Comparison of associations of body mass index, abdominal adiposity, and risk of colorectal cancer in a large prospective cohort study

Marlen Keimling, Andrew G. Renehan, Gundula Behrens, Beate Fischer, Albert R. Hollenbeck, Amanda J. Cross, Michael F. Leitzmann

    Research output: Contribution to journalArticlepeer-review


    Background: Increased body mass index (BMI) is an established colorectal cancer risk factor. High waist circumference or waist-hip-ratio (WHR) may better reflect an abnormal metabolic state and be more predictive of colorectal cancer risk than BMI. Methods: We examined BMI, waist circumference, WHR, and hip circumference in relation to colorectal cancer risk among 203,177 participants followed for 10 years. We derived standardized colorectal cancer risk estimates for each anthropometric parameter and compared predictive characteristics (Harrell's C-index). In women, we examined whether hormone replacement therapy (HRT) use modified the associations between anthropometric measures and colorectal cancer. Results: We ascertained 2,869 colorectal cancers. In men, increased colon cancer risks were associated with BMI [HR per SD, 1.14; 95% confidence interval (CI), 1.08-1.20], waist circumference (HR per SD, 1.17; 95% CI, 1.08-1.27), andWHR(HR per SD, 1.09; 95% CI, 1.04-1.14). In women, anthropometric variables were unrelated to colon cancer. Formenand women, anthropometric variables were unrelated to rectal cancer. Compared with BMI, waist circumference and WHR did not materially influence colon cancer prediction models [C-index changes: ≤0.0041 and 0.0046 (men); 0.0004 and 0.0005 (women)]. In current HRT users, colon cancer was inversely or suggestively inversely associated with waist circumference (HR per SD, 0.78; 95% CI, 0.63-0.97) andWHR(HR per SD, 0.88;95% CI, 0.76-1.01), but positively related to hip circumference (HRper SD, 1.39; 95% CI, 1.13-1.71). Conclusion: BMI, waist circumference, andWHRshow comparable positive associations with colon cancer in men. Associations between anthropometric measures and colon cancer are weak or null in women, but there is some evidence for effect modification by HRT. Impact: These findings may improve our understanding of the relation of adiposity to colorectal cancer. Cancer Epidemiol Biomarkers Prev; 22(8); 1383-94. ©2013 AACR.
    Original languageEnglish
    Pages (from-to)1383-1394
    Number of pages11
    JournalCancer Epidemiology Biomarkers and Prevention
    Issue number8
    Publication statusPublished - Aug 2013


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