Adult-Attained Height and Colorectal Cancer Risk: A Cohort Study, Systematic Review, and Meta-Analysis

Abstract

Background: The influence of anthropometric characteristics on colorectal neoplasia biology is unclear. We conducted a systematic review and meta-analysis to determine if adult-attained height is independently associated with the risk of colorectal cancer or adenoma.

Methods: We searched MEDLINE, EMBASE, the Cochrane Library, and Web of Science from inception to August 2020 for studies on the association between adult-attained height and colorectal cancer or adenoma. The original data from the Johns Hopkins (Baltimore, MD) Colon Biofilm study was also included. The overall HR/OR of colorectal cancer/adenoma with increased height was estimated using random-effects meta-analysis.

Results: We included 47 observational studies involving 280,644 colorectal cancer and 14,139 colorectal adenoma cases. Thirty-three studies reported data for colorectal cancer incidence per 10-cm increase in height; 19 yielded an HR of 1.14 [95% confidence interval (CI), 1.11-1.17; P < 0.001), and 14 engendered an OR of 1.09 (95% CI, 1.05-1.13; P < 0.001). Twenty-six studies compared colorectal cancer incidence between individuals within the highest versus the lowest height percentile; 19 indicated an HR of 1.24 (95% CI, 1.19-1.30; P < 0.001), and seven resulting in an OR of 1.07 (95% CI, 0.92-1.25; P = 0.39). Four studies reported data for assessing colorectal adenoma incidence per 10-cm increase in height, showing an overall OR of 1.06 (95% CI, 1.00-1.12; P = 0.03).

Conclusions: Greater adult attained height is associated with an increased risk of colorectal cancer and adenoma.

Impact: Height should be considered as a risk factor for colorectal cancer screening.

Figure 1.. Hazard ratio of colorectal cancer per 10-cm increase in height

The forest plot shows the hazard ratio (HR) of colorectal cancer per 10-cm increase in height for each study and for all studies combined. A HR larger than 1 indicates increased colorectal cancer risk with height increase. A HR lower than 1 indicates decreased colorectal cancer risk with height increase. All studies showed increased HR of colorectal cancer with height increase, and most studies reported significant results. The overall HR is therefore highly significant (p<0.00001) and reflects an increased risk. Abbreviation: CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 2.. Odds ratio of colorectal cancer per 10-cm increase in height

The forest plot shows the odds ratio (OR) of colorectal cancer per 10-cm increase in height for each study and for all studies combined. An OR larger than 1 indicates increased colorectal cancer risk with height increase. An OR lower than 1 indicates decreased colorectal cancer risk with height increase. Most studies showed increased OR of colorectal cancer with height increase. The two studies with the largest sample sizes (tightest confidence intervals), Boursi et al. 2014, and Demb 2019 et al., showed highly significant results, while studies with smaller sample sizes (wider confidence intervals) reported nonsignificant results. Combining all studies, the overall HR is highly significant (p<0.00001) and reflects an increased risk. Abbreviation: CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 3.. Hazard ratio of colorectal cancer comparing the highest versus lowest height percentile.

The forest plot shows the hazard ratio (HR) of colorectal cancer, comparing the highest versus the lowest height percentile for each study and for all studies combined. A HR larger than 1 indicates increased colorectal cancer risk with height increase. A HR lower than 1 indicates decreased colorectal cancer risk with height increase. Most studies showed increased HR of colorectal cancer with height increase, many of which with highly significant results. Combining all studies, the overall HR is highly significant (p<0.00001) and reflects an increased risk. Abbreviation: CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 4.. Odds ratio of colorectal cancer comparing the highest versus the lowest height percentile.

The forest plots show the odds ratio (OR) of colorectal cancer comparing the highest versus the lowest height percentile for each study and for all studies combined. An OR larger than 1 indicates increased colorectal cancer risk with increased height. An OR lower than 1 indicates decreased colorectal cancer risk with increased height. A. Four out of the seven studies showed increased OR of colorectal cancer with an increased height. Combining all studies, the overall OR the estimated overall OR of colorectal cancer comparing the highest versus the lowest height percentile (N=7 studies) was 1.07 (95% CI, 0.92 to 1.25, P=0.39, I²=66%). B. Results of a sensitivity analysis excluding the outlier study by Suadicani et al. pulled the overall results away from null but did not qualitatively change the conclusion [OR 1.10 (0.96 to 1.26, P=0.15, I²=59%)]. Abbreviation: CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 5.. Odds ratio of colorectal adenoma per 10-cm increase in height.

The forest plot shows the odds ratio (OR) of colorectal adenoma per 10-cm increase in height. An OR larger than 1 indicates an increased colorectal cancer risk with increased height. An OR lower than 1 indicates a decreased colorectal cancer risk with increased height. Three out of the four studies showed increased OR of colorectal cancer with increased height. Combining all studies, the overall OR is significant (p=0.03) and reflects increased risk. Abbreviation: CI, confidence interval; SE, standard error; IV, inverse variance.