Abstract
BackgroundObesity and diabetes are two risk factors for cancer. To evaluate the association of body mass index (BMI) with cancer risk in diabetic patients may improve current understanding of potential mechanisms.MethodsA retrospective cohort study was conducted in 51,004 newly diagnosed T2DM patients derived from an electronic health record (EHR) database of Minhang district in Shanghai, China. Incident cancer cases and all-cause deaths occurred before September 30, 2015 were identified by linking with the Shanghai Cancer Registry and the Shanghai Vital Statistics. To examine the potential non-linear and linear relationships of BMI and cancer risk, Cox proportional hazard models with and without restricted cubic spline functions were used, respectively.ResultsA non-linear association was observed between BMI and overall cancer incidence in men younger than 60 years old (p for non-linearity = 0.009). Compared with those having BMI of 25.0 kg/m2, the cancer risk increased in those with either lower or higher BMI. In women older than 60 years old, linear dose-response relationships were observed between BMI and the risk of both overall cancer and breast cancer. As each unit increase in BMI, the overall cancer risks elevated by 3% (95%CI: 1–5%) and the breast cancer risks increased by 7% (95%CI: 1–13%). No significant association was observed between BMI and other common cancer sites.ConclusionsOur results show that the effect of BMI on cancer risk in Chinese patients with T2DM may vary by gender, age and cancer subtypes, suggesting different underlying biological mechanisms.
Highlights
Obesity and diabetes are two risk factors for cancer
Data collection Baseline information on demographic factors, diagnosis date of diabetes, self-reported standing height and body weight, and regular exercise was derived from the electronic health record database
Significant differences were found for age at diagnosis of Type 2 diabetes mellitus (T2DM), gender, family history of diabetes, pre-existing hypertension, and regular exercise across body mass index (BMI) categories
Summary
Obesity and diabetes are two risk factors for cancer. To evaluate the association of body mass index (BMI) with cancer risk in diabetic patients may improve current understanding of potential mechanisms. The associations of obesity [1,2,3,4] and diabetes [5, 6] with cancer risks have recently been drawing much attention, mainly due to alarmingly increasing prevalence of the two chronic conditions [7, 8]. As two independent risk factors for overall and certain types of cancer in general population, diabetes and obesity have common biological mechanisms, such as insulin resistance. To evaluate the association of BMI with cancer risk among T2DM patients is another approach to better understanding the mechanisms that link obesity and diabetes with cancers. We conducted a large-scale retrospective cohort study based on the diabetes management database in Minhang district of Shanghai, China, to examine the association between BMI and risks of overall and site-specific cancers in Chinese diabetic patients
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