Could Reducing Body Fatness Reduce the Risk of Aggressive Prostate Cancer via the Insulin Signalling Pathway? A Systematic Review of the Mechanistic Pathway
Abstract
:1. Introduction
2. Material and Methods
2.1. PICO Questions
2.2. Standards of Reporting
2.3. Inclusion and Exclusion Criteria
2.3.1. Body Fatness–Insulin Signalling-Specific Criteria
2.3.2. Insulin Signalling–PCa-Specific Criteria
2.4. Data Collection and Analysis
2.4.1. Search Methods
2.4.2. Identification and Selection of Studies
2.4.3. Data Extraction and Management
2.4.4. Data/Statistical Analysis
2.4.5. Subgroup Analyses
2.5. Assessment of Methodological Quality of Included Studies
2.6. Overall Assessment of the Strength of the Evidence: GRADE
3. Results
3.1. Body Fatness–Insulin Association Studies
3.2. Effect of Reduction in Body Fatness on Biomarkers of Insulin Sensitivity
3.3. Insulin–Prostate Association Cancer Studies
3.4. Associations between Biomarkers of Insulin Sensitivity and PCa Risk
4. Discussion
4.1. Overall Findings
4.2. Strengths and Limitations of Our Review
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Author (Date) | Country of Origin | Adiposity Status 1 | Ethnicity | Number of Participants: (Intervention/Control) | Age of Participants 2: (Intervention/Control) | Intervention Group | Control Group | Outcome Measured |
---|---|---|---|---|---|---|---|---|
Ross R (2000) | Canada | Obese men-BMI >27 kg/m2 | NA | 22 (14/8) | 42.6 (9.7)/46.0 (10.9) | Baseline period: Weight maintenance diet (4–5 weeks) | Fasting glucose | |
Diet-induced weight loss group: Reduction in isocaloric diet by 700 kcal/d to achieve a weight loss of 0.6kg/week. Free-living participants (self-selected foods. Weekly 1 h seminars with dietitian. Participants kept daily food records, reviewed by the dietitian. | Body weight maintenance group: Participants asked to maintain their body weight throughout the study period. Free-living participants (self-selected foods. Weekly 1 h seminars with dietitian. Participants kept daily food records, reviewed by the dietitian. | |||||||
Fasting insulin | ||||||||
OGTT glucose (2 h) | ||||||||
OGTT insulin (2 h) | ||||||||
Glucose disposal rate | ||||||||
Glucose disposal (Oxidative fraction) | ||||||||
Glucose disposal (Nonoxidative fraction) | ||||||||
Intervention period: 12 weeks | ||||||||
Teng NIMF (2013) | Malaysia | BMI: 23.0- 29.9 kg/m2; range | Malay | 56 (28/28) | 59.6 (5.4)/59.1 (6.2) | Baseline period: No, but eligible subjects should not have practiced Muslim Sunnah fasting or have changed their dietary pattern three months before the study. | Fasting glucose | |
Fasting calorie restriction (FCR) group: Reduction of 300–500 kcal/d combined with 2 days/week of Muslim Sunnah Fasting. During fasting day: a light meal before sunrise (Sahur), no food and drink during the day (approximately for 13 h) and a complete meal after sunset (Iftar). Subjects provided with seven-day food menu guidelines. Weekly telephone-call to obtain information regarding subjects’ dietary intake and to ensure compliance. Fasting log book and food diaries were provided during each assessment meeting. | Maintenance group: Participants were asked to maintain their present lifestyle. | |||||||
Intervention period: 12 weeks | ||||||||
Pritchard J (2002) | Australia | Overweight men-BMI: 29.0 (2.6) kg/m2; mean (SD) | Australian | 24 [12 (10 available at baseline)/12 (2 available at baseline)] | 43.4 (5.7)/43.4 (5.7) | Baseline period: No | Fasting insulin | |
