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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
Department of Translational Medicine, Lund University, Malmö, Sweden.
Department of Translational Medicine, Lund University, Malmö, Sweden.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
Department of Translational Medicine, Lund University, Malmö, Sweden; Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
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2024 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 45, article id 101034Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 45, article id 101034
Keywords [en]
Body mass index, Cancer, Obesity
National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-228809DOI: 10.1016/j.lanepe.2024.101034Scopus ID: 2-s2.0-85201383782OAI: oai:DiVA.org:umu-228809DiVA, id: diva2:1892844
Projects
ODDSMONICASIMPLERSwedish Twin RegistryWICTORY
Funder
Swedish Research Council, 2017-00650Swedish Research Council, 2017-00644Swedish Research Council, 2021-00160Swedish Research Council, 2021-00180Lund University, STYR 2019/2046).Available from: 2024-08-28 Created: 2024-08-28 Last updated: 2024-08-28Bibliographically approved

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Wahlström, Jensvan Guelpen, BethanyHäggström, Christel

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Section of Sustainable HealthDepartment of Diagnostics and InterventionWallenberg Centre for Molecular Medicine at Umeå University (WCMM)OncologyDepartment of Public Health and Clinical Medicine
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The Lancet Regional Health: Europe
Cancer and OncologyPublic Health, Global Health, Social Medicine and Epidemiology

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