A Body Shape Index (ABSI), hip index, and risk of cancer in the UK Biobank cohort

Abstract

Abdominal size is associated positively with the risk of some cancers but the influence of body mass index (BMI) and gluteofemoral size is unclear because waist and hip circumference are strongly correlated with BMI. We examined associations of 33 cancers with A Body Shape Index (ABSI) and hip index (HI), which are independent of BMI by design, and compared these with waist and hip circumference, using multivariable Cox proportional hazards models in UK Biobank. During a mean follow‐up of 7 years, 14,682 incident cancers were ascertained in 200,289 men and 12,965 cancers in 230,326 women. In men, ABSI was associated positively with cancers of the head and neck (hazard ratio HR = 1.14; 95% confidence interval 1.03–1.26 per one standard deviation increment), esophagus (adenocarcinoma, HR = 1.27; 1.12–1.44), gastric cardia (HR = 1.31; 1.07–1.61), colon (HR = 1.18; 1.10–1.26), rectum (HR = 1.13; 1.04–1.22), lung (adenocarcinoma, HR = 1.16; 1.03–1.30; squamous cell carcinoma [SCC], HR = 1.33; 1.17–1.52), and bladder (HR = 1.15; 1.04–1.27), while HI was associated inversely with cancers of the esophagus (adenocarcinoma, HR = 0.89; 0.79–1.00), gastric cardia (HR = 0.79; 0.65–0.96), colon (HR = 0.92; 0.86–0.98), liver (HR = 0.86; 0.75–0.98), and multiple myeloma (HR = 0.86; 0.75–1.00). In women, ABSI was associated positively with cancers of the head and neck (HR = 1.27; 1.10–1.48), esophagus (SCC, HR = 1.37; 1.07–1.76), colon (HR = 1.08; 1.01–1.16), lung (adenocarcinoma, HR = 1.17; 1.06–1.29; SCC, HR = 1.40; 1.20–1.63; small cell, HR = 1.39; 1.14–1.69), kidney (clear‐cell, HR = 1.25; 1.03–1.50), and post‐menopausal endometrium (HR = 1.11; 1.02–1.20), while HI was associated inversely with skin SCC (HR = 0.91; 0.83–0.99), post‐menopausal kidney cancer (HR = 0.77; 0.67–0.88), and post‐menopausal melanoma (HR = 0.90; 0.83–0.98). Unusually, ABSI was associated inversely with melanoma in men (HR = 0.89; 0.82–0.96) and pre‐menopausal women (HR = 0.77; 0.65–0.91). Waist and hip circumference reflected associations with BMI, when examined individually, and provided biased risk estimates, when combined with BMI. In conclusion, preferential positive associations of ABSI or inverse of HI with several major cancers indicate an important role of factors determining body shape in cancer development.

Association of body-shape phenotypes with imaging measures of body composition in the UK Biobank cohort: relevance to colon cancer risk

“…UK Biobank comprises half a million participants from the general population in the United Kingdom (UK), with age at enrolment 40 to 70 years, who were recruited between 2006 and 2010 and have been followed-up prospectively [ 8 , 9 ]. In accordance with our previous studies in UK Biobank [ 7 , 10 ], we restricted the study dataset to participants with self-reported white ancestry. To examine associations with body composition, we retained 32,068 participants with DXA measurement and 8399 with MRI measurements, excluding participants with missing imaging measurements, with anthropometric measurements which were extreme or missing at the imaging visit, with a mismatch between genetically determined and self-reported sex, younger than 45 or older than 75 at the imaging visit (to match the 30 years age window at enrolment and to minimise the influence of sarcopenia in the elderly), with prevalent cancer at the imaging visit, or with incident cancer or death within the first two years after the imaging visit (to minimise the influence of cancer cachexia).…”

“…Cancer cases in UK Biobank are ascertained based on cancer registry linkage. The outcome of interest was first primary colon cancer diagnosed after enrolment, defined as in our previous publication with code C18 from the 10th version of the International Classification of Diseases, and with behavioural code 3 or 5, excluding rare morphologies (histological codes 8240, 8241, 8243, 8245, 8246, 8472, 8743, 8936, 9680, 9699) [ 7 ]. We censored at the date of diagnosis participants with first colon cancer with behavioural codes 6, 9, or missing, or with colon cancer with rare morphology (as stated above), or with first primary cancer with other location.…”

“…To calculate HI for men, we used simple-fraction coefficients based on UK Biobank data. HI calculated with coefficients from NHANES was uncorrelated with BMI in women but was inversely correlated with BMI in men from the UK Biobank cohort [ 7 ] and, similarly, in men from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort [ 3 ]. This suggests ethnic differences in HI, as 28% of NHANES participants had black ethnic background [ 5 ].…”

“…In analogy to BMI, which compares body mass among individuals with the same height, ABSI and HI, which are related to body volume, compare the transversal body dimensions, waist and hip circumference, among individuals with the same weight and height. Positive associations with ABSI and inverse with HI have been reported for mortality, cardio-metabolic risk factors and various cancers, including several cancers which are not considered obesity related [ 3 , 4 , 6 , 7 ].…”

“…Using high-quality body-composition measurements from dual-emission X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) scans available for a subset of UK Biobank participants, we examined the body-composition profile of body-shape phenotypes defined with ABSI and HI and explored heterogeneity by BMI. To illustrate the relevance of this information to cancer epidemiology, we examined in the complete cohort the association between body-shape phenotypes and the risk of development of colon cancer, as the most common obesity-related cancer relevant to both men and women, for which we have already reported for UK Biobank positive associations with ABSI and BMI and, in men, an inverse association with HI [ 7 ].…”