Low-fat (25% of dietary energy) diet group: The intervention was personalised according to the subject’s usual dietary pattern and using the National Heart Foundation booklet, The Weight Loss Guide. Compliance was monitored from food diaries and measurement of weight at monthly sessions. | Maintenance group: Participants were instructed to maintain their pre-study dietary and activity patterns, monitored at monthly measurement sessions similar to those of the intervention group. | |||||||
Intervention period: 48 weeks | ||||||||
Katzel LI (1995) | USA | Obese men-BMI: 30.0 (1.0) kg/m2; mean [Standard error of the mean (SEM)] | 96% white (whole sample) | 62 (44/18) | 61.0 (1.0)/60.0 (1.0); mean [Standard error of the mean (SEM)] | Baseline period: Isoenergetic American Heart Association (AHA) phase I diet (3 months) | Fasting glucose | |
Diet-induced weight loss group: Instructed to reduce energy intake by 1260 to 2100 kJ (300 to 500 kcal) per day. Goal was to decrease body weight by more than 10% during a 9 month period. Weekly group weight loss sessions. Food records were reviewed to ensure compliance to the diet. | Body weight maintenance group: Instructed not to lose weight or change their diets or level of physical activity. Weekly 1 h dietary counselling meetings to ensure compliance to the protocol. | |||||||
Fasting insulin | ||||||||
OGTT glucose (2 h) | ||||||||
OGTT insulin (2 h) | ||||||||
Intervention period: 36 weeks | ||||||||
Joris PJ (2016) | NA; Netherlands | Abdominally obese men-Waist circumference: 102–110 cm; range | Caucasian | 49 (23/26) | 52.4 (46.8-61.7)/52.0 (45.4-61.1); median (Q1-Q3) | Baseline period: Measurements of abdominally obese men were balanced (18 months) | Fasting glucose | |
Diet-induced weight loss group: Calorie-restricted diet for 6 weeks to obtain a waist circumference <102 cm followed by a weight-maintenance period of 2 weeks. Visited a research dietitian weekly (12 times in total) and consumed a very-low-calorie diet (VLCD) for >=4 weeks under strict guidance. If the waist circumference was still >102 cm after 4 weeks, the VLCD was continued for another week. The VLCD was supplied in powder sachets that had to be dissolved in water. Three sachets to be consumed daily. Participants were allowed to eat 250 g vegetables or fruit/day. After the VLCD period, subjects were prescribed a mixed, solid, calorie-restricted diet. | Body weight maintenance group: Maintained their habitual diet, physical activity levels, and use of alcohol throughout the total study period. Visited a research dietitian on 2 occasions. | |||||||
Fasting insulin | ||||||||
C-peptide | ||||||||
HOMA-IR | ||||||||
Intervention period: 8 weeks (a calorie-restricted diet for 6 weeks to obtain a waist circumference <102 cm followed by a weight-maintenance period of 2 weeks) | ||||||||
Guo X (2018) | China | Overweight/obese men-BMI > 24 kg/m2 | Chinese | 80 (42/38) | 38.9 (6.5)/38.0 (6.6) | Baseline period: No | Fasting glucose | |
Meal replacement with mild caloric restriction group: Consumed one liquid meal replacement which contained 388 kcal in total energy at dinner time during the intervention. Individuals were advised to continue their regular physical activity regimen. Dietary habits were assessed through a self-administered 77-item Food Frequency Questionnaire (FFQ) at the first and last visit (12th week). | Routine diet group: Followed a routine Chinese dinner as before. Individuals were advised to continue their regular physical activity regimen. | |||||||
Intervention period: 12 weeks | ||||||||
Alves RDM (2014) | Brazil and Spain | Overweight/obese men-BMI: 30.1 (2.8) kg/m2; mean (SD) | NA | 39 (21/18) | 29.3 (7.3)/31.4 (7.6) | Baseline period: Weight-maintaining diet (3 days) | Fasting glucose | |
