and walls decorated with bright pictures like rainbows, sunshine and sunflowers, to try to create a cheery atmosphere.

“At first, the children were bewildered by studying here, it felt unfamiliar to them, but interacting with each other and with their teachers helped them to adapt,” Iryna Tarasenko from Kharkiv’s education department told me.

Iryna Tarasenko from Kharkiv's education department
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Iryna Tarasenko from Kharkiv’s education department

Sky News chief correspondent Stuart Ramsay and Kharkiv education official Iryna Tarasenko
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Sky News’ Stuart Ramsay and Kharkiv education official Iryna Tarasenko

Iryna is showing me around the school. They feel it’s their way of contributing to the war effort.

She said: “In the summer of 2023, the Defence Council didn’t permit children to study in regular school buildings, so, we had to find a solution. This is our frontline – our educational frontline.”

There are of course health concerns for both the teachers and the pupils spending so much time underground, so medical examinations are done on a regular basis.

It is an opportunity for doctors and behavioural specialists to monitor the effects of this war on them.

Dmytro Mitelyov is the neurologist on duty monitoring the children’s behaviour, checking for any signs of stress – physical and mental.

He gently asks each child how they’re feeling, and asks if they have any aches and pains.

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Dmytro Mitelyov (centre), the neurologist on duty monitoring the children as they spend large parts of their days underground, speaks to a child
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Neurologist Dmytro Mitelyov (centre) monitors children as they spend large parts of their days underground

“These are children who haven’t left Kharkiv since the war began, they live in a constant state of stress, multifaceted stress caused by a range of factors. They are exposed to things they see and hear, like alarms, explosions, and they feel it all,” Dmytro told me.

“When these children grow older, all the trauma they’ve endured during their formative years can, unfortunately, leave a lasting and serious imprint on their mental health. They haven’t had a healthy, carefree childhood – the kind where they can learn, play, and feel safe as children normally would.”

As the first group’s school day ends, children from one of Kharkiv’s most bombed districts, wrap up warm before being led to the surface to catch a school bus to their old school – which was hit by a missile.

It’s still where they meet their parents for normal pick-up.

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Students eating in their classrooms in Kharkiv's metro system
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Students eating in their classrooms in Kharkiv’s metro system

We jump on the bus with them for the journey past destroyed government buildings, shopping centres and restaurants.

When the air raid suddenly sounds, I look around to see how the children and teachers on this bus will react.

They barely flinch it’s so common.

“People have, to some extent, adapted,” one of the headmistresses, Olena Nikolienko, said.

“If we see missiles coming, heaven forbid, we’ll stop near a designated shelter, following our evacuation plan, and that’s where the children will go for cover.”

Headmistresses Olena Nikolienko
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Headmistress Olena Nikolienko

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Remember, these children are safe underground at school, up here they are not.

During the bus ride, 10-year-old Alisa began quietly sobbing. Her teacher told me her grandfather was killed four months ago on the frontline, and since then she has been prone to tears.

Alisa’s teacher comforted her and told her everything would be ok.

It feels like everyone here has to carry their own sadness.

Everyone.

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‘Ukraine war will end sooner under Trump’

Parents, standing in the first snowfall of the season, greet the children as they get off the bus.

The kids run off the bus, and start throwing snowballs at each other, enjoying this precious moment.

It will be the last time they’re outside today.

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Xi Jinping says China is ‘ready to work’ with Donald Trump during last meeting with Joe Biden

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Xi Jinping says China is 'ready to work' with Donald Trump during last meeting with Joe Biden

Joe Biden has met with Xi Jinping for the last time as US president, where the Chinese leader said he is “ready to work” with Donald Trump.

Speaking at the Asia-Pacific Economic Cooperation forum in Lima, Peru, Mr Biden said the US and China’s relationship should be about “competition, not conflict”.

“We haven’t always agreed, but our conversations have always been candid and always been frank,” he said.

“We’ve never kidded one another. These conversations prevent miscalculations, and they ensure the competition between our two countries will not veer into conflict.

“We’ve been level with one another. I think that’s vital.”

