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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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South Korean court clears Wemade ex-CEO in Wemix manipulation case

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Is there £15bn of wiggle room in Rachel Reeves’s fiscal rules?

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Is there £15bn of wiggle room in Rachel Reeves's fiscal rules?

Are Rachel Reeves’s fiscal rules quite as iron clad as she insists?

How tough is her armour really? And is there actually scope for some change, some loosening to avoid big tax hikes in the autumn?

We’ve had a bit of clarity early this morning – and that’s a question we discuss on the Politics at Sam and Anne’s podcast today.

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And tens of billions of pounds of borrowing depends on the answer – which still feels intriguingly opaque.

You might think you know what the fiscal rules are. And you might think you know they’re not negotiable.

For instance, the main fiscal rule says that from 2029-30, the government’s day-to-day spending needs to be in surplus – i.e. rely on taxation alone, not borrowing.

And Rachel Reeves has been clear – that’s not going to change, and there’s no disputing this.

But when the government announced its fiscal rules in October, it actually published a 19-page document – a “charter” – alongside this.

And this contains all sorts of notes and caveats. And it’s slightly unclear which are subject to the “iron clad” promise – and which aren’t.

There’s one part of that document coming into focus – with sources telling me that it could get changed.

And it’s this – a little-known buffer built into the rules.

It’s outlined in paragraph 3.6 on page four of the Charter for Budget Responsibility.

This says that from spring 2027, if the OBR forecasts that she still actually has a deficit of up to 0.5% of GDP in three years, she will still be judged to be within the rules.

In other words, if in spring 2027 she’s judged to have missed her fiscal rules by perhaps as much as £15bn, that’s fine.

Rachel Reeves during a visit to Cosy Ltd.
Pic: PA
Image:
A change could save the chancellor some headaches. Pic: PA

Now there’s a caveat – this exemption only applies, providing at the following budget the chancellor reduces that deficit back to zero.

But still, it’s potentially helpful wiggle room.

This help – this buffer – for Reeves doesn’t apply today, or for the next couple of years – it only kicks in from the spring of 2027.

But I’m being told by a source that some of this might change and the ability to use this wiggle room could be brought forward to this year. Could she give herself a get out of jail card?

The chancellor could gamble that few people would notice this technical change, and it might avoid politically catastrophic tax hikes – but only if the markets accept it will mean higher borrowing than planned.

But the question is – has Rachel Reeves ruled this out by saying her fiscal rules are iron clad or not?

Or to put it another way… is the whole of the 19-page Charter for Budget Responsibility “iron clad” and untouchable, or just the rules themselves?

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Is Labour plotting a ‘wealth tax’?

And what counts as “rules” and are therefore untouchable, and what could fall outside and could still be changed?

I’ve been pressing the Treasury for a statement.

And this morning, they issued one.

A spokesman said: “The fiscal rules as set out in the Charter for Budget Responsibility are iron clad, and non-negotiable, as are the definition of the rules set out in the document itself.”

So that sounds clear – but what is a definition of the rule? Does it include this 0.5% of GDP buffer zone?

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The Treasury does concede that not everything in the charter is untouchable – including the role and remit of the OBR, and the requirements for it to publish a specific list of fiscal metrics.

But does that include that key bit? Which bits can Reeves still tinker with?

I’m still unsure that change has been ruled out.

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