BMC Medicine (Nov 2023)

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies

  • Emma Fontvieille,
  • Vivian Viallon,
  • Martina Recalde,
  • Reynalda Cordova,
  • Anna Jansana,
  • Laia Peruchet-Noray,
  • Hannah Lennon,
  • Alicia K. Heath,
  • Dagfinn Aune,
  • Sofia Christakoudi,
  • Verena Katzke,
  • Rudolf Kaaks,
  • Elif Inan-Eroglu,
  • Matthias B. Schulze,
  • Lene Mellemkjær,
  • Anne Tjønneland,
  • Kim Overvad,
  • Marta Farràs,
  • Dafina Petrova,
  • Pilar Amiano,
  • María-Dolores Chirlaque,
  • Conchi Moreno-Iribas,
  • Sandar Tin Tin,
  • Giovanna Masala,
  • Sabina Sieri,
  • Fulvio Ricceri,
  • Salvatore Panico,
  • Anne M. May,
  • Evelyn M. Monninkhof,
  • Elisabete Weiderpass,
  • Marc J. Gunter,
  • Pietro Ferrari,
  • Heinz Freisling

DOI
https://doi.org/10.1186/s12916-023-03114-z
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 15

Abstract

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Abstract Background Whether cancer risk associated with a higher body mass index (BMI), a surrogate measure of adiposity, differs among adults with and without cardiovascular diseases (CVD) and/or type 2 diabetes (T2D) is unclear. The primary aim of this study was to evaluate separate and joint associations of BMI and CVD/T2D with the risk of cancer. Methods This is an individual participant data meta-analysis of two prospective cohort studies, the UK Biobank (UKB) and the European Prospective Investigation into Cancer and nutrition (EPIC), with a total of 577,343 adults, free of cancer, T2D, and CVD at recruitment. We used Cox proportional hazard regressions to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between BMI and incidence of obesity-related cancer and in turn overall cancer with a multiplicative interaction between BMI and the two cardiometabolic diseases (CMD). HRs and 95% CIs for separate and joint associations for categories of overweight/obesity and CMD status were estimated, and additive interaction was quantified through relative excess risk due to interaction (RERI). Results In the meta-analysis of both cohorts, BMI (per ~ 5 kg/m2) was positively associated with the risk of obesity-related cancer among participants without a CMD (HR: 1.11, 95%CI: 1.07,1.16), among participants with T2D (HR: 1.11, 95% CI: 1.05,1.18), among participants with CVD (HR: 1.17, 95% CI: 1.11,1.24), and suggestively positive among those with both T2D and CVD (HR: 1.09, 95% CI: 0.94,1.25). An additive interaction between obesity (BMI ≥ 30 kg/m2) and CVD with the risk of overall cancer translated into a meta-analytical RERI of 0.28 (95% CI: 0.09–0.47). Conclusions Irrespective of CMD status, higher BMI increased the risk of obesity-related cancer among European adults. The additive interaction between obesity and CVD suggests that obesity prevention would translate into a greater cancer risk reduction among population groups with CVD than among the general population.

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