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Obesity, Bariatric Surgery, and Cancer Risk: Nutritional Perspectives and Long-Term Clinical Implications
(2026)
Reytor González, Claudia
;
Gerardo Sarno
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Martha Montalvan
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Ludovica Verde
;
Giuseppe Annunziata
Obesity is recognized as a causal risk factor for the development of multiple cancers, with risk magnitude varying by tumor site, sex, life stage, and adipose tissue distribution. This narrative review synthesizes recent epidemiological evidence linking excess body fatness with cancer incidence and mortality and integrates the biological mechanisms that explain this association. Chronic low-grade inflammation, insulin resistance with compensatory hyperinsulinemia, dysregulation of adipose-derived hormones and sex steroids, impairment of anti-tumor immune responses, alterations in the gut microbiota, and remodeling of the tumor microenvironment collectively create conditions that favor tumor initiation and progression. Bariatric surgery is the most effective clinical intervention for achieving substantial and sustained weight loss in individuals with severe obesity, and growing evidence indicates that it is associated with a reduction in overall cancer risk and cancer-related mortality, particularly for malignancies strongly linked to obesity. However, the extent of this benefit differs by surgical technique and remains less consistent for colorectal cancer. Beyond metabolic improvements, bariatric surgery produces long-term changes in nutritional physiology that may also influence oncologic outcomes. Persistent deficiencies of micronutrients such as iron, folate, vitamin B12, vitamin D, and calcium can affect DNA synthesis, methylation, oxidative balance, and cellular repair. Altered protein and energy intake may contribute to loss of lean mass and reduced metabolic resilience, while changes in alcohol absorption and metabolism can increase systemic exposure to ethanol and its carcinogenic metabolites. In addition, bariatric surgery induces sustained remodeling of the gut microbiome and bile acid metabolism, which may further modulate tumorigenic signaling. Overall, the oncological impact of bariatric surgery reflects a balance between metabolic improvement and long-term nutritional management, underscoring the need for structured follow-up and targeted nutritional strategies to optimize cancer risk reduction.
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Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment
(2026)
Sebastián Chapela
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Daniel Tettamanti Miranda
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Claudia Kecskes
Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I–III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p < 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = −13 to −15 kcal·kg−1·day−1; p < 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.
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Hot flashes: a potential marker of deterioration of health-related quality of life
(2026)
Juan E. Blümel
;
María S. Vallejo
;
Peter Chedraui
;
Eugenio Arteaga
;
Félix Ayala
Objective: Hot flashes are among the most common symptoms of the menopausal transition and have traditionally been considered benign and self-limiting. However, increasing evidence suggests that they may indicate broader neurovascular and inflammatory dysregulation linked to reproductive aging. The possible effect of hot flush severity on health-related quality of life (HRQoL) remains inadequately studied, particularly in Latin American populations. This study aimed to examine the association between hot flash severity and HRQoL in middle-aged women using validated tools and a large, multicenter sample. Method: A cross-sectional study was conducted between June 2024 and January 2025 in 30 healthcare centers across 12 Latin American countries. A total of 3523 women aged 40–60 years were assessed using the Menopause Rating Scale (MRS) to evaluate vasomotor symptoms and the Short Form-36 Health Survey (SF-36) to measure HRQoL. Multivariable logistic regression models were utilized to estimate the association between hot flush severity and low HRQoL, adjusting for sociodemographic, behavioral and clinical covariates. Results: Increasing severity of hot flushes was significantly associated with lower HRQoL scores across all SF-36 domains. In the logistic regression analysis, mild hot flushes (MRS item 1 score = 1) were associated with increased odds of impaired HRQoL (odds ratio [OR] 1.29; 95% confidence interval [CI]: 1.08–1.55), whereas very severe symptoms (MRS item 1 score = 4) demonstrated a substantially stronger association (OR 4.10; 95% CI: 2.93–5.74). Additional factors significantly associated with lower HRQoL included physical inactivity, the presence of comorbidities, obesity, current use of psychotropic medication, age ≥50 years and having two or more children. Conclusion: Hot flush severity is a strong and independent determinant of HRQoL in midlife women. These findings underscore the need for systematic assessment and targeted management of vasomotor symptoms in routine care, supporting the hypothesis that hot flashes may be a clinical marker of systemic aging. © 2026 International Menopause Society.
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Severe obesity and menopause symptoms are associated with cognitive impairment in postmenopausal women from Latin America
(2025)
Juan Enrique Blümel
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Maria Soledad Vallejo
;
Peter Chedraui
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Socrates Aedo
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Marcio Alexandre Hipolito Rodrigues
Objective: This study aimed to evaluate the association between obesity and cognitive impairment. Methods: This study is a sub-analysis of an observational, cross-sectional study in nine Latin American counties. Sociodemographic, clinical and anthropometric data were collected, and cognition was assessed using the Montreal Cognitive Assessment (MoCA) tool in 722 postmenopausal women. Results: The mean age, body mass index (BMI) and years of education of the cohort were 56.9 years, 26.8 kg/m2 and 13.6 years, respectively. Women with cognitive impairment, compared to those without, had a higher BMI (27.8 ± 5.9 vs. 26.6 ± 4.9 kg/m2, p = 0.037), had more children (3.1 ± 2.4 vs. 2.5 ± 1.7, p = 0.023), experienced more severe menopausal symptoms (56.3% vs. 31.9%, p < 0.001) and presented more comorbidities (60.0% vs. 43.8%, p = 0.006). They also had fewer years of study (10.8 ± 5.1 vs. 13.9 ± 4.9 years, p = 0.001), were less physically active (35.0% vs. 49.1%, p = 0.018) and were less likely to use menopausal hormone therapy (MHT) (11.3% vs. 28.8%, p = 0.001). In binary logistic regression analysis, BMI ≥ 35.0 kg/m2 (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.08–4.76) and severe menopausal symptoms (OR 2.10, 95% CI 1.29–3.43) were associated with cognitive impairment. In the model, factors related to lower risk were ever use of MHT (OR 0.44, 95% CI 0.21–0.92) and having more years of education (OR 0.38, 95% CI 0.20–0.64). Conclusion: Severe obesity and severe menopausal symptoms increased the risk of cognitive impairment in postmenopausal women, while higher education and ever use of MHT were protective factors.
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