General And Abdominal Obesity And Risk Of Cancer Development In Older Adults: A Study Of Cohorts In Europe

Heinz FREISLING, International Agency for Research on Cancer (IARC), France
FREISLING H. 1 , ARNOLD M. 2 , SOERJOMATARAM I. 2 , O’DOHERTY M. 3 , ORDONEZ-MENA J. 4,5 , BAMIA C. 6,7 , KAMPMAN E. 8 , KEE F. 3 , ROMIEU I. 9 , LEITZMANN M. 10 , JENAB M. 9

1 Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
2 Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
3 UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Northern Ireland, UK
4 Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
5 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
6 Hellenic Health Foundation, Athens, Greece
7 Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
8 Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
9 Nutrition Epidemiology Group, International Agency for Research on Cancer, Lyon, France
10 Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany

Purpose: To investigate, in elderly European populations, the association of anthropometric indicators of general (body mass index, BMI) and central adiposity (waist circumference, WC; hip circumference, HC; and waist-to-hip ratio, WHR) with risk of cancer development, and potential effect modifications by sex, smoking and hormone replacement therapy (HRT).
Methods: We used data from 7 cohorts participating in the CHANCES consortium – a large collection of population-based cohort studies of older adults. Data were harmonized, analyzed separately using Cox proportional hazards models, and combined by random effects meta-analysis. Adjustment for the most important confounders common to all cohorts was performed.
Results: Overall, 43 419 men and women with a mean age of 62.5 y (range: 50-84 y) were included in this study, of whom 1 473 developed first incident cancers of the breast (postmenopausal), colorectum, pancreas, kidney, gallbladder, and endometrium, together labelled as ‘obesity-related cancers’ (median follow-up time: 12 years). Pooled analyses of adiposity indicators, per standard deviation (SD) increase, in relation to risk for obesity-related cancers yielded the following summary hazard ratios: 1.13 (95% CI: 1.02, 1.24) for BMI (SD=4.2 kg/m2), 1.12 (95% CI:1.01, 1.24) for WC (SD=12.1 cm), 1.10 (95% CI: 0.97, 1.22) for HC (SD=8.6 cm), and 1.11 (95% CI: 0.97, 1.24) for WHR (SD=0.1). For postmenopausal breast cancer, increased risks were confined to women who never used HRT (P-interaction<0.001), showing ~20% increases in risk per SD of BMI, WC, and HC; no association was observed with WHR.
Conclusions: General adiposity as measured by BMI and central adiposity as measured by WC show comparable positive associations with obesity-related cancers combined. Weaker results were observed for HC and WHR. Associations between anthropometric measures and postmenopausal breast cancer demonstrated effect modification by HRT use.
Funding source: FP7 framework programme of DG-RESEARCH in the European Commission (grant agreement no. HEALTH-F3-2010-242244).