Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants

Abstract

Background: This study was performed to investigate the association between body mass index (BMI) and gastric cancer in East and Southeast Asia where most of gastric cancer is non-cardia gastric cancer. Methods: On the basis of 8,997 gastric cancer cases among the Asia Cohort Consortium participants from China, Japan, Korea, and Singapore (N = 538,835), we assessed gastric cancer risk according to BMI by calculating hazard ratios (HR) and 95% confidence intervals (CI) using the Cox proportional hazard regression model. Results: A U-shaped associations between BMI and gastric cancer risk were observed. Gastric cancer risks in underweight group (<18.5 kg/m2) and in obesity group (≥27.5 kg/m2) were higher than reference BMI group (23–24.9 kg/m2; HR, 1.15; 95% CI, 1.05–1.25 for underweight; HR, 1.12; 95% CI, 1.03–1.22 for obesity, respectively). The associations of underweight and obesity with gastric cancer risk were consistent in the analyses for non-cardia gastric cancer, intestinal-type gastric cancer, and late-onset gastric cancer. No significant association of underweight and obesity with the risk of cardia gastric cancer, diffuse-type gastric cancer, and early-onset gastric cancer was observed. In addition, we found that the U-shaped association between BMI and gastric cancer risk remained in nonsmokers, while only underweight was related to increased gastric cancer risk in smokers. Conclusions: BMI has a U-shaped association with gastric cancer risk in East and Southeast Asian population, especially for the non-cardia gastric cancer, intestinal-type gastric cancer, and late-onset gastric cancer. Impact: Future studies with consideration of anatomic location and histology of gastric cancer are needed to establish the association of underweight as well as obesity with gastric cancer risk.

Body mass index and esophageal and gastric cancer: A pooled analysis of 10 population‐based cohort studies in Japan

“…A recent large‐scale pooled analysis in Asian countries with more than 800,000 individuals reported that underweight (BMI <18.5 kg/m 2 ) and extreme obesity (BMI ≥35 kg/m 2 ) were associated with the mortality risk of overall esophageal and esophageal squamous cell carcinoma, but showed no clear association between esophageal adenocarcinoma and BMI 20 . A second pooled analysis including more than 500,000 Asian individuals showed a U‐shaped association between BMI and incidence risk of overall gastric and gastric noncardia cancer, but failed to confirm increased risk of gastric cardia cancer incidence in overweight and obese people 19 . These findings suggest that the association between BMI and these cancers shows different patterns between populations.…”

“…9 Given that Asians generally have greater adiposity with the same BMI 12 and different dietary activities and lifestyles compared with Caucasians, it is crucial to assess whether the magnitude and direction of the associations between BMI and risk of upper gastrointestinal cancer in Asians are comparable to those in Caucasians. Several epidemiological studies have evaluated the association between BMI and esophageal and gastric cancer risk among Asian populations, [13][14][15][16][17][18][19][20] but the findings were inconsistent and limited, particularly with regard to esophageal adenocarcinoma and gastric cardia cancer.…”

An analysis of the relationship of triglyceride glucose index with gastric cancer prognosis: A retrospective study

“…Gastric cancer, the fifth most common malignancy worldwide, has the third highest mortality rate, and is particularly prevalent in Southeast Asia (mainly China). 2,3 Radical surgical resection is still considered the only effective treatment, 4 and postoperative recurrence and metastasis are the major causes of treatment failure. 5 The 5-year survival rate after radical gastrectomy for gastric cancer is less than 50%, 6 and many factors influence its prognosis.…”

“…Despite the recent decrease in the incidence of gastric cancer, it remains one of the most frequent malignancies, 1 with most patients being diagnosed at a progressive or advanced stage. Gastric cancer, the fifth most common malignancy worldwide, has the third highest mortality rate, and is particularly prevalent in Southeast Asia (mainly China) 2,3 . Radical surgical resection is still considered the only effective treatment, 4 and postoperative recurrence and metastasis are the major causes of treatment failure 5 .…”

Editorial: Obesity and gastrointestinal cancer

“…Many studies have highlighted the relationship between high body mass index (BMI) and cancer's prevalence and prognosis (5)(6)(7). However, other studies have shown that cancer prognosis is negatively affected by low body weight.…”