Hypocaloric diet (~10% of caloric restriction)-Diurnal carbohydrate/nocturnal protein (DCNP) group: Received a prescription of a high-carbohydrate/low-protein lunch (69.3 and 7.2%, respectively) and a high-protein/low-carbohydrate dinner (41.7 and 18.8%, respectively). Subjects were asked to maintain habitual physical activity. Subject received nutritional advice and education from registered dietitians. Instructed to use an exchange-based self-selected food list, which assigned foods into categories according to their macronutrient composition. Subjects provided two 3-day food records (2 week days and 1 weekend day | Macronutrient-balanced group: Macronutrient-balanced lunch and dinner (18.0% protein, 46.8% carbohydrate, 35.2% fat). | |||||||
Fasting insulin | ||||||||
HOMA-IR | ||||||||
Intervention period: 8 weeks | ||||||||
Alves RDM (2014) | Brazil and Spain | Overweight/obese men-BMI: 30.1 (2.8) kg/m2; mean (SD) | NA | 37 (19/18) | 29.5 (7.5)/31.4 (7.6) | As Alves et al. (2014a) above except the lunch and dinner in the intervention group were reversed. |
Case–Control Studies Nested in a Prospective Cohort | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Author (Date) | Country of Origin | Study Name | Source of Participants | Duration of Follow-Up 1 | Ethnicity | Number of Participants (Cases/Controls) | Age 2 of Participants at Baseline (Cases/Controls) | Exposure Measured | Outcomes Assessed | Adjustment Variables |
Lai GY (2010) | USA | CLUE II cohort | General population | 5.6 years (mean), (range: 0.3–12.1 years) | Majority White Americans; 2.3% African Americans (cases and controls) | 139/139 | 64.6 (9.0)/64.6 (9.0) | C-peptide | PCa total | BMI (overweight: 25-29.9, obese: ≥30, normal: <25 kg/m2), family history of prostate cancer (yes, missing, no) |
127/127 | PCa, localised | |||||||||
57/57 | PCa, advanced | |||||||||
128/128 | PCa, low-grade | |||||||||
80/80 | PCa, high-grade | |||||||||
Lai GY (2014) | USA | Health Professionals Follow-Up Study (HPFS) | Occupational group (health professionals) | 5.4 years (median) (IQR: 3.1–7.7 years) | White Americans (cases: 94.2%, controls: 92.9%) | 1314/1314 | 64.2 (40.0-75.0)/64.2 (40.0-75.0); mean (range) | C-peptide | PCa total | BMI (kg/m2, continuous), history of diabetes |
1064/1314 | PCa, localised | BMI (kg/m2, continuous), history of diabetes, height (in, continuous), first degree family history of prostate cancer, vigorous physical activity (MET-hrs/wk, continuous), smoking in the past 10 years, history of vasectomy, total energy intake (kcal/day, continuous), alcohol intake (g/day), energy-adjusted intake of calcium (mg/day), alpha-linolenic acid (g/day), lycopene (μg/day), fructose (g/day), cumulative updated intake (1986–1994) of red meat and fish (servings/week), use of a vitamin E or selenium supplement | ||||||||
156/1314 | PCa, advanced | |||||||||
736/1314 | PCa, low-grade | |||||||||
477/1314 | PCa, high-grade | |||||||||
Albanes D (2009) | Finland | Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study | General population | 9.2 years (mean), (range: 5–12 years) | Finnish | 100/400 | 59.0 (4.6)/56.4 (5.0) | Fasting insulin | PCa total | Age (years), BMI (kg/m2) |
69/400 | PCa, localised | |||||||||
30/400 | PCa, advanced | |||||||||
100/400 | Fasting glucose | PCa total | ||||||||
100/400 | Molar ratio of insulin to glucose | |||||||||
100/400 | HOMA-IR | |||||||||
Prospective cohorts | ||||||||||
Author (Date) | Country of Origin | Study Name | Source of Participants | Duration of Follow-Up | Ethnicity | Number of Participants (Cases/Total) | Age of Participants at Baseline | Exposure Measured | Outcomes Assessed | Adjusted Variables |