Their last-ever meeting comes as president-elect Donald Trump vows to introduce blanket 60% tariffs on US imports of Chinese goods as part of a series of “America First” trade measures.

Pic: Reuters
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Pic: Reuters

But despite Mr Trump’s proposed measures, Mr Xi said his country’s goal “of a stable, healthy and sustainable China-US relationship remains unchanged”.

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“Our commitment to mutual respect, peaceful coexistence and… cooperation as principles for handling China-US relations remains unchanged,” he added.

The Chinese president then said the country is “ready to work with the new US administration to maintain communication, expand cooperation and manage differences, so as to strive for a steady transition”.

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Neither Mr Xi nor Mr Biden responded to a question about whether there were concerns about Mr Trump’s proposed tariffs.

The president-elect has also named several China hawks to his transition team, such as Senator Marco Rubio as secretary of state and Representative Mike Waltz as national security adviser.

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Under Mr Biden, Washington has introduced restrictions on US investment in Chinese artificial intelligence, quantum computing and semiconductors.

Former house speaker Nancy Pelosi also visited the island of Taiwan – which China views as a breakaway province – in April 2022.

In their meeting at this time last year – which followed a surge in tensions when an alleged Chinese spy balloon was shot down over the US – both leaders said direct communication between American and Chinese military forces would be restored.

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Mike Tyson reveals he ‘almost died’ ahead of fight with YouTuber-turned-boxer Jake Paul

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Mike Tyson reveals he 'almost died' ahead of fight with YouTuber-turned-boxer Jake Paul

Former heavyweight champion Mike Tyson says the health scare in June, which forced the postponement of his boxing match with Jake Paul, almost cost him his life.

“I almost died in June,” Tyson wrote on X, adding that he “had 8 blood transfusions. Lost half my blood and 25lbs in hospital”.

The 58-year-old, who lost to the YouTuber-turned-boxer in a unanimous points decision in Texas, tweeted that the situation was far worse than people had realised.

Following Tyson’s recovery, after reportedly suffering an ulcer flareup, he reflected on the result of the fight.

“This is one of those situations when you lost but still won… no regrets to get in the ring one last time,” he said.

That contrasts with Tyson’s comments after the match in which he refused to confirm whether it would be his last fight.

“It depends on the situation,” Tyson said before suggesting a fight with Paul’s older brother, Logan Paul, who was standing near him in the ring.

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Critics argued that the revised match – which involved fewer and shortened rounds, as well as heavier gloves – fell short of entertaining.

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Paul beats Tyson by unanimous decision

Some claimed it appeared more like a glorified sparring session.

It was Tyson’s first sanctioned pro bout since 2005, when he lost to Kevin McBride and then went into retirement – only briefly reappearing for an exhibition match in 2020 against Roy Jones Jr.

Jake Paul is driven to the ring before a heavyweight boxing match against Mike Tyson, Friday, Nov. 15, 2024, in Arlington, Texas. (AP Photo/Julio Cortez)
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Jake Paul believes he can fight for a championship belt within two years. Pic: AP

Paul has plenty to prove

Paul, 27, still has plenty to prove. The social media influencer wants to be a championship fighter and compete for a championship belt within two years. “I think it could happen in the next 24 months,” Paul said.

“I truly, truly believe in my skills and my ability and my power. And the cruiserweight division is seemingly open for the taking on that timeline,” he added.

The only professional match he has lost so far has been to Tommy Fury, the less-accomplished brother of former heavyweight champion Tyson Fury.

But there are questions about when Paul will fight a contender in his prime, as opposed to former champions or mixed martial artists.

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Could Paul really take on Alvarez?

Intriguingly, in the days before his fight with Tyson, Paul mentioned super middleweight champion Canelo Alvarez, considered one of the best boxers in the world.

According to reports, the Texas bout earned Paul $40m (£31.7m) versus $20m (£15.8m) for Tyson.

Netflix said 60 million households worldwide viewed the contest on its streaming platform, and nearly 50 million tuned in to watch the undercard which saw Ireland’s Katie Taylor beat Puerto Rico’s Amanda Serrano.

Even so there were some technical glitches. More than 90,000 users reported problems on Netflix at its peak, according to the website Downdetector, which tracks outages.

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