Abstract
Previous studies on the association of adiposity with endometrial cancer risk have mostly used body mass index (BMI) as the main exposure of interest. Whether more precise measures of body fat, such as body fat percentage and fat mass estimated by bioimpedance analyses, are better indicators of risk than BMI is unknown. The role of central adiposity and fat-free mass in endometrial cancer development remains unclear. We used Cox regression models to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI) for the associations of various measures of body size/composition with the risk of endometrial cancer among 135 110 postmenopausal women enrolled in UK Biobank. During a mean follow up of 6.8 years, 706 endometrial cancers were diagnosed, with a mean age at diagnosis of 65.5 years. The HRs (95% CIs) for endometrial cancer per 1 SD increase in BMI, body fat percentage and fat mass were broadly comparable, being 1.71 (1.61-1.82), 1.92 (1.75-2.11) and 1.73 (1.63-1.85), respectively. There was an indication of positive association between central adiposity, as reflected by waist circumference (HRper 1-SD increase = 1.08, 95% CI: 1.00-1.17) and waist to hip ratio (HRper 1-SD increase = 1.13, 95% CI: 1.01-1.26), and endometrial cancer risk after accounting for BMI. Fat-free mass was not an independent predictor of risk in this cohort. These findings suggest that body fat percentage and fat mass are not better indicators of endometrial cancer risk than BMI. Further studies are needed to establish whether central adiposity contributes to risk beyond overall adiposity.
Highlights
IntroductionExcess adiposity, often defined by body mass index (BMI), is an established risk factor for endometrial cancer.[1,2,3,4,5,6,7,8] BMI reflects both fat and fat-free mass, which may have different associations with disease risk, and it does not assess fat distribution, which varies considerably even among individuals with a similar BMI.[9]Int
Note: Models were stratified by year of birth and year of recruitment, and adjusted for age, deprivation score, UK region, parity, use of hormone replacement therapy (HRT), smoking status, physical activity, age at menopause, oral contraceptive use, age at menarche and diabetes. aAdjusted for body mass index (BMI) using the standard method that is, BMI included as a covariate in the model. bHR presented for waist to hip ratio. In this large prospective cohort, endometrial cancer risk was positively associated with all measures of overall adiposity (BMI, weight, body fat percentage and fat mass) and central adiposity
The positive associations between measures of central adiposity and endometrial cancer risk were substantially attenuated after adjusting for BMI, but waist circumference and waist to hip ratio remained marginally associated with risk
Summary
Excess adiposity, often defined by body mass index (BMI), is an established risk factor for endometrial cancer.[1,2,3,4,5,6,7,8] BMI reflects both fat and fat-free mass, which may have different associations with disease risk, and it does not assess fat distribution, which varies considerably even among individuals with a similar BMI.[9]Int. Often defined by body mass index (BMI), is an established risk factor for endometrial cancer.[1,2,3,4,5,6,7,8] BMI reflects both fat and fat-free mass, which may have different associations with disease risk, and it does not assess fat distribution, which varies considerably even among individuals with a similar BMI.[9]
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