Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort.

Yunxia Lu,Guy Fagherazzi,Rosario Tumino,Carmen Navarro,Salvatore Panico,Neil Murphy,Antonia Trichopoulou,Frida Renström,Peter D Siersema,Ingegerd Johansson,Christos Tsironis,Amanda J Cross,Elisabete Weiderpass,Heinz Freisling,Aurelio Barricarte,Marc J Gunter,H B Bueno-De-Mesquita,Elio Riboli,Rudolf Kaaks,Antoine Racine,Åsa Olsson,Ruth C Travis,Domenico Palli,Pietro Ferrari,Valeria Pala,Eleni Klinaki,Antonio Agudo,Marie Christine Boutron-Ruault ,María José Sánchez ,Petra H.m Peeters ,Verena Katzke

doi:10.1007/s10552-016-0772-z

Abstract

BackgroundThe etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC.MethodsWe investigated overall obesity and abdominal adiposity in relation to SIC in the European Prospective Investigation into Cancer and Nutrition (EPIC), a large prospective cohort of approximately half a million men and women from ten European countries. Overall obesity and abdominal obesity were assessed by body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression modeling was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Stratified analyses were conducted by sex, BMI, and smoking status.ResultsDuring an average of 13.9 years of follow-up, 131 incident cases of SIC (including 41 adenocarcinomas, 44 malignant carcinoid tumors, 15 sarcomas and 10 lymphomas, and 21 unknown histology) were identified. WC was positively associated with SIC in a crude model that also included BMI (HR per 5-cm increase = 1.20, 95 % CI 1.04, 1.39), but this association attenuated in the multivariable model (HR 1.18, 95 % CI 0.98, 1.42). However, the association between WC and SIC was strengthened when the analysis was restricted to adenocarcinoma of the small intestine (multivariable HR adjusted for BMI = 1.56, 95 % CI 1.11, 2.17). There were no other significant associations.ConclusionWC, rather than BMI, may be positively associated with adenocarcinomas but not carcinoid tumors of the small intestine.ImpactAbdominal obesity is a potential risk factor for adenocarcinoma in the small intestine.

Highlights

Small intestinal cancer (SIC) is very rare, with an annual incidence rate ranging from 0.2 to 2.6 per 100,000 people per year worldwide [1,2,3,4]
waist circumference (WC) was positively associated with small intestinal cancer (SIC) in a crude model that included body mass index (BMI) (HR per 5-cm increase = 1.20, 95 % confidence intervals (CIs) 1.04, 1.39), but this association attenuated in the multivariable model (HR 1.18, 95 % CI 0.98, 1.42)
The association between WC and SIC was strengthened when the analysis was restricted to adenocarcinoma of the small intestine

Summary

Introduction

Small intestinal cancer (SIC) is very rare, with an annual incidence rate ranging from 0.2 to 2.6 per 100,000 people per year worldwide [1,2,3,4]. Recent studies from the USA and Europe have indicated an increasing incidence of SIC, which seems to be explained by the increasing incidence of adenocarcinoma of the duodenum [1, 3, 4, 7,8,9,10,11]. The main histological subtypes of malignant SICs include adenocarcinomas, carcinoid tumors, lymphomas, and sarcomas. Adenocarcinoma is the dominant histological subtype in the duodenum, and carcinoid tumors are most common in the ileum [12,13,14,15]. The etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC

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Conclusion