BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults

Abstract

BACKGROUND: It is unclear whether the increased risk of colon cancer associated with obesity differs for men and women, by distribution of body fat, or by location of the tumor. The primary goal of this study was to address these questions. METHODS: Eligible subjects from the Framingham Study cohort were classified according to body mass index (BMI) and waist size during two age periods: 30-54 y (n ¼ 3764) and 55-79 y (n ¼ 3802). All eligible men and women were cancer-free at baseline and had complete information on the following potential confounders: age, sex, education, height, activity, smoking, and alcohol. There were 157 incident lifetime cases of colon cancer among those followed beginning at 30-54 y of age and 149 lifetime cases among those whose follow up began at 55-79 y. Subjects were stratified further by gender, activity, and tumor location. The Cox Proportional Hazards Models were used to adjust for possible confounding by the above-described factors. RESULTS: A BMI Z30 led to a 50% increased risk (95% CI: 0.92-2.5) of colon cancer among middle-aged (30-54 y) and a 2.4-fold increased risk (95% CI: 1.5-3.9) among older (55-79 y) adults. The BMI effect was stronger for men than for women and for cases occurring in the proximal colon. These adverse effects generally diminished when waist was added to the multivariable models. A larger waist size (Z99.1 cm (39 in) and 101.6 cm (40 in) for women and men, respectively) was associated with a twofold increased risk of colon cancer; this risk increased linearly with increasing waist size and was evident for both proximal and distal colon cancer. There was no attenuation of these effects when BMI was added to the multivariable models. A larger waist had a particularly adverse effect among sedentary subjects (relative risk (RR) ¼ 4.4 for middle-aged adults; RR ¼ 3.0 for older adults). CONCLUSION: These findings suggest that waist circumference is a stronger predictor of colon cancer risk than is BMI, and that central obesity is responsible for an increased risk of cancer of both the proximal and distal colon.

Association Between Body Size and Colorectal Adenoma Recurrence

“…Similar to what has been observed for the association between BMI and colon cancer 24,27,34 , when we stratified by gender, we found that a high BMI was associated with adenoma recurrence in men, but not women. A separate analysis for waist circumference did not appreciably alter the direction or magnitude of the association between BMI category and odds of recurrence.…”

“…The evidence for obesity as a common risk factor in a number of human diseases, including colorectal cancer, has led to the hypothesis that the metabolic changes associated with chronic overeating and sedentary behaviors have a role in development of many pathologies 8 . The majority of epidemiologic studies support a role for obesity as a risk factor for colorectal adenomas [9][10][11][12][13][14][15][16][17][18] , cancers 12,[19][20][21][22][23][24][25][26][27][28][29][30] ; and colon cancer mortality 31,32 . These observations suggest a continuous action of the adverse effects of obesity along the adenoma to carcinoma continuum, starting early in colon tumorigenesis.…”

“…Findings from the prospectively-collected Framingham Cohort 27 , suggest that waist circumference and WHR may be more informative for risk of colon cancer than measures of BMI. Earlier data from the Health Professionals Follow up Study 12 reported similar findings, where stronger associations for colorectal cancer were observed with measures of waist circumference than for BMI.…”

Counties eliminating racial disparities in colorectal cancer mortality

“…We also did not have individuallevel socioeconomic data such as income, poverty, education, or insurance status, nor did we have any information regarding any of the individual health behaviors or risk factors (smoking, diet, exercise, etc) associated with CRC incidence and morbidity. [90][91][92] We also did not control for migration patterns or county-level demographic trends. For example, if welleducated, well-insured African American individuals moved en masse into a county in which they were poorly represented in the past, it could create the appearance of a county that has improving health outcomes rather than the simple in-migration of individuals more likely to have better outcomes.…”

Índice de Massa Corporal e fatores associados em mulheres climatéricas

“…El advenimiento de la obesidad trae un aumento del conjunto de riesgos para las otras patologías crónicas como diabetes, hipertensión arterial, depresión y neoplasias múltiples 4 . Sus características destacadas son el aumento de la adiposidad localizada en la región abdominal o generalizada 5 .…”