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Body mass index and risk of over 100 cancer forms and subtypes in 4.1 million individuals in Sweden : the Obesity and Disease Development Sweden (ODDS) pooled cohort study

Sun, Ming LU ; da Silva, Marisa LU orcid ; Bjørge, Tone LU ; Fritz, Josef LU ; Mboya, Innocent B LU orcid ; Jerkeman, Mats LU ; Stattin, Pär ; Wahlström, Jens ; Michaëlsson, Karl and van Guelpen, Bethany , et al. (2024) In The Lancet regional health. Europe 45.
Abstract

BACKGROUND: Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers.

METHODS: Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m2) vs. normal weight (BMI 18.5-24.9 kg/m2) or per 5 kg/m2 higher BMI, for which obesity is not an... (More)

BACKGROUND: Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers.

METHODS: Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m2) vs. normal weight (BMI 18.5-24.9 kg/m2) or per 5 kg/m2 higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related.

FINDINGS: After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15 cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck, gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, and haematological malignancies. Among these, there was evidence of differential associations with BMI between subtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values for heterogeneity in HRs <0.05). The HR (95% confidence interval) per 5 kg/m2 higher BMI was 1.17 (1.15-1.20) in men and 1.13 (1.11-1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22-1.26) in men and 1.12 (1.11-1.13) in women for established obesity-related cancers (84,384 cases).

INTERPRETATION: This study suggests a large number of potential obesity-related cancers could be added to already established ones. Importantly, the magnitudes of the associations were largely comparable to those of the already established obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associations with BMI. Studies accounting for cancer-specific confounders are needed to confirm these findings.

FUNDING: Swedish Research Council, Swedish Cancer Society, Mrs. Berta Kamprad's Cancer Foundation, Crafoord Foundation, Cancer Research Foundation at the Department of Oncology, Malmö University Hospital, and China Scholarship Council.

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type
Contribution to journal
publication status
published
subject
in
The Lancet regional health. Europe
volume
45
article number
101034
publisher
Elsevier
external identifiers
  • pmid:39253735
ISSN
2666-7762
DOI
10.1016/j.lanepe.2024.101034
language
English
LU publication?
yes
additional info
© 2024 The Author(s).
id
9e067525-ed03-45b1-8d75-068479dea696
date added to LUP
2024-10-04 08:31:51
date last changed
2024-10-04 08:31:51
@article{9e067525-ed03-45b1-8d75-068479dea696,
  abstract     = {{<p>BACKGROUND: Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers.</p><p>METHODS: Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR &gt;1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m2) vs. normal weight (BMI 18.5-24.9 kg/m2) or per 5 kg/m2 higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related.</p><p>FINDINGS: After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15 cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck, gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, and haematological malignancies. Among these, there was evidence of differential associations with BMI between subtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values for heterogeneity in HRs &lt;0.05). The HR (95% confidence interval) per 5 kg/m2 higher BMI was 1.17 (1.15-1.20) in men and 1.13 (1.11-1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22-1.26) in men and 1.12 (1.11-1.13) in women for established obesity-related cancers (84,384 cases).</p><p>INTERPRETATION: This study suggests a large number of potential obesity-related cancers could be added to already established ones. Importantly, the magnitudes of the associations were largely comparable to those of the already established obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associations with BMI. Studies accounting for cancer-specific confounders are needed to confirm these findings.</p><p>FUNDING: Swedish Research Council, Swedish Cancer Society, Mrs. Berta Kamprad's Cancer Foundation, Crafoord Foundation, Cancer Research Foundation at the Department of Oncology, Malmö University Hospital, and China Scholarship Council.</p>}},
  author       = {{Sun, Ming and da Silva, Marisa and Bjørge, Tone and Fritz, Josef and Mboya, Innocent B and Jerkeman, Mats and Stattin, Pär and Wahlström, Jens and Michaëlsson, Karl and van Guelpen, Bethany and Magnusson, Patrik K E and Sandin, Sven and Yin, Weiyao and Lagerros, Ylva Trolle and Ye, Weimin and Nwaru, Bright and Kankaanranta, Hannu and Lönnberg, Lena and Chabok, Abbas and Isaksson, Karolin and Pedersen, Nancy L and Elmståhl, Sölve and Lind, Lars and Hedman, Linnea and Häggström, Christel and Stocks, Tanja}},
  issn         = {{2666-7762}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet regional health. Europe}},
  title        = {{Body mass index and risk of over 100 cancer forms and subtypes in 4.1 million individuals in Sweden : the Obesity and Disease Development Sweden (ODDS) pooled cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.lanepe.2024.101034}},
  doi          = {{10.1016/j.lanepe.2024.101034}},
  volume       = {{45}},
  year         = {{2024}},
}