Obesity, Lung Cancer, and The Paradox of its Association: A Narrative Review

Main Article Content

Kemal Akbar Suryoadji
Jason Theola
Valentino Ryu Yudianto


Background: The obesity rate in Indonesia always increases every year. RISKESDAS (Indonesian National Health Research Data) 2007, 2013 and 2018 showed that obesity rate is always increasing in Indonesia. Lung cancer is the most common cancer in Indonesia which causes death.

Objective: This review aims to explain various diseases which are associated with obesity, risk factors of lung cancer and the association between them.

Methods: Literature search was conducted in pubmed and textbooks regarding obesity and lung cancer risk factors. The literature search on association between obesity and lung cancer was done in pubmed with the keyword "(Lung Cancer [Title]) AND (Obesity [Title])".

Results: Based on the research conducted, it was found that obesity was associated with various diseases including type 2 diabetes, dyslipidemia, cancer risk, mood disorders, heart disease, hypertension, liver disease, and reproductive disorders. Furthermore, there are various risk factors for lung cancer, including gender, genetics, tobacco use, and exposure to toxic agents. The association between obesity and lung cancer is a paradoxical phenomenon that occurs, in which obese patients have a lower risk of developing lung cancer based on the meta-analysis research (RR: 0.79; 95% CI 0.73-0.85).

Conclusion: Obesity can increase the risk of various diseases, and lung cancer which is one of the most common cancers in Indonesia also has various risk factors. However, current clinical research studies have shown that obesity actually reduces the risk of lung cancer. Thus we advise researchers around the world to further enhance experimental research either in clinical or laboratory about the body mechanisms that can explain this phenomenon. Regardless of this paradox association, we also suggest that the public should keep on controlling body weight because of the risk of various diseases associated with obesity.

Article Details

How to Cite
Suryoadji, K. A., Theola, J. and Yudianto, V. R. . (2021) “Obesity, Lung Cancer, and The Paradox of its Association: A Narrative Review”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia, 9(1). doi: 10.52629/jamsa.v9i1.257.
Review Articles


Hasil utama RISKESDAS 2018. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan. 2018.

Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998;158(17):1855–1867.

International Agency for Research on Cancer. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. France: World Health Organization; 2012.

World Health Organization. Cancer: Fact sheet: World Health Organization;2015.

Laporan tahunan divisi onkologi toraks departemen pulmonology dan ilmu kedokteran respirasi FKUI-RSUP Persahabatan. 2015.

World Health Organization. World health organization-cancer country profile: indonesia. World Health Organization.;2014.

James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001 Nov;9 Suppl 4:228S-233S.

WHO/IASO/IOTF . The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia; Melbourne: 2000.

Malone JI, Hansen BC. Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite? Pediatr Diabetes. 2019 Feb;20(1):5-9.

Vekic J, Zeljkovic A, Stefanovic A, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V. Obesity and dyslipidemia. Metabolism. 2019 Mar;92:71-81.

Avgerinos KI, Spyrou N, Mantzoros CS, Dalamaga M. Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism. 2019 Mar;92:121-135.

Soczynska JK, Kennedy SH, Woldeyohannes HO, Liauw SS, Alsuwaidan M, Yim CY, McIntyre RS. Mood disorders and obesity: understanding inflammation as a pathophysiological nexus. Neuromolecular Med. 2011 Jun;13(2):93-116.

Saliba LJ, Maffett S. Hypertensive Heart Disease and Obesity: A Review. Heart Fail Clin. 2019 Oct;15(4):509-517.

Corey KE, Kaplan LM. Obesity and liver disease: the epidemic of the twenty-first century. Clin Liver Dis. 2014 Feb;18(1):1-18.

Lainez NM, Coss D. Obesity, Neuroinflammation, and Reproductive Function. Endocrinology. 2019 Nov 1;160(11):2719-2736.

Malhotra J, Malvezzi M, Negri E, La-Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Res J. 2016;10:1183

White MC, Holman DM, Boehm JE, Peipins LA, Grossman MS, Henley J. Age and cancer risk: a potentially modifiable relationship. Am J Prev Med. 2014;46(3S1):S7-S15.

Hea Y, Lb S, Rena S, Caib X, Lib X, Zhaob C, et al. Impact of family history of cancer on the incidence of mutation in epidermal growth factor receptor gene in non-small cell lung cancer patients. Lung Cancer. 2013:1-5.

Samet JM, Gupta PC, Ray CS, Sayvaget, C, Winn DM. Tobacco smoking and smokeless tobacco use. In: Stewar BW, Wild CP, et al. World cancer Report 2014. France: The International Agency for Research on Cancer;2014. p.88-95

World Health Organization. Environmental and occupational cancers: World Health Organization; 2011.

Yang Y, Dong J, Sun K, Zhao L, Zhao F, Wang L, Jiao Y. Obesity and incidence of lung cancer: a meta-analysis. Int J Cancer. 2013 Mar 1;132(5):1162-9.

Ardesch FH, Ruiter R, Mulder M, Lahousse L, Stricker BHC, Kiefte-de Jong JC. The Obesity Paradox in Lung Cancer: Associations With Body Size Versus Body Shape. Front Oncol. 2020 Nov 10;10:591110.

Mavridis K, Michaelidou K. The obesity paradox in lung cancer: is there a missing biological link? J Thorac Dis. 2019 Mar;11(Suppl 3):S363-S366.

Nagano H, Hashimoto N, Nakayama A, et al. p53-inducible DPYSL4 associates with mitochondrial supercomplexes and regulates energy metabolism in adipocytes and cancer cells. Proc Natl Acad Sci U S A 2018;115:8370-5.

Kimura J, Kudoh T, Miki Y, et al. Identification of dihydropyrimidinase-related protein 4 as a novel target of the p53 tumor suppressor in the apoptotic response to DNA damage. Int J Cancer 2011;128:1524-31.

Shen N, Fu P, Cui B, Bu CY, Bi JW. Associations between body mass index and the risk of mortality from lung cancer: A dose-response PRISMA-compliant meta-analysis of prospective cohort studies. Medicine (Baltimore). 2017 Aug;96(34):e7721.

Leung CC, Lam TH, Yew WW, et al. Lower lung cancer mortality in obesity. Int J Epidemiol 2011;40:174–82.

Siahpush M, Singh GK, Tibbits M, et al. It is better to be a fat ex-smoker than a thin smoker: findings from the 1997-2004 National Health Interview Survey-National Death Index linkage study. Tobacco Control 2014;23:395–402.

Meyer J, Rohrmann S, Bopp M, et al. Impact of smoking and excess body weight on overall and site-specific cancer mortality risk. Cancer Epidemiol Biomarkers Prev 2015;24:1516–22.

Taghizadeh N, Boezen HM, Schouten JP, et al. BMI and lifetime changes in BMI and cancer mortality risk. PLoS One 2015;10.e0125261.