Abstract
BackgroundA high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC.MethodsProspective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites.ResultsAfter a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m2 increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers.ConclusionsIn this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity.
Highlights
A high body mass index (BMI) has been associated with increased risk of several cancers; whether BMI is related to a larger number of cancers than currently recognized is unclear
Recalde et al BMC Medicine (2021) 19:10 (Continued from previous page). In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck cancers
BMI and waist circumference (WC) showed comparable estimates of cancer risk associated with adiposity
Summary
A high body mass index (BMI) has been associated with increased risk of several cancers; whether BMI is related to a larger number of cancers than currently recognized is unclear. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC. Results from previous large cohort studies suggest that BMI is associated with a larger number of cancer types than currently recognized and that some of those associations may be non-linear [3, 4]. Typically assessed using waist circumference (WC), has been suggested to increase the risk of several cancer types and to better discriminate risk associated with obesity for colon and breast post-menopausal cancers [6,7,8]. Only few studies have systematically compared the effect estimates of BMI and WC for multiple site-specific cancers, and none have studied less frequently occurring cancer types [9, 10]
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