Obesity and incidence of lung cancer: A meta‐analysis

Yang, Yang; Dong, Jia-Yi; Sun, Ke‐kang; Zhang, Lin; Zhao, Fei; Wang, Lili; Jiao, Yang

doi:10.1002/ijc.27719

Cited by 144 publications

(136 citation statements)

References 44 publications

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“…Male smokers also tend to be leaner than female smokers, which may explain why the protective BMI did not quite reach statistical significance for females. Others have noted that smoking may mask the effect of BMI (41). Also, since males were more likely to smoke in this study, and smoking is usually correlated with other inflammatory factors, such as increased CRP and decreased BMI, further studies are needed to specifically examine the differences between males and females, and to determine which mechanisms may be causing these differential results.…”

Section: Discussionmentioning

confidence: 83%

Prospective evaluation of C-reactive protein, smoking and lung cancer death in the Third National Health and Nutrition Examination Survey

Bittoni

Focht

Clinton

et al. 2015

International Journal of Oncology

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Abstract.Chronic inflammation plays an important role in lung carcinogenesis. Few prospective studies have examined associations between lung cancer, serum C-reactive protein (CRP), a measure of systemic inflammation, and inflammatory lifestyle factors, such as smoking and obesity. This study prospectively examined the relationship between CRP and lung cancer death and its interrelationships with several lifestyle factors. Baseline data on smoking and other lifestyle variables were collected for 8,950 participants in the Third National Health and Nutrition Examination Survey (NHANES III: 1988-1994. Baseline CRP levels were measured in serum samples by nephelometry. Mortality status was ascertained through probabilistic record matching using the National Death Index through 2006. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) for CRP and lung cancer death, with adjustment for smoking and other variables. During 18 years of follow-up, 219 individuals died from lung cancer. Multivariate regression models revealed a dose-response effect for elevated CRP and risk of lung cancer death when adjusting for age, gender, BMI and smoking. Compared to individuals with CRP <3 mg/l, lung cancer death was significantly associated with elevated levels of CRP: HR=1.63 (95% CI=1.15-2.26) for 3-7 mg/l and HR=2.44 (95% CI=1.81-3.45) for CRP >7 mg/l, P-trend <0.0001). The risk of lung cancer death for smokers increased 9-fold in adjusted models (P<0.0001). When stratified by gender and smoking status the effects of CRP were similar for smokers and males but did not reach statistical significance for females and non-smokers. This study supports a dose-dependent relationship between lung cancer death and CRP for males and smokers, but additional efforts are needed to better elucidate these relationships in women and non-smokers. The results suggest that CRP may emerge as a valuable tool in identifying high-risk subgroups of smokers for lung cancer prevention strategies.

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Section: Discussionmentioning

confidence: 83%

Prospective evaluation of C-reactive protein, smoking and lung cancer death in the Third National Health and Nutrition Examination Survey

Bittoni

Focht

Clinton

et al. 2015

International Journal of Oncology

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“…Present analyses included 1,071 lung cancer patients (89% of participating cases) and 1,431 controls (95% of participating controls). Based on World Health Organization standards, 28 BMI was categorized into four categories (kg/m 2 ): underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (30). The change in recent BMI category relative to that at age 20 (BMI change ) was classified into four levels: decrease by at least one category, no change, increase by one category, and increase by more than one category.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][7][8][9][10][11][12][13]30 Moreover, the inverse association did not significantly vary by smoking strata. Null associations were mostly reported among never and former smokers.…”

Section: Discussionmentioning

confidence: 99%

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Body mass index, lifetime smoking intensity and lung cancer risk

