Obesity and incidence of cancer: a large cohort study of over 145 000 adults in Austria

Rapp, Kilian; Schroeder, Jane C.; Klenk, Jochen; Stoehr, Susanne; Ulmer, Hanno; Concin, Hans; Diem, Guenter; Oberaigner, Willi; Weiland, Stephan K.

doi:10.1038/sj.bjc.6602819

Cited by 290 publications

(239 citation statements)

References 29 publications

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“…These results should be considered with caution, however, as some of these studies found no statistically significant increase in liver cancer risk and no trend of increasing risk with increasing BMI (Rapp et al, 2005), did not control accurately for all major risk factors for HCC (Moller et al, 1994) or controlled only for hospital discharge of alcoholism and diabetes (Calle et al, 2003;Samanic et al, 2004), or found no increased risk for liver cancer due to obesity when excluding patients with diabetes (Wolk et al, 2001). By contrast, in a large USA cohort study of male veterans hospitalized with a diagnosis of obesity, excess risks for liver cancer were also observed when the analysis was restricted to white men without a history of diabetes or alcoholism (Samanic et al, 2004).…”

Section: Diabetes and Hepatocellular Carcinomamentioning

confidence: 75%

“…Obesity and hepatocellular carcinoma Some population-based cohort studies from Central and Northern Europe and from the USA found that obesity is associated with a 2-4-fold increased risk of liver cancer, higher among men than women (Moller et al, 1994;Wolk et al, 2001;Calle et al, 2003;Samanic et al, 2004;Rapp et al, 2005). These results should be considered with caution, however, as some of these studies found no statistically significant increase in liver cancer risk and no trend of increasing risk with increasing BMI (Rapp et al, 2005), did not control accurately for all major risk factors for HCC (Moller et al, 1994) or controlled only for hospital discharge of alcoholism and diabetes (Calle et al, 2003;Samanic et al, 2004), or found no increased risk for liver cancer due to obesity when excluding patients with diabetes (Wolk et al, 2001).…”

Section: Diabetes and Hepatocellular Carcinomamentioning

confidence: 99%

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Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediatehigh prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably cofactors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

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Section: Diabetes and Hepatocellular Carcinomamentioning

confidence: 75%

Section: Diabetes and Hepatocellular Carcinomamentioning

confidence: 99%

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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“…We identified 11 eligible cohort studies (Møller et al, 1994;Wolk et al, 2001;Nair et al, 2002;Calle et al, 2003;Samanic et al, 2004Samanic et al, , 2006Batty et al, 2005;Kuriyama et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006), of which 7 on overweight (with a total of 5037 cases) (Calle et al, 2003;Batty et al, 2005;Kuriyama et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006;Samanic et al, 2006) and 10 on obesity (with a total of 6042 cases) (Møller et al, 1994;Wolk et al, 2001;Nair et al, 2002;Calle et al, 2003;Samanic et al, 2004Samanic et al, , 2006Batty et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006) were suitable for metaanalysis. Characteristics of the studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…With stratification by assessment of obesity, the summary relative risks for the association between obesity and liver cancer were 2.15 (95% CI: 1.66 -2.77) for studies based on measured or self-reported weight and height (Nair et al, 2002;Calle et al, 2003;Batty et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006;Samanic et al, 2006) and 1.61 (95% CI: 1.14 -2.27) for studies based on a discharge diagnosis of obesity (Møller et al, 1994;Wolk et al, 2001;Samanic et al, 2004).…”

Section: Resultsmentioning

confidence: 99%

Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

2007

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Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis by searching MEDLINE and EMBASE databases from 1966 to June 2007 and the reference lists of retrieved articles. Results from individual studies were combined using a random-effects model. We identified 11 cohort studies, of which seven on overweight (with a total of 5037 cases) and 10 on obesity (with 6042 cases) were suitable for meta-analysis. Compared with persons of normal weight, the summary relative risks of liver cancer were 1.17 (95% confidence interval (CI): 1.02 -1.34) for those who were overweight and 1.89 (95% CI: 1.51 -2.36) for those who were obese. This meta-analysis finds that excess body weight is associated with an increased risk of liver cancer. Although relatively rare in the United States and other developed countries, liver cancer is the third most common cause of death from cancer worldwide (Parkin et al, 2005). It is rarely detected early and is often fatal within a few months of diagnosis. The 5-year survival rate is only about 6 -11% (Coleman et al, 2003;Ries et al, 2006). The age-adjusted incidence and mortality rates of liver cancer have been increasing rapidly in the United States since the mid-1980s (Ries et al, 2006). While approximately half of this increase can be attributable to hepatitis C virus infection, a minimal or no increase has been related to hepatitis B virus and alcoholic liver disease (El-Serag and Mason, 2000;Hassan et al, 2002). Given that about half of the increase in liver cancer incidence is not related to hepatitis, the major risk factor in a significant proportion of the cases has yet to be identified.Coinciding with the rising incidence of liver cancer, the prevalence of obesity has been increasing markedly over the past two decades worldwide (Larsson and Wolk, 2006). Obesity has been recognised as a risk factor for several malignancies, including cancer of the breast (in premenopausal women), endometrium, kidney (renal cell), colon, pancreas, gallbladder, and esophagus (adenocarcinoma) (IARC, 2002;. Accumulating epidemiologic evidence also indicates that excess body weight may be a risk factor for liver cancer, but the evidence has not been quantitatively summarised. We have therefore quantitatively assessed the associations of overweight and obesity with liver cancer risk in a meta-analysis of cohort studies. MATERIALS AND METHODS Study selectionA literature search was conducted in the MEDLINE and EMBASE databases for pertinent studies published in any language from 1966 to June 2007. We used the keywords 'body mass index', 'BMI', or 'obesity' in combination with 'hepatocellular carcinoma', 'liver cancer', or 'liver neoplasm'. Moreover, we manually reviewed the reference lists of retrieved articles to search for more studies.Studies were included in the meta-analysis if they fulfilled the following criteria: (1) cohort study in which liver cancer incidence or mortality was an outcome; (2) the exposure of interest was overweight and/or obesity defined by body ma...

