Abstract
BackgroundAdiposity is a strong risk factor for cancer incidence and mortality. However, most of the evidence available has focused on body mass index (BMI) as a marker of adiposity. There is limited evidence on relationships of cancer with other adiposity markers, and if these associations are linear or not. The aim of this study was to investigate the associations of six adiposity markers with incidence and mortality from 24 cancers by accounting for potential non-linear associations.MethodsA total of 437,393 participants (53.8% women; mean age 56.3 years) from the UK Biobank prospective cohort study were included in this study. The median follow-up was 8.8 years (interquartile range 7.9 to 9.6) for mortality and 9.3 years (IQR 8.6 to 9.9) for cancer incidence. Adiposity-related exposures were BMI, body fat percentage, waist-hip ratio, waist-height ratio, and waist and hip circumference. Incidence and mortality of 24 cancers sites were the outcomes. Cox proportional hazard models were used with each of the exposure variables fitted separately on penalised cubic splines.ResultsDuring follow-up, 47,882 individuals developed cancer and 11,265 died due to cancer during the follow-up period. All adiposity markers had similar associations with overall cancer incidence. BMI was associated with a higher incidence of 10 cancers (stomach cardia (hazard ratio per 1 SD increment 1.35, (95% CI 1.23; 1.47)), gallbladder (1.33 (1.12; 1.58)), liver (1.27 (1.19; 1.36)), kidney (1.26 (1.20; 1.33)), pancreas (1.12 (1.06; 1.19)), bladder (1.09 (1.04; 1.14)), colorectal (1.10 (1.06; 1.13)), endometrial (1.73 (1.65; 1.82)), uterine (1.68 (1.60; 1.75)), and breast cancer (1.08 (1.05; 1.11))) and overall cancer (1.03 (1.02; 1.04)). All these associations were linear except for breast cancer in postmenopausal women. Similar results were observed when other markers of central and overall adiposity were used. For mortality, nine cancer sites were linearly associated with BMI and eight with waist circumference and body fat percentage.ConclusionAdiposity, regardless of the marker used, was associated with an increased risk in 10 cancer sites.
Highlights
Adiposity is a strong risk factor for cancer incidence and mortality
There was no evidence against linear associations with these cancer sites for all adiposity markers, the magnitude of association was higher for liver cancer incidence (HR ranging from 1.19 to 1.33 per 1-SD higher adiposity) compared with colorectal cancer (HR ranging from 1.07 to 1.13 per 1-SD higher adiposity), as shown in Additional file 1: Table S1
A similar shape of association was observed for risk of pancreatic cancer incidence across all adiposity markers, only body mass index (BMI) was significantly associated with a higher risk after adjusting for multiple testing (Fig. 1)
Summary
Adiposity is a strong risk factor for cancer incidence and mortality. most of the evidence available has focused on body mass index (BMI) as a marker of adiposity. Most of the evidence available to date have assumed a linear association between markers of adiposity and cancer risk from most common sites (colorectal, breast cancer, liver, kidney, and gallbladder) [4, 12], with a limited number of studies investigating non-linear association [2, 14, 15]. To address these limitations, we used data from the UK Biobank cohort, a large prospective cohort study, to investigate the associations of six adiposity markers with incidence and mortality from 24 cancers by accounting for potential non-linear associations
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