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Meta-Analysis
. 2017 May 23;116(11):1486-1497.
doi: 10.1038/bjc.2017.106. Epub 2017 Apr 25.

Comparison of general obesity and measures of body fat distribution in older adults in relation to cancer risk: meta-analysis of individual participant data of seven prospective cohorts in Europe

Heinz Freisling  1 , Melina Arnold  2 , Isabelle Soerjomataram  2 , Mark George O'Doherty  3 , José Manuel Ordóñez-Mena  4   5   6 , Christina Bamia  7   8 , Ellen Kampman  9 , Michael Leitzmann  10 , Isabelle Romieu  1 , Frank Kee  3 , Konstantinos Tsilidis  7   11   12 , Anne Tjønneland  13 , Antonia Trichopoulou  7   8 , Paolo Boffetta  7   14 , Vassiliki Benetou  7   8 , H B As Bueno-de-Mesquita  12   15   16 , José María Huerta  17   18 , Hermann Brenner  5   19   20 , Tom Wilsgaard  21 , Mazda Jenab  1
Affiliations
Meta-Analysis

Comparison of general obesity and measures of body fat distribution in older adults in relation to cancer risk: meta-analysis of individual participant data of seven prospective cohorts in Europe

Heinz Freisling et al. Br J Cancer. .

Abstract

Background: We evaluated the associations of anthropometric indicators of general obesity (body mass index, BMI), an established risk factor of various cancer, and body fat distribution (waist circumference, WC; hip circumference, HC; and waist-to-hip ratio, WHR), which may better reflect metabolic complications of obesity, with total obesity-related and site-specific (colorectal and postmenopausal breast) cancer incidence.

Methods: This is a meta-analysis of seven prospective cohort studies participating in the CHANCES consortium including 18 668 men and 24 751 women with a mean age of 62 and 63 years, respectively. Harmonised individual participant data from all seven cohorts were analysed separately and alternatively for each anthropometric indicator using multivariable Cox proportional hazards models.

Results: After a median follow-up period of 12 years, 1656 first-incident obesity-related cancers (defined as postmenopausal female breast, colorectum, lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney) had occurred in men and women. In the meta-analysis of all studies, associations between indicators of adiposity, per s.d. increment, and risk for all obesity-related cancers combined yielded the following summary hazard ratios: 1.11 (95% CI 1.02-1.21) for BMI, 1.13 (95% CI 1.04-1.23) for WC, 1.09 (95% CI 0.98-1.21) for HC, and 1.15 (95% CI 1.00-1.32) for WHR. Increases in risk for colorectal cancer were 16%, 21%, 15%, and 20%, respectively per s.d. of BMI, WC, HC, and WHR. Effect modification by hormone therapy (HT) use was observed for postmenopausal breast cancer (Pinteraction<0.001), where never HT users showed an ∼20% increased risk per s.d. of BMI, WC, and HC compared to ever users.

Conclusions: BMI, WC, HC, and WHR show comparable positive associations with obesity-related cancers combined and with colorectal cancer in older adults. For postmenopausal breast cancer we report evidence for effect modification by HT use.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant inclusion.
Figure 2
Figure 2
Random-effects meta-analysis of the association of different obesity indicators per 1 standard deviation (s.d.) increment with ‘obesity-related cancers’a. aFirst primary cancers of the breast (postmenopausal), colorectum, lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney. Adjustments were made for sex, age at entry, daily smoking (never, former, current, missing), average alcohol consumption (g per day), education (primary or less, more than primary but less than college, college or university, missing), vigorous physical activity (yes, no, missing), recruitment year, and height. BMI=body mass index; DK=Denmark; GR=Greece; HC=hip circumference; NL=The Netherlands; SP=Spain; WC=waist circumference; WHR=waist-to-hip ratio.
Figure 3
Figure 3
Random-effects meta-analysis of the association of different obesity indicators per 1 standard deviation (s.d.) increment with colorectal cancer. Adjustments were made for sex, age at entry, daily smoking (never, former, current, missing), average alcohol consumption (g per day), education (primary or less, more than primary but less than college, college or university, missing), vigorous physical activity (yes, no, missing), recruitment year, and height. BMI=body mass index; DK=Denmark; GR=Greece; HC=hip circumference; NL=The Netherlands; SP=Spain; WC=waist circumference; WHR=waist-to-hip ratio.
Figure 4
Figure 4
Random-effects meta-analysis of the association of different obesity indicators per 1 standard deviation (s.d.) increment with postmenopausal breast cancer. Adjustments were made for age at entry, daily smoking (never, former, current, missing), average alcohol consumption (g per day), education (primary or less, more than primary but less than college, college or university, missing), vigorous physical activity (yes, no, missing), recruitment year, and height. BMI=body mass index; DK=Denmark; GR=Greece; HC=hip circumference; NL=The Netherlands; SP=Spain; WC=waist circumference; WHR=waist-to-hip ratio.
Figure 5
Figure 5
Random-effects meta-analysis of the association of different obesity indicators per 1 standard deviation (s.d.) increment with ‘other obesity-related cancers’a. aFirst primary cancers of the lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney. Adjustments were made for sex, age at entry, daily smoking (never, former, current, missing), average alcohol consumption (g per day), education (primary or less, more than primary but less than college, college or university, missing), vigorous physical activity (yes, no, missing), recruitment year, and height. BMI=body mass index; DK=Denmark; GR=Greece; HC=hip circumference; NL=the Netherlands; SP=Spain; WC=waist circumference; WHR=waist-to-hip ratio.
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