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. 2024 Jan 23;331(4):318-328.
doi: 10.1001/jama.2023.25869.

Cancer Diagnoses After Recent Weight Loss

Qiao-Li Wang  1   2 , Ana Babic  1 , Michael H Rosenthal  3   4 , Alice A Lee  5 , Yin Zhang  6 , Xuehong Zhang  6   7 , Mingyang Song  6   8   9 , Leandro F M Rezende  10 , Dong Hoon Lee  6   11 , Leah Biller  1 , Kimmie Ng  1 , Marios Giannakis  1 , Andrew T Chan  7   9 , Jeffrey A Meyerhardt  1 , Charles S Fuchs  12   13 , A Heather Eliassen  6   7   8 , Brenda M Birmann  7 , Meir J Stampfer  6   7   8 , Edward L Giovannucci  6   8 , Peter Kraft  8   14 , Jonathan A Nowak  15 , Chen Yuan  1 , Brian M Wolpin  1
Affiliations

Cancer Diagnoses After Recent Weight Loss

Qiao-Li Wang et al. JAMA. .

Abstract

Importance: Weight loss is common in primary care. Among individuals with recent weight loss, the rates of cancer during the subsequent 12 months are unclear compared with those without recent weight loss.

Objective: To determine the rates of subsequent cancer diagnoses over 12 months among health professionals with weight loss during the prior 2 years compared with those without recent weight loss.

Design, setting, and participants: Prospective cohort analysis of females aged 40 years or older from the Nurses' Health Study who were followed up from June 1978 until June 30, 2016, and males aged 40 years or older from the Health Professionals Follow-Up Study who were followed up from January 1988 until January 31, 2016.

Exposure: Recent weight change was calculated from the participant weights that were reported biennially. The intentionality of weight loss was categorized as high if both physical activity and diet quality increased, medium if only 1 increased, and low if neither increased.

Main outcome and measures: Rates of cancer diagnosis during the 12 months after weight loss.

Results: Among 157 474 participants (median age, 62 years [IQR, 54-70 years]; 111 912 were female [71.1%]; there were 2631 participants [1.7%] who self-identified as Asian, Native American, or Native Hawaiian; 2678 Black participants [1.7%]; and 149 903 White participants [95.2%]) and during 1.64 million person-years of follow-up, 15 809 incident cancer cases were identified (incident rate, 964 cases/100 000 person-years). During the 12 months after reported weight change, there were 1362 cancer cases/100 000 person-years among all participants with recent weight loss of greater than 10.0% of body weight compared with 869 cancer cases/100 000 person-years among those without recent weight loss (between-group difference, 493 cases/100 000 person-years [95% CI, 391-594 cases/100 000 person-years]; P < .001). Among participants categorized with low intentionality for weight loss, there were 2687 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 1220 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 1467 cases/100 000 person-years [95% CI, 799-2135 cases/100 000 person-years]; P < .001). Cancer of the upper gastrointestinal tract (cancer of the esophagus, stomach, liver, biliary tract, or pancreas) was particularly common among participants with recent weight loss; there were 173 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 36 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 137 cases/100 000 person-years [95% CI, 101-172 cases/100 000 person-years]; P < .001).

