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Comparing waist circumference with body mass index on obesity-related cancer risk : A pooled Swedish study

Sun, Ming LU ; Häggström, Christel LU ; Da Silva, Marisa LU orcid ; Mboya, Innocent B. LU orcid ; Lagerros, Ylva Trolle ; Michaëlsson, Karl ; Sandin, Sven ; Leppert, Jerzy ; Hägg, Sara and Elmståhl, Sölve LU , et al. (2025) In Journal of the National Cancer Institute 117(10). p.1999-2009
Abstract

Background General adiposity, assessed by body mass index (BMI), is a well-established cancer risk factor. This study compared waist circumference (WC), a measure of abdominal adiposity, with BMI as a risk factor for obesity-related cancers, and assessed whether WC provides additional information beyond BMI. Methods We analyzed data from 339 190 individuals in a pooled Swedish cohort with baseline BMI and WC assessments from 1981 to 2019 (61% objectively measured, mean age 51.4 years). Cancer diagnoses were obtained from the Swedish Cancer Register. Hazard ratios (HRs) for WC and BMI were calculated using multivariable-adjusted Cox regression. To account for WC's greater variability, we corrected HRs using regression dilution ratios. To... (More)

Background General adiposity, assessed by body mass index (BMI), is a well-established cancer risk factor. This study compared waist circumference (WC), a measure of abdominal adiposity, with BMI as a risk factor for obesity-related cancers, and assessed whether WC provides additional information beyond BMI. Methods We analyzed data from 339 190 individuals in a pooled Swedish cohort with baseline BMI and WC assessments from 1981 to 2019 (61% objectively measured, mean age 51.4 years). Cancer diagnoses were obtained from the Swedish Cancer Register. Hazard ratios (HRs) for WC and BMI were calculated using multivariable-adjusted Cox regression. To account for WC's greater variability, we corrected HRs using regression dilution ratios. To assess WC's additional contribution beyond BMI, we analyzed WC residuals in multivariable, BMI-adjusted models. Results During a median follow-up of 13.9 years (interquartile range: 8.0-22.5), 18 185 IARC-established obesity-related cancers were recorded. In men, a 1-standard deviation (SD) increase in WC was associated with a 25% higher risk of obesity-related cancers (HR1-SD = 1.25, 95% CI = 1.21 to 1.30), compared to a 19% increase for BMI (HR1-SD = 1.19, 95% CI = 1.15 to 1.23, P = 0.014 for heterogeneity). Among women, associations were weaker and similar for both WC (HR1-SD = 1.13, 95% CI = 1.11 to 1.16) and BMI (HR1-SD = 1.13, 95% CI = 1.11 to 1.15, P = 0.357 for heterogeneity). Waist circumference residuals were more strongly associated with obesity-related cancer risk in men (HR1-SD = 1.09, 95% CI = 1.06 to 1.12) than in women (HR1-SD = 1.03, 95% CI = 1.02 to 1.05). Including an additional 6893 potential obesity-related cancers yielded similar patterns of associations. Conclusion(s) Waist circumference is a stronger risk factor than BMI for obesity-related cancer in men, conveying additional risk information, whereas this is less evident in women.

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Contribution to journal
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published
subject
in
Journal of the National Cancer Institute
volume
117
issue
10
pages
11 pages
publisher
Oxford University Press
external identifiers
  • scopus:105018312102
  • pmid:40156135
ISSN
0027-8874
DOI
10.1093/jnci/djaf075
language
English
LU publication?
yes
id
a4f7470f-85dd-4611-92ab-31af3b6cdc60
date added to LUP
2026-01-13 13:39:08
date last changed
2026-01-13 13:40:03
@article{a4f7470f-85dd-4611-92ab-31af3b6cdc60,
  abstract     = {{<p>Background General adiposity, assessed by body mass index (BMI), is a well-established cancer risk factor. This study compared waist circumference (WC), a measure of abdominal adiposity, with BMI as a risk factor for obesity-related cancers, and assessed whether WC provides additional information beyond BMI. Methods We analyzed data from 339 190 individuals in a pooled Swedish cohort with baseline BMI and WC assessments from 1981 to 2019 (61% objectively measured, mean age 51.4 years). Cancer diagnoses were obtained from the Swedish Cancer Register. Hazard ratios (HRs) for WC and BMI were calculated using multivariable-adjusted Cox regression. To account for WC's greater variability, we corrected HRs using regression dilution ratios. To assess WC's additional contribution beyond BMI, we analyzed WC residuals in multivariable, BMI-adjusted models. Results During a median follow-up of 13.9 years (interquartile range: 8.0-22.5), 18 185 IARC-established obesity-related cancers were recorded. In men, a 1-standard deviation (SD) increase in WC was associated with a 25% higher risk of obesity-related cancers (HR1-SD = 1.25, 95% CI = 1.21 to 1.30), compared to a 19% increase for BMI (HR1-SD = 1.19, 95% CI = 1.15 to 1.23, P = 0.014 for heterogeneity). Among women, associations were weaker and similar for both WC (HR1-SD = 1.13, 95% CI = 1.11 to 1.16) and BMI (HR1-SD = 1.13, 95% CI = 1.11 to 1.15, P = 0.357 for heterogeneity). Waist circumference residuals were more strongly associated with obesity-related cancer risk in men (HR1-SD = 1.09, 95% CI = 1.06 to 1.12) than in women (HR1-SD = 1.03, 95% CI = 1.02 to 1.05). Including an additional 6893 potential obesity-related cancers yielded similar patterns of associations. Conclusion(s) Waist circumference is a stronger risk factor than BMI for obesity-related cancer in men, conveying additional risk information, whereas this is less evident in women.</p>}},
  author       = {{Sun, Ming and Häggström, Christel and Da Silva, Marisa and Mboya, Innocent B. and Lagerros, Ylva Trolle and Michaëlsson, Karl and Sandin, Sven and Leppert, Jerzy and Hägg, Sara and Elmståhl, Sölve and Magnusson, Patrik K.E. and Söderberg, Stefan and Yin, Weiyao and Chabok, Abbas and Wood, Angela and Stocks, Tanja and Fritz, Josef}},
  issn         = {{0027-8874}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1999--2009}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of the National Cancer Institute}},
  title        = {{Comparing waist circumference with body mass index on obesity-related cancer risk : A pooled Swedish study}},
  url          = {{http://dx.doi.org/10.1093/jnci/djaf075}},
  doi          = {{10.1093/jnci/djaf075}},
  volume       = {{117}},
  year         = {{2025}},
}