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Furthermore, obesity is associated with worse <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> cancer outcomes. Body mass index is a commonly used measure of fat accumulation, although specific patterns such as abdominal\/central obesity and visceral fat quantity sometimes predict disease risk more accurately. Metabolic syndrome (<jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>) is a related condition characterized by central adiposity and insulin resistance. The reasons for the associations with neoplasia are diverse. Established cancer\u2010related conditions that have a higher prevalence in overweight subjects include Barrett's oesophagus and gallstones. Preneoplastic lesions such as colorectal adenoma, colorectal serrated lesions and pancreatic intraepithelial neoplasia are also associated with obesity\/<jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>. At the cellular level, adipocytes can release carcinogens such as adipokines, insulin\u2010like growth factor, and vascular endothelial growth factor. Inflammatory cells constitute a further potential source of carcinogens; in obese subjects, their numbers are increased systemically and in adipose tissue. Animal studies have contributed additional information. For example, mice with a genetic predisposition to develop colorectal carcinoma given a high\u2010fat diet have larger and more numerous intestinal adenomas than controls, and there may be demonstrably higher levels of mucosal oncogenic factors. The associations between obesity and <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> disease are of variable strength, and the underlying mechanisms are incompletely understood, but it is clear that obesity and <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> have a significant, potentially avoidable and often under\u2010recognized impact on the population burden of <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> disease.<\/jats:p>","DOI":"10.1111\/his.12907","type":"journal-article","created":{"date-parts":[[2015,11,24]],"date-time":"2015-11-24T15:23:16Z","timestamp":1448378596000},"page":"630-640","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Obesity and metabolic syndrome: pathological effects on the gastrointestinal tract"],"prefix":"10.1111","volume":"68","author":[{"given":"Roger M","family":"Feakins","sequence":"first","affiliation":[{"name":"Department of Cellular Pathology Royal London Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,19]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Cancer Research UK.The 20 most common causes of cancer deaths UK.2015. 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