Conclusions and relevance: Health professionals with weight loss within the prior 2 years had a significantly higher risk of cancer during the subsequent 12 months compared with those without recent weight loss. Cancer of the upper gastrointestinal tract was particularly common among participants with recent weight loss compared with those without recent weight loss.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rosenthal reported receiving personal fees from Merck. Dr Ng reported receiving grants from Pharmavite, Evergrande Group, Janssen, and Revolution Medicines and receiving personal fees from Bayer, SeaGen, BiomX, GSK (formerly GlaxoSmithKline), Bicara Therapeutics, Pfizer, CytomX, X-Biotix Therapeutics, and Redesign Health. Dr Giannakis reported receiving grants from Bristol Myers Squibb, Merck, Servier, and Janssen and receiving personal fees from AstraZeneca. Dr Chan reported receiving personal fees from Bayer Pharma AG, Boehringer Ingelheim, and Pfizer and receiving grants from Zoe, Freenome, and Pfizer. Dr Meyerhardt reported receiving personal fees from Merck and COTA Healthcare. Dr Fuchs reported being employed by Genentech and Roche; serving on the board of directors for CytomX Therapeutics and Evolveimmune Therapeutics; receiving personal fees from Amylin Pharmaceuticals, AstraZeneca, Bain Capital, CytomX Therapeutics, Daiichi-Sankyo, Eli Lilly, Entrinsic Health, Evolveimmune Therapeutics, Genentech, Merck, and Taiho; owning unexercised stock options for CytomX and Entrinsic Health; being a co-founder of Evolveimmune Therapeutics and having equity in this private company; and providing expert testimony for Amylin Pharmaceuticals and Eli Lilly. Dr Wolpin reported receiving grants from AstraZeneca, Celgene, Bristol Myers Squibb, Eli Lilly, Novartis, and Revolution Medicines and receiving personal fees from BioLineRx, Mirati, Ipsen, GRAIL, Celgene, Bristol Myers Squibb, and Third Rock Ventures. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Recent Weight Change and 1-Year Risk of Cancer Overall and by Category of Weight Loss–Promoting Behaviors
Weight loss–promoting behaviors (intentionality of weight loss) were categorized as (1) high if both physical activity (in metabolic equivalent task hours per week) and diet quality (based on Alternative Healthy Eating Index 2010 score) increased during consecutive questionnaires, (2) medium if only 1 of these increased (physical activity or diet quality score), and (3) low if neither increased. Intentionality of weight loss was assessed starting in 1988. aIncluded age (in months), calendar year of the survey cycle, sex and cohort, race (White or non-White), family history of cancer (yes or no), smoking (never and <5, 5-19, 20-39, or ≥40 pack-years), duration since smoking cessation (current, <2.0 years, 2.0-3.9 years, 4.0-5.9 years, and never or quit ≥6.0 years ago), alcohol consumption (0 g/d, 0.1-4.9 g/d, 5.0-14.9 g/d, 15.0-29.9 g/d, or ≥30.0 g/d), multivitamin use (yes or no), physical activity in metabolic equivalent task hours per week (quintiles by sex), Alternative Healthy Eating Index 2010 score (excludes alcohol consumption and uses quintiles by sex), previous body mass index (calculated as weight in kilograms divided by height in meters squared; continuous variable), menopausal status and hormone therapy use in females (premenopausal, postmenopausal and never user, postmenopausal and past user, or postmenopausal and current user).
Figure 2.
Figure 2.. One-Year Relative Risk of Individual and Total Cancer Among Participants Who Experienced a Recent Weight Loss of Greater Than 10.0% of Body Weight
Individual cancer types within each system are ranked in descending order based on the multivariable-adjusted relative risk comparing recent weight loss of greater than 10.0% vs no weight loss. aIncluded age (in months), calendar year of the survey cycle, sex and cohort, race (White or non-White), family history of cancer (yes or no), smoking (never and <5, 5-19, 20-39, or ≥40 pack-years), duration since smoking cessation (current, <2.0 years, 2.0-3.9 years, 4.0-5.9 years, and never or quit ≥6.0 years ago), alcohol consumption (0 g/d, 0.1-4.9 g/d, 5.0-14.9 g/d, 15.0-29.9 g/d, or ≥30.0 g/d), multivitamin use (yes or no), physical activity in metabolic equivalent task hours per week (quintiles by sex), Alternative Healthy Eating Index 2010 score (excludes alcohol consumption and uses quintiles by sex), previous body mass index (calculated as weight in kilograms divided by height in meters squared; continuous variable), menopausal status and hormone therapy use in females (premenopausal, postmenopausal and never user, postmenopausal and past user, or postmenopausal and current user). bCalculated using medians of weight change from each category (no weight loss, 0.1%-5.0% weight loss, 5.1%-10.0% weight loss, and >10.0% weight loss) in the regression model and the Wald test.
Figure 3.
Figure 3.. Percentage of Recent Weight Change and Relative Risk of Cancer During the Subsequent Year (1-12 Months) and Second Year (13-24 Months) After Reported Weight Change
The shading indicates the 95% CIs. The P values indicate the significance of the overall relationship and were calculated using the likelihood ratio test. aIncluded esophageal, stomach, liver, biliary tract, and pancreatic cancer. bIncluded non-Hodgkin lymphoma, multiple myeloma, and leukemia.
Figure 4.
Figure 4.. One-Year Absolute Risk of Cancer Among Individuals Aged 60 Years or Older by Recent Weight Change During the Past 2 Years
aWeight loss–promoting behaviors (intentionality of weight loss) were categorized as (1) high if both physical activity (in metabolic equivalent task hours per week) and diet quality (based on Alternative Healthy Eating Index 2010 score) increased during consecutive questionnaires, (2) medium if only 1 of these increased (physical activity or diet quality score), and (3) low if neither increased. Intentionality of weight loss was assessed starting in 1988. bAge of 70 years or older, male sex, or low category of weight loss–promoting behaviors.
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