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Meta-Analysis
. 2023 Nov 23;21(1):418.
doi: 10.1186/s12916-023-03114-z.

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies

Emma Fontvieille  1 , Vivian Viallon  1 , Martina Recalde  1 , Reynalda Cordova  1 , Anna Jansana  1 , Laia Peruchet-Noray  1   2 , Hannah Lennon  1 , Alicia K Heath  3 , Dagfinn Aune  3   4   5 , Sofia Christakoudi  3   6 , Verena Katzke  7 , Rudolf Kaaks  7 , Elif Inan-Eroglu  8 , Matthias B Schulze  8   9 , Lene Mellemkjær  10 , Anne Tjønneland  10   11 , Kim Overvad  12 , Marta Farràs  13 , Dafina Petrova  14   15   16 , Pilar Amiano  17   18   19 , María-Dolores Chirlaque  16   20 , Conchi Moreno-Iribas  16   21   22 , Sandar Tin Tin  23 , Giovanna Masala  24 , Sabina Sieri  25 , Fulvio Ricceri  26 , Salvatore Panico  27 , Anne M May  28 , Evelyn M Monninkhof  28 , Elisabete Weiderpass  1 , Marc J Gunter  1   3 , Pietro Ferrari  1 , Heinz Freisling  29
Affiliations
Meta-Analysis

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies

Emma Fontvieille et al. BMC Med. .

Abstract

Background: Whether cancer risk associated with a higher body mass index (BMI), a surrogate measure of adiposity, differs among adults with and without cardiovascular diseases (CVD) and/or type 2 diabetes (T2D) is unclear. The primary aim of this study was to evaluate separate and joint associations of BMI and CVD/T2D with the risk of cancer.

Methods: This is an individual participant data meta-analysis of two prospective cohort studies, the UK Biobank (UKB) and the European Prospective Investigation into Cancer and nutrition (EPIC), with a total of 577,343 adults, free of cancer, T2D, and CVD at recruitment. We used Cox proportional hazard regressions to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between BMI and incidence of obesity-related cancer and in turn overall cancer with a multiplicative interaction between BMI and the two cardiometabolic diseases (CMD). HRs and 95% CIs for separate and joint associations for categories of overweight/obesity and CMD status were estimated, and additive interaction was quantified through relative excess risk due to interaction (RERI).

Results: In the meta-analysis of both cohorts, BMI (per ~ 5 kg/m2) was positively associated with the risk of obesity-related cancer among participants without a CMD (HR: 1.11, 95%CI: 1.07,1.16), among participants with T2D (HR: 1.11, 95% CI: 1.05,1.18), among participants with CVD (HR: 1.17, 95% CI: 1.11,1.24), and suggestively positive among those with both T2D and CVD (HR: 1.09, 95% CI: 0.94,1.25). An additive interaction between obesity (BMI ≥ 30 kg/m2) and CVD with the risk of overall cancer translated into a meta-analytical RERI of 0.28 (95% CI: 0.09-0.47).

Conclusions: Irrespective of CMD status, higher BMI increased the risk of obesity-related cancer among European adults. The additive interaction between obesity and CVD suggests that obesity prevention would translate into a greater cancer risk reduction among population groups with CVD than among the general population.

Keywords: Cardiovascular diseases; Comorbidities; Multimorbidity; Obesity; Obesity-related cancers; Type 2 diabetes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
BMI and obesity-related cancer risk by cardiometabolic disease status in EPIC and UKB cohorts. I2, the proportion of total variability due to between-study heterogeneity from random effects meta-analysis. BMI body mass index, EPIC European Prospective Investigation into Cancer and nutrition, UKB UK Biobank, HR hazard ratio, CI confidence interval, T2D type 2 diabetes, CVD cardiovascular diseases, CMD cardiometabolic diseases
Fig. 2
Fig. 2
Relative excess risk of obesity-related cancers due to interaction between overweight/obesity and cardiometabolic diseases in EPIC and UKB cohorts. I2, the proportion of total variability due to between-study heterogeneity from random effects meta-analysis. CI confidence interval, EPIC European Prospective Investigation into Cancer and nutrition, UKB UK Biobank, RERI relative excess risk due to interaction, BMI body mass index, T2D type 2 diabetes, CVD cardiovascular diseases
See this image and copyright information in PMC

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