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The inverse association of body mass index with lung cancer: Exploring residual confounding, metabolic aberrations and within-person variability in smoking
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz, Austria.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.ORCID-id: 0000-0001-6808-4405
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2021 (Engelska)Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 30, nr 8, s. 1489-1497Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers.

Methods: We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants.

Results: Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85–0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44–1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI.

Conclusions: The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking.

Impact: Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.

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American Association for Cancer Research Inc , 2021. Vol. 30, nr 8, s. 1489-1497
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Cancer och onkologi
Identifikatorer
URN: urn:nbn:se:umu:diva-186556DOI: 10.1158/1055-9965.EPI-21-0058ISI: 000681661300004Scopus ID: 2-s2.0-85111624918OAI: oai:DiVA.org:umu-186556DiVA, id: diva2:1584368
Tillgänglig från: 2021-08-11 Skapad: 2021-08-11 Senast uppdaterad: 2023-09-05Bibliografiskt granskad

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Jonsson, HåkanHäggström, Christel

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