El‐Zein

Parent

Nicolau

et al. 2013

Intl Journal of Cancer

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There is as yet no generally accepted explanation for the common finding that low body mass index (BMI) is associated with an increased risk of lung cancer. We investigated this association in a Canadian population-based case-control study (1996)(1997)(1998)(1999)(2000)(2001)(2002) with a particular view to assessing the hypothesis that the observed association was due to residual confounding by smoking. Analyses were based on 1,076 cases and 1,439 controls who provided their height at enrollment and their weight at two points in time, at age 20 and 2 years before enrollment. BMI, in kg/m 2 , was classified into underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (30). Smoking history was synthesized into a comprehensive smoking index (CSI) that integrated duration, intensity and time since quitting. Odds ratios (ORs) and 95% confidence intervals (CIs) for BMI-lung cancer associations were estimated, adjusting for CSI as well as several sociodemographic, lifestyle and occupational factors. The normal BMI category was used as the reference. Among those who were underweight at age 20, there was a lower risk of lung cancer (OR 5 0.69, 95% CI: 0.50-0.95). Conversely, lung cancer risk was increased among those who were underweight 2 years before enrollment (OR 5 2.30, 95% CI: 1.30-4.10). The results were almost identical when stratifying analyses based on smoking history into never/lighter and heavier smokers. The inverse association between recent BMI and lung cancer is unlikely to be largely attributable to residual confounding by smoking. Reverse causality or a true relationship between BMI and lung cancer remain plausible.Elevated body mass index (BMI) has been associated with an increased risk of several cancers, including esophageal, pancreatic, colorectal, endometrial, postmenopausal breast, and prostate cancers.1 By contrast, BMI appears to be inversely related to lung cancer risk.2-16 However, the robustness and meaning of this ostensible inverse association has been challenged in some studies by the finding that such an inverse association was not present among nonsmokers. 4,9,10,12 Smoking is both a powerful risk factor for lung cancer, 17 and is also inversely associated with body weight. 18,19 Several explanations have been hypothesized regarding the observed inverse BMI-lung cancer association. First, a methodological argument, according to which residual confounding by smoking accounted for observing an inverse, or disguising a true positive, BMI-lung cancer relation. Second, reverse causality due to pre-clinical effects of lung cancer, especially for studies in which weight was documented shortly before cancer diagnosis. Third, an etiologic explanation, namely through carcinogenic DNA adducts 6 or effects of estrogens. 16 In any case, the interplay between BMI, smoking, and lung cancer remains uncertain.In the context of a large population-based case-control study on the environmental etiology of lung cancer, data on sociodemographic, anthropometric, and lifestyle factors were c...

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“…Unlike all the other positive associations between paired risk categories, the finding of an inverse association between obesity and lung cancer among ever smokers is in accordance with the results of other studies. 33,34 Obesity is shown to be a stronger risk factor for breast, endometrial, and pancreatic cancers for those who never used hormone therapy than for those who used HT. This finding is in agreement with the results of previous studies [16][17][18][19] and may be explained by the fact that the increase in risk associated with hormone therapy is easier to detect in non-obese women compared to in obese women who have higher circulating estrogen levels due to the conversion of testosterone to estrogen in adipose tissue.…”

Section: Discussionmentioning

confidence: 99%

Optimal Cutoffs of Obesity Measures in Relation to Cancer Risk in Postmenopausal Women in the Women's Health Initiative Study

Heo

Kabat

Strickler

et al. 2015

Journal of Women's Health

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Background: Obesity is a risk factor for several cancers in postmenopausal women. We attempted to determine cutoffs of adiposity measures in relation to risk of obesity-related cancers among postmenopausal women and to examine the effects of hormone therapy (HT) use on the cutoffs, neither of which has been broadly studied. Methods: We used data from the Women's Health Initiative cohort (n = 144,701) and applied Cox-proportional hazards regressions to each combination of 17 cancer types and 6 anthropometric measures (weight, body mass index [BMI], weight to height ratio, waist circumference, waist to hip ratio [WHR], and waist to height ratio). Interactions between the anthropometric measures and HT use were also examined. Cutoffs were determined by applying a grid search followed by a two-fold cross validation method. Survival ROC analysis of 5-and 10-year incidence followed. Results: Breast, colorectal, colon, endometrium, kidney, and all cancers combined were significantly positively associated with all six anthropometric measures, whereas lung cancer among ever smokers was significantly inversely associated with all measures except WHR. The derived cutoffs of each obesity measure varied across cancers (e.g., BMI cutoffs for breast and endometrium cancers were 30 kg/m 2 and 34 kg/m

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Obesity and incidence of lung cancer: A meta‐analysis

Cited by 144 publications

References 44 publications

Prospective evaluation of C-reactive protein, smoking and lung cancer death in the Third National Health and Nutrition Examination Survey

Prospective evaluation of C-reactive protein, smoking and lung cancer death in the Third National Health and Nutrition Examination Survey

Body mass index, lifetime smoking intensity and lung cancer risk

Optimal Cutoffs of Obesity Measures in Relation to Cancer Risk in Postmenopausal Women in the Women's Health Initiative Study

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