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Meta-Analysis
. 2022 May 5;20(1):143.
doi: 10.1186/s12916-022-02336-x.

Adiposity and risk of prostate cancer death: a prospective analysis in UK Biobank and meta-analysis of published studies

Aurora Perez-Cornago  1 , Yashvee Dunneram  2 , Eleanor L Watts  2 , Timothy J Key  2 , Ruth C Travis  2
Affiliations
Meta-Analysis

Adiposity and risk of prostate cancer death: a prospective analysis in UK Biobank and meta-analysis of published studies

Aurora Perez-Cornago et al. BMC Med. .

Abstract

Background: The association of adiposity with prostate cancer specific mortality remains unclear. We examined how adiposity relates to fatal prostate cancer and described the cross-sectional associations of commonly used adiposity measurements with adiposity estimated by imaging in UK Biobank. We also conducted a dose-response meta-analysis to integrate the new data with existing prospective evidence.

Methods: 218,237 men from UK Biobank who were free from cancer at baseline were included. Body mass index (BMI), total body fat percentage (using bioimpedance), waist circumference (WC) and waist-to-hip ratio (WHR) were collected at recruitment. Risk of dying from prostate cancer (primary cause) by the different adiposity measurements was estimated using multivariable-adjusted Cox proportional hazards models. Results from this and other prospective cohort studies were combined in a dose-response meta-analysis.

Results: In UK Biobank, 661 men died from prostate cancer over a mean follow-up of 11.6 years. In the subsample of participants with magnetic resonance imaging and dual-energy X-ray absorptiometry, BMI, body fat percentage and WC were strongly associated with imaging estimates of total and central adiposity (e.g. visceral fat, trunk fat). The hazard ratios (HR) for prostate cancer death were 1.07 (95% confidence interval = 0.97-1.17) per 5 kg/m2 higher BMI, 1.00 (0.94-1.08) per 5% increase in total body fat percentage, 1.06 (0.99-1.14) per 10 cm increase in WC and 1.07 (1.01-1.14) per 0.05 increase in WHR. Our meta-analyses of prospective studies included 19,633 prostate cancer deaths for BMI, 670 for body fat percentage, 3181 for WC and 1639 for WHR, and the combined HRs for dying from prostate cancer for the increments above were 1.10 (1.07-1.12), 1.03 (0.96-1.11), 1.07 (1.03-1.11), and 1.06 (1.01-1.10), respectively.

Conclusion: Overall, we found that men with higher total and central adiposity had similarly higher risks of prostate cancer death, which may be biologically driven and/or due to differences in detection. In either case, these findings support the benefit for men of maintaining a healthy body weight.

Keywords: Adiposity; Imaging; Mortality; Population-attributable risk; Prostate cancer.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Multivariable-adjusted hazard ratios (95% CI) for prostate cancer death in relation to adiposity measurements at baseline in men from UK Biobank. Abbreviations: BMI, body mass index. Cox regression analyses. All models are stratified by region and age at recruitment and adjusted for age (underlying time variable), Townsend deprivation score, ethnicity, lives with a wife or partner, smoking, physical activity, alcohol consumption, height, diabetes, and history of PSA test. Full details for each covariate are provided in the statistical section
Fig. 2
Fig. 2
Meta-analysis of prospective studies on the risk of prostate cancer death in relation to BMI. Study-specific hazard ratios (HR) are represented by squares (with their 95% confidence intervals [CIs] as lines). HRs were combined using inverse-variance-weighted averages of the log HRs in the separate studies, yielding a result and its 95% CI, which is plotted as a diamond. Please see Supplementary Table 1 for further details about each study. Abbreviations: AGES-Reykjavik, Age, Gene/Environment Susceptibility-Reykjavik; CHAC, The Chicago Heart Association; CPS I, Cancer Prevention Study I Nutrition Cohort Study; CPS II, Cancer Prevention Study II Nutrition Cohort Study; DCPP, Diet and Cancer Pooling Project; EPIC, European Prospective Investigation into Cancer and Nutrition; JACC, Japan Collaborative Cohort Study; HUNT 2, Nord-Trøndelag Health Study; NHEFS, Nutrition Examination Survey Epidemiology Follow-Up Study; WS, Whitehall study
Fig. 3
Fig. 3
Meta-analysis of prospective studies on the risk of prostate cancer death in relation to body fat percentage (A), waist circumference (B), and waist to hip ratio (C). Study-specific hazard ratios (HR) are represented by squares (with their 95% confidence intervals [CIs] as lines). HRs were combined using inverse-variance-weighted averages of the log HRs in the separate studies, yielding a result and its 95% CI, which is plotted as a diamond. Please see Supplementary Tables 2 and 3 for further details about each study. Abbreviations: AGES-Reykjavik, Age, Gene/Environment Susceptibility-Reykjavik; DCPP, Diet and Cancer Pooling Project; EPIC, European Prospective Investigation into Cancer and Nutrition; HUNT 2, NordTrøndelag Health Study
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