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. 2024 Aug 1;7(8):e2429494.
doi: 10.1001/jamanetworkopen.2024.29494.

Body Mass Index and Risk of Colorectal Cancer Incidence and Mortality in Asia

Pedram Paragomi  1 , Zhongjie Zhang  2 , Sarah Krull Abe  3 , Md Rashedul Islam  3   4 , Md Shafiur Rahman  3   5 , Eiko Saito  6 , Xiao-Ou Shu  7 , Bashir Dabo  8 , Yen Thi-Hai Pham  1   2 , Yu Chen  9   10 , Yu-Tang Gao  11   12 , Woon-Puay Koh  13   14 , Norie Sawada  15 , Reza Malekzadeh  16 , Ritsu Sakata  17 , Atsushi Hozawa  18 , Jeongseon Kim  19 , Seiki Kanemura  18 , Chisato Nagata  20 , San-Lin You  21 , Hidemi Ito  22 , Sue K Park  23 , Jian-Min Yuan  1   2 , Wen-Harn Pan  24   25 , Wanqing Wen  7 , Renwei Wang  1 , Hui Cai  18 , Shoichiro Tsugane  15 , Akram Pourshams  16 , Yumi Sugawara  18 , Keiko Wada  20 , Chien-Jen Chen  26 , Isao Oze  27 , Aesun Shin  23   28 , Habibul Ahsan  29 , Paolo Boffetta  30   31 , Kee Seng Chia  32 , Keitaro Matsuo  27   33 , You-Lin Qiao  34 , Nathaniel Rothman  35 , Wei Zheng  7 , Manami Inoue  3 , Daehee Kang  23 , Hung N Luu  1   2
Affiliations

Body Mass Index and Risk of Colorectal Cancer Incidence and Mortality in Asia

Pedram Paragomi et al. JAMA Netw Open. .

Abstract

Importance: The global burden of obesity is increasing, as are colorectal cancer (CRC) incidence and mortality.

Objectives: To assess the association between body mass index (BMI) and risks of incident CRC and CRC-related death in the Asian population.

Design, setting, and participants: This cohort study includes data pooled from 17 prospective cohort studies included in The Asia Cohort Consortium. Cohort enrollment was conducted from January 1, 1984, to December 31, 2002. Median follow-up time was 15.2 years (IQR, 12.1-19.2 years). Data were analyzed from January 15, 2023, through January 15, 2024.

Exposure: Body mass index, calculated as weight in kilograms divided by height in meters squared.

Main outcomes and measures: The primary outcomes were CRC incidence and CRC-related mortality. The risk of events is reported as adjusted hazard ratios (AHRs) and 95% CIs for incident CRC and death from CRC using the Cox proportional hazards regression model.

Results: To assess the risk of incident CRC, 619 981 participants (mean [SD] age, 53.8 [10.1] years; 52.0% female; 11 900 diagnosed incident CRC cases) were included in the study, and to assess CRC-related mortality, 650 195 participants (mean [SD] age, 53.5 [10.2] years; 51.9% female; 4550 identified CRC deaths) were included in the study. A positive association between BMI and risk of CRC was observed among participants with a BMI greater than 25.0 to 27.5 (AHR, 1.09 [95% CI, 1.03-1.16]), greater than 27.5 to 30.0 (AHR, 1.19 [95% CI, 1.11-1.29]), and greater than 30.0 (AHR, 1.32 [95% CI, 1.19-1.46]) compared with those with a BMI greater than 23.0 to 25.0 (P < .001 for trend), and BMI was associated with a greater increase in risk for colon cancer than for rectal cancer. A similar association between BMI and CRC-related death risk was observed among participants with a BMI greater than 27.5 (BMI >27.5-30.0: AHR, 1.18 [95% CI, 1.04-1.34]; BMI >30.0: AHR, 1.38 [95% CI, 1.18-1.62]; P < .001 for trend) and was present among men with a BMI greater than 30.0 (AHR, 1.87 [95% CI, 1.49-2.34]; P < .001 for trend) but not among women (P = .15 for trend) (P = .02 for heterogeneity).

Conclusions and relevance: In this cohort study that included a pooled analysis of 17 cohort studies comprising participants across Asia, a positive association between BMI and CRC incidence and related mortality was found. The risk was greater among men and participants with colon cancer. These findings may have implications to better understand the burden of obesity on CRC incidence and related deaths in the Asian population.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Association Between Body Mass Index and Risk of Incident Colorectal Cancer
A, Model adjusted for age at baseline, sex, diabetes at baseline, current smoker, and ever alcohol use. B, Model adjusted for age at baseline, diabetes at baseline, current smoker, and ever alcohol use. Body mass index was calculated as weight in kilograms divided by height in meters squared. Shaded areas indicate 95% CIs.
Figure 2.
Figure 2.. Association Between Body Mass Index and Risk of Colorectal Cancer Mortality
A, Model adjusted for age at baseline, sex, diabetes at baseline, current smoker, and ever alcohol use. B, Model adjusted for age at baseline, diabetes at baseline, current smoker, and ever alcohol use. Body mass index was calculated as weight in kilograms divided by height in meters squared. Shaded areas indicate 95% CIs.
See this image and copyright information in PMC

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