Impact of body mass index and fat distribution on sex steroid levels in endometrial carcinoma: a retrospective study

Willem Jan van WeeldenEmail author View ORCID ID profile,
Kristine Eldevik Fasmer,
Ingvild L. Tangen,
Joanna IntHout,
Karin Abbink,
Antionius E. van Herwaarden,
Camilla Krakstad,
Leon F. A. G. Massuger,
Ingfrid S. Haldorsen and
Johanna M. A. Pijnenborg

BMC Cancer201919:547

https://doi.org/10.1186/s12885-019-5770-6

Received: 3 December 2018
Accepted: 29 May 2019
Published: 7 June 2019

Open Peer Review reports

Abstract

Background

Obesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC). The relation between obesity and cancer is complicated and involves alterations in insulin metabolism, response to inflammation and alterations in estradiol metabolism. Visceral obesity is assumed to play the most important role in the first two mechanisms, but its role in estradiol metabolism is unclear. Therefore, this retrospective study explores the relationship of body mass index (BMI), visceral fat volume (VAV) and subcutaneous fat volume (SAV) and serum levels of sex steroids and lipids in patients with endometrial cancer.

Methods

Thirty-nine postmenopausal EC patients with available BMI, blood serum and Computed Tomography (CT) scans were included. Serum was analyzed for estradiol, dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, cholesterol, triglycerides and high (HDL), low (LDL) and non-high density (NHDL) lipoprotein. VAV and SAV were quantified on abdominal CT scan images. Findings were interpreted using pearson correlation coefficient and linear regression with commonality analysis.

Results

Serum estradiol is moderately correlated with BMI (r = 0.62) and VAV (r = 0.58) and strongly correlated with SAV (r = 0.74) (p < 0.001 for all). SAV contributes more to estradiol levels than VAV (10.3% for SAV, 1.4% for VAV, 35.9% for SAV and VAV, p = 0.01). Other sex steroids and lipids have weak and moderate correlations with VAV or SAV.

Conclusions

This study shows that serum estradiol is correlated with BMI and other fat-distribution measures in postmenopausal endometrial cancer patients. Subcutaneous fat tissue contributes more to the estradiol levels indicating that subcutaneous fat might be relevant in endometrial cancer carcinogenesis.