Cancers Due to Excess Weight, Low Physical Activity, and Unhealthy Diet

Abstract

Background: Excess weight, low physical activity, low intakes of dietary fiber, fruits, and vegetables, and high meat and salt intake increase cancer risk.

Methods: Numbers and proportions (population-attributable fractions, PAF) of incident cancer cases in Germany in 2018 attributable to these factors were estimated by sex and age groups for ages 35 to 84 years using population projections, national cancer incidence and exposure data, and published risk estimates.

Results: Estimated numbers (percentages) of attributable cancers were 30 567 (7%) for excess weight, 27 081 (6%) for low physical activity, 14 474 (3%) for low dietary fiber intake, 9447 (2%) for low fruit and vegetable consumption, 9454 (2%) and 1687 (0.4%) for processed meat and high red meat consumption, respectively, and 1204 (0.3%) for high salt intake. Excess weight substantially contributed to endometrial, renal, and liver cancer (PAF = 24 to 35%). Low physical activity contributed to endometrial, renal, and lung cancer (PAF = 15 to 19%), and dietary factors mainly contributed to colorectal, breast, and lung cancer (PAF = 9 to 16%).

Conclusion: A considerable proportion of cancer cases are attributable to excess weight, physical inactivity, and unhealthy dietary habits. Major prevention efforts are needed to reduce the cancer incidence attributable to these avoidable factors.

Figure 1

Prevalence of selected lifestyle factors among men and women aged 25–74 years (N = 6087 for body weight, N = 6696 for physical activity, N = 6129 for dietary factors) from the nationally representative DEGS1 survey, 2008 to 2011, Germany

Figure 2

Estimated number of site-specific incident cancer cases attributable to excess weight (BMI=25 kg/m²) among men and women aged 35 to 84 years in Germany for the year 2018, assuming a 10-year latency period between exposure and cancer incidence. *The PAF for the category “All above cancer types combined” was computed with respect to total cancer incidence (ICD-10 C00-C99 without C44). ICD, International Classification of Diseases; PAF, population-attributable fraction, BMI, body mass index

Figure 3

Estimated number of site-specific incident cancer cases attributable to low physical activity (<150 min/week of moderate to vigorous physical activity) among men and women aged 35 to 84 years in Germany for the year 2018, assuming a 10-year latency period between exposure and cancer incidence. *The PAF for the category “All above cancer types combined” was computed with respect to total cancer incidence (ICD-10 C00-C99 without C44). ICD, International Classification of Diseases; PAF, population-attributable fraction

Figure 4

Estimated number of site-specific incident cancer cases attributable to high consumption of red meat (=500 g/week), any consumption of processed meat (>0 g/week), high intake of salt (=6 g/day), low intake of dietary fiber (<32 g/day) and low consumption of fruit and vegetables (<400 g/day) among men and women aged 35 to 84 years in Germany for the year 2018, assuming a 10-year latency period between exposure and cancer incidence. *¹ The PAF for the category “All above cancer types combined” was computed with respect to total cancer incidence (ICD-10 C00-C99 without C44). *² The PAF for the category “All dietary factors combined” was computed with the sequential PAF formula separately for each cancer type and each age group. The resulting age- and sex-specific attributable cancer cases were then summated to yield an overall estimate for the whole population and set against the total number of cancer cases (ICD-10 C00-C99 without C44; cf. eSupplement E and eTable 21). ICD, International Classification of Diseases; PAF, population-attributable fraction