Analysis of Body Mass Index in Early and Middle Adulthood and Estimated Risk of Gastrointestinal Cancer

Abstract

ImportanceIn a population with significantly increasing rates of individuals with overweight or obesity, understanding the association of obesity with long-term disease risk, such as cancer, is necessary to improve public health.ObjectiveTo investigate the association between body mass index (BMI) and gastrointestinal (GI) cancer risk (colorectal cancer [CRC] and noncolorectal GI cancer) in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.Design, Setting, and ParticipantsThis retrospective cohort study was a secondary analysis of data from the PLCO Cancer Screening Trial. Participants aged 55 to 74 years were enrolled and randomized to the intervention (screening group) or control group at 10 screening centers between November 8, 1993, and July 2, 2001. The initial analysis of PLCO Cancer Screening Trial data occurred after 13 years of follow-up or December 31, 2009, whichever came first. Participants were reconsented in 2011 and either continued follow-up or refused additional follow-up. For those who reconsented, follow-up for incident cancers continued until December 31, 2014, or death, whichever occurred first. Data analysis for this secondary analysis was performed from April 2022 through November 2022.ExposuresBody mass index and aspirin use, defined as the frequency of use of aspirin or aspirin-containing substances in the last 12 months.Main Outcomes and MeasuresThe primary outcomes were the diagnoses of CRC and noncolorectal GI cancer. The association between BMI and cancer (CRC and noncolorectal GI cancer) was assessed using Cox proportional hazards regression modeling. The association between cancer risk and change in BMI was further analyzed at different ages, and an exploratory analysis was performed to evaluate GI cancer risk among aspirin users.ResultsThis analysis included 135 161 participants (median [range] age, 62 [55-78] years; 67 643 [50.0%] female). Overweight BMI in early adulthood (hazard ratio [HR], 1.23; 95% CI, 1.10-1.37) and overweight BMI in middle adulthood (HR, 1.23; 95% CI, 1.13-1.34) and later adulthood (HR, 1.21; 95% CI, 1.10-1.32) as well as obese BMI in middle adulthood (HR, 1.55; 95% CI, 1.38-1.75) and later adulthood (HR, 1.39; 95% CI, 1.25-1.54) were associated with increased risk of CRC. Similar results were observed for the association with overall GI and non-CRC GI risk and BMI in middle and later adulthood. Maintaining overweight or obese BMI or increasing BMI to overweight or obese in later adulthood was also associated with increased CRC risk. Aspirin use 3 or more times per week did not significantly modify this association.Conclusions and RelevanceIn this secondary analysis of the PLCO Cancer Screening Trial, overweight and obese BMI in early and middle adulthood was associated with an elevated risk of CRC and noncolorectal GI cancers. The results of the current study prompt further exploration into the mechanistic role of obese BMI in carcinogenesis.

Obesity and Gastrointestinal Cancer: A Life Course Perspective

“…The findings by Loomans-Kropp et al provide relatively consistent messaging that overweight or obesity from early to later adulthood as well as BMI increases throughout adulthood were associated with increased risk of GI cancers, especially CRC. Such important findings highlight the unmet need to identify the critical time window linking adiposity and GI cancer.…”

“…However, most epidemiologic studies examined BMI at one time point, missing the opportunity to delineate the contribution of adiposity throughout the life course. In this issue, Loomans-Kropp et al explored the associations between BMI at early adulthood (aged 20 years), middle adulthood (aged 50 years), and later adulthood (aged ≥55 years), as well as BMI changes (from early or middle adulthood to later adulthood) with risk of CRC and non-CRC GI cancers (including esophageal, gastric, liver, and pancreatic cancer), using data from 135 161 participants aged 55 to 74 years at enrollment from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2014). In the baseline questionnaire, participants self-reported weight and height at 20 years of age, 50 years of age, and current weight and height.…”

Anthropometric Indices in Predicting the Risks of Occurrence and Outcomes of Diseases at Present Stage

“…В работе H.A. Loomans-Kropp и A. Umar [27] избыточный вес и ожирение, высокие значения ИМТ в раннем и 1-м периоде зрелого возраста, указывали на прямую связь с риском развития колоректального рака и других видов рака желудочно-кишечного тракта. Авторы данного исследования побуждают коллег к дальнейшему изучению роли ИМТ не только в ожирении, но и в канцерогенезе.…”

Single-cell transcriptome analysis reveals immunosuppressive landscape in overweight and obese colorectal cancer

“…Obesity has become a major public health issue in China where 34.3% of adults face issues of overweight, and 16.4% contend with obesity [ 11 ]. Notably, the sustained or escalating presence of overweight or obese Body Mass Index (BMI) over time is correlated with an increased susceptibility to gastrointestinal cancer [ 12 ]. Consequently, it is crucial to reveal the mechanism by which obesity increases tumor burden.…”