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“…In studies carried out in the U.S.A., a positive relationship was demonstrated for both men and women in the 3 largest cohort studies, [15][16][17] while 4 other smaller studies found a positive association only in men. 10,22,26,33 The 6 other studies, including the 2 largest European cohort studies, 6,[18][19][20][21]35 did not find any significant association in the combined data of men and women. Similar to cohort studies, case-control studies have also produced contradictory results with a meta-analysis carried out in 2003 concluding that the risk of pancreatic cancer was only weakly associated with obesity.…”

Section: Discussionmentioning

confidence: 99%

Obesity, physical activity and the risk of pancreatic cancer in a large Japanese cohort

Lin

Kikuchi

Tamakoshi

et al. 2007

Intl Journal of Cancer

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It is unclear whether body mass index (BMI) and physical activity are associated with the risk of pancreatic cancer in Asian populations. We examined these associations in the Japanese Collaborative Cohort Study for Evaluation of Cancer Risk. Our cohort study included 110,792 Japanese men and women at enrollment (1988)(1989)(1990). Data on height, body weight (at baseline and at age 20 years) and physical activity were obtained from a questionnaire. Cox proportional hazards models were used to estimate the relative risks of pancreatic cancer mortality. We observed a total of 402 pancreatic cancer deaths during the follow-up period. Men with a BMI of 30 or more at age 20 years had a 3.5-fold greater risk compared with men with a normal BMI. Women with a BMI of 27.5-29.9 at baseline had 60% increased risk compared with women with a BMI of 20.0-22.4. In men, weight loss of 5 kg or more between 20 years of age and baseline age was associated with an increased risk of pancreatic cancer death. In contrast, women with weight loss of 5 kg or more over the same period had a decreased risk. Physical activity was not associated with pancreatic cancer risk in either men or women. Obesity in young adulthood may be associated with an increased risk of death from pancreatic cancer in Japanese men. The risk of pancreatic cancer in relation to BMI seems to differ according to sex and the period over which BMI was measured. ' 2007 Wiley-Liss, Inc.Key words: body mass index; physical activity; pancreatic cancer; obesity; relative risk; cohort study Pancreatic cancer is the fifth leading cause of cancer-related death in Japan, accounting for 20,000 deaths each year. 1 The etiology of pancreatic cancer remains largely unknown. Although epidemiological studies have reported that many environmental factors may contribute to the development of pancreatic cancer, only age and cigarette smoking have been established as consistent risk factors for the disease. 2 The association between diabetes and pancreatic cancer is less consistent, although epidemiological evidence strongly suggests that long-standing diabetes is also a risk factor for pancreatic cancer. [3][4][5][6][7][8][9] Recently, several studies have shown a positive association between post-load plasma glucose concentration and pancreatic cancer risk, [10][11][12] suggesting that impaired glucose tolerance and insulin resistance may have a role in the etiology of pancreatic cancer. As there is an established link between obesity and significant metabolic abnormalities such as glucose intolerance, 13,14 a positive association between obesity and pancreatic cancer seems possible. However, there are conflicting epidemiological findings on the link between obesity and risk of pancreatic cancer. Several large prospective studies carried out in the U.S.A. have demonstrated that overweight and obese subjects have an increased risk of pancreatic cancer compared with normal weight subjects, 15-17 whereas other studies did not observe this association. [18][19][20][21] A meta-analysis c...

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Obesity and incidence of cancer: a large cohort study of over 145 000 adults in Austria

Cited by 290 publications

References 29 publications

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

Obesity, physical activity and the risk of pancreatic cancer in a large Japanese cohort

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