Obesity is one of the well-known initiating and aggravating factors of lymphedema. Body mass index (BMI) is typically used to define obesity, but in Asian populations, health risks are elevated at lower BMI levels, and abdominal fat may be a better obesity metric. Thus, we assessed the potential association between abdominal obesity and lymphedema severity in postoperative breast cancer patients.
Methods and Results:
Thirty-three women with breast cancer-related lymphedema participated in this study. Arm circumference was measured at four locations per arm to identify the maximal circumference difference (MCD) between the affected and unaffected sides. All patients underwent lymphoscintigraphy, and we calculated the quantitative asymmetry index (QAI) of both arms. A computed tomography was also performed to assess abdominal obesity after lymphedema. Abdominal obesity was classified as a visceral fat cross-sectional area larger than 70 cm2. Fourteen women (42%) were obese (BMI ≥25 kg/m2), and 18 women (54%) had increased abdominal fat. BMI obesity and abdominal obesity were significantly correlated, but five patients were classified with abdominal obesity, despite a BMI below 25 kg/m2. The mean arm circumference difference was 2.8 ± 2.4 cm. Decreased axillary QAI was significantly correlated with obesity, and increased arm edema (MCD ≥2 cm) was significantly correlated with abdominal obesity.
Conclusion:
Abdominal obesity was significantly correlated with increased MCD and should be considered along with obesity as an aggravating factor for lymphedema severity.
Get full access to this article
View all access options for this article.
References
1.
PassikSD, McDonaldMV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer, 1998; 83:2817–2820.
2.
PetrekJA, HeelanMC. Incidence of breast carcinoma-related lymphedema. Cancer, 1998; 83:2776–2781.
3.
SenerSF, WinchesterDJ, MartzCH, FeldmanJL, CavanaughJA, WinchesterDP, WeigelB, BonnefoiK, KirbyK, MoreheadC. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer, 2001; 92:748–752.
4.
HayesSC, JandaM, CornishB, BattistuttaD, NewmanB. Lymphedema after breast cancer: Incidence, risk factors and effect on upper body function. J Clin Oncol, 2008; 26:3536–3542.
5.
PaivaDM, RodriguesVO, CescaMG, PalmaPV, LeiteIC. Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil. BMC Womens Health, 2013; 13:6.
6.
WarrenAG, BrorsonH, BorudLJ, SlavinSA. Lymphedema: A comprehensive review. Ann Plast Surg, 2007; 59:464–472.
7.
MorrellRM, HalyardMY, SchildSE, AliMS, GundersonLL, PockajBA. Breast cancer-related lymphedema. Mayo Clin Proc, 2005; 80:1480–1484.
8.
ChenYW, TsaiHJ, HungHC, TsauoJY. Reliability study of measurements for lymphedema in breast cancer patients. Am J Phys Med Rehabil, 2008; 87:33–38.
9.
CzerniecSA, WardLC, RefshaugeKM, BeithJ, LeeMJ, YorkS, KilbreathSL. Assessment of breast cancer-related arm lymphedema—comparison of physical measurement methods and self-report. Cancer Invest, 2010; 28:54–62.
10.
GodoyJM, SilvaSH, GodoyMF. Sensitivity and specificity of combined perimetric and volumetric evaluations in the diagnosis of arm lymphedema. Prague Med Rep, 2007; 108:243–247.
11.
CornishBH, ChapmanM, HirstC, MiroloB, BunceIH, WardLC, ThomasBJ. Early diagnosis of lymphedema using multiple frequency bioimpedance. Lymphology, 2001; 34:2–11.
12.
CambriaRA, GloviczkiP, NaessensJM, WahnerHW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: A prospective, semiquantitative analysis in 386 extremities. J Vasc Surg, 1993; 18:773–782.
13.
TerSE, AlaviA, KimCK, MerliG. Lymphoscintigraphy. A reliable test for the diagnosis of lymphedema. Clin Nucl Med, 1993; 18:646–654.
14.
Monnin-DelhomED, GallixBP, AchardC, BruelJM, JanbonC. High resolution unenhanced computed tomography in patients with swollen legs. Lymphology, 2002; 35:121–128.
ShawC, MortimerP, JuddPA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer, 2007; 109:1949–1956.
17.
SoranA, D'AngeloG, BegovicM, ArdicF, HarlakA, Samuel WieandH, VogelVG, JohnsonRR. Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema?. Breast J, 2006; 12:536–543.
18.
RidnerSH, DietrichMS, StewartBR, ArmerJM. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer, 2011; 19:853–857.
19.
HelyerLK, VarnicM, LeLW, LeongW, McCreadyD. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J, 2010; 16:48–54.
20.
WernerRS, McCormickB, PetrekJ, CoxL, CirrincioneC, GrayJR, YahalomJ. Arm edema in conservatively managed breast cancer: Obesity is a major predictive factor. Radiology, 1991; 180:177–184.
21.
BuzatoE, BrigidioPAF. Increased levels of abdominal fat in patients with arm lymphedema after the surgical treatment of breast cancer: A quantitative, cross-sectional, randomized study. J Phlebol Lymphol, 2013; 6:1–3.
22.
BalkauB, CharlesMA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med, 1999; 16:442–443.
23.
LeeCM, HuxleyRR, WildmanRP, WoodwardM. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: A meta-analysis. J Clin Epidemiol, 2008; 61:646–653.
24.
World Health Organization. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. World Health Organization; 2000.
25.
HarrisSR, SchmitzKH, CampbellKL, McNeelyML. Clinical practice guidelines for breast cancer rehabilitation: Syntheses of guideline recommendations and qualitative appraisals. Cancer, 2012; 118:2312–2324.
26.
YooJN, CheongYS, MinYS, LeeSW, ParkHY, JungTD. Validity of quantitative lymphoscintigraphy as a lymphedema assessment tool for patients with breast cancer. Ann Rehabil Med, 2015; 39:931–940.
27.
GoluekePJ, MontgomeryRA, PetronisJD, MinkenSL, PerlerBA, WilliamsGM. Lymphoscintigraphy to confirm the clinical diagnosis of lymphedema. J Vasc Surg, 1989; 10:306–312.
28.
StantonAW, ModiS, MellorRH, PetersAM, SvenssonWE, LevickJR, MortimerPS. A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment. Clin Sci (Lond), 2006; 110:553–561.
29.
SzubaA, StraussW, SirsikarSP, RocksonSG. Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity. Nucl Med Commun, 2002; 23:1171–1175.
30.
HanJH, ParkHS, KimSM, LeeSY, KimDJ, ChoiWH. Visceral adipose tissue as a predictor for metabolic risk factors in the Korean population. Diabet Med, 2008; 25:106–110.
31.
Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan. Circ J, 2002; 66:987–992.
32.
MarcksP. Lymphedema. Pathogenesis, prevention, and treatment. Cancer Pract, 1997; 5:32–38.
33.
GetzDH. The primary, secondary, and tertiary nursing interventions of lymphedema. Cancer Nurs, 1985; 8:177–184.
34.
EnziG, GasparoM, BiondettiPR, FioreD, SemisaM, ZurloF. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr, 1986; 44:739–746.
35.
WeisslederH, WeisslederR. Lymphedema: Evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology, 1988; 167:729–735.
36.
SzubaA, StraussW, SirsikarSP, RocksonSG. Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity. Nucl Med Commun, 2002; 23:1171–1175.
37.
BorkanGA, GerzofSG, RobbinsAH, HultsDE, SilbertCK, SilbertJE. Assessment of abdominal fat content by computed tomography. Am J Clin Nutr, 1982; 36:172–177.