152/1492 | HOMA-IR | |||||||||
75/1215 | HbA1c (%) | |||||||||
152/1,493 | Fasting insulin | |||||||||
Dickerman BA (2018) | Iceland | The Reykjavik Study | General population | 25 years (mean) | Icelandic | 1061/9097 | 52.0; median | Fasting glucose | PCa total | Entry age (linear and quadratic terms) and stage (categorical) of cohort entry (1967–68, 1970–71, 1974–76, 1979–81, 1985–87), family history of prostate cancer (yes, no), smoking status (never, former, current), regular check-ups (yes, no), attained education (primary, secondary, college, university), height (quartiles), BMI (<25.0, 25.0–29.9, ≥30 kg/m2) |
374/9097 | PCa, high-grade | |||||||||
145/9097 | PCa, advanced | |||||||||
336/9097 | PCa mortality | |||||||||
Marrone MT (2019) | USA | The Atherosclerosis Risk in Communities (ARIC) Study | General population | 22 years (max) | 27% African American | 626/4127 | 48.0–67.0; range | Fasting glucose | PCa total | Age (continuous, visit 2), joint categories for race and field centre (White from Minnesota; White from Washington Co. or Forsyth Co.; Black from Jackson; Black from Washington Co. or Forsyth Co.), BMI (kg/m2, continuous, visit 2), waist circumference (cm, continuous, visit 2), education (<high school, high school with some college, college graduate), cigarette smoking status (current/former smoker who quit <10 years ago; former smoker who quit ≥10 years ago, never smoker, visit 2) |
64/4689 | PCa, advanced | |||||||||
59/4694 | PCa mortality | |||||||||
626/4127 | HbA1c (%) | PCa total | ||||||||
64/4689 | PCa, advanced | |||||||||
59/4694 | PCa mortality | |||||||||
Darbinian JA (2008) | NA; USA | Kaiser Permanente Medical Care Program | General population | 18.4 years (median) | White: 78.6%; Black: 13.2%; Asian: 4.4%; Other: 3.8% | 2554/* | 48.0 (35.0–80.0); median (range) | Glucose tolerance | PCa total | Glycaemic status (serum glucose levels measured 1 h after ingestion of 75 g oral glucose challenge among MHC examination participants who did not self-report history of diabetes or as diabetes per self-report (at MHC examination) of either physician diagnosis or diabetes-related medication usage during past year or two), year of MHC examination (<55, ≥55), race/ethnicity (White, African American), BMI per the WHO classification (<25, ≥25 kg/m2) |
1727/* | PCa, localised | |||||||||
642/* | PCa, regional (stages 2–5), distant (stage 7) |
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James, R.; Dimopoulou, O.; Martin, R.M.; Perks, C.M.; Kelly, C.; Mathias, L.; Brugger, S.; Higgins, J.P.T.; Lewis, S.J. Could Reducing Body Fatness Reduce the Risk of Aggressive Prostate Cancer via the Insulin Signalling Pathway? A Systematic Review of the Mechanistic Pathway. Metabolites 2021, 11, 726. https://doi.org/10.3390/metabo11110726
James R, Dimopoulou O, Martin RM, Perks CM, Kelly C, Mathias L, Brugger S, Higgins JPT, Lewis SJ. Could Reducing Body Fatness Reduce the Risk of Aggressive Prostate Cancer via the Insulin Signalling Pathway? A Systematic Review of the Mechanistic Pathway. Metabolites. 2021; 11(11):726. https://doi.org/10.3390/metabo11110726
Chicago/Turabian StyleJames, Rachel, Olympia Dimopoulou, Richard M. Martin, Claire M. Perks, Claire Kelly, Louise Mathias, Stefan Brugger, Julian P. T. Higgins, and Sarah J. Lewis. 2021. "Could Reducing Body Fatness Reduce the Risk of Aggressive Prostate Cancer via the Insulin Signalling Pathway? A Systematic Review of the Mechanistic Pathway" Metabolites 11, no. 11: 726. https://doi.org/10.3390/metabo11110726