Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
J Natl Cancer Inst. 2023 Jan 10;115(1):43-51. doi: 10.1093/jnci/djac192.
Elevated childhood body mass index (BMI), commonly examined as a "once-only" value, increases the risk of cancer and type 2 diabetes (T2D) in adulthood. Continuous exposure to adiposity during childhood may further increase cancer risk. We examined whether longitudinal childhood BMI trajectories were associated with adult obesity-related cancer and the role of adult-onset T2D in these associations.
Five sex-specific latent class BMI trajectories were generated for 301 927 children (149 325 girls) aged 6-15 years from the Copenhagen School Health Records Register. Information on obesity-related cancers and T2D was obtained from national health registers. Incidence rate ratios (IRR), cumulative incidences, and confidence intervals (CI) were estimated using Poisson regressions.
Compared with the average childhood BMI trajectory (containing approximately 40% of individuals), the rate of obesity-related cancer (excluding breast cancer) increased with higher childhood BMI trajectories among women. The highest rates occurred in the overweight (IRR = 1.27, 95% CI = 1.17 to 1.38) and obesity (IRR = 1.79, 95% CI = 1.53 to 2.08) BMI trajectories. Similar patterns were observed among men. In contrast, women with the obesity childhood BMI trajectory had the lowest rate of pre- and postmenopausal breast cancer (IRR = 0.59, 95% CI = 0.43 to 0.80, and IRR = 0.41, 95% CI = 0.30 to 0.57, respectively). For all trajectories, the cumulative risk of obesity-related cancer increased with adult-onset T2D.
Consistent childhood overweight or obesity may increase the rates of adult obesity-related cancer and decrease the rates of breast cancer. Adult-onset T2D conferred additional risk for obesity-related cancer, but the effect did not differ across childhood BMI trajectories.
儿童时期的体重指数（BMI）升高，通常以“一次性”值来衡量，会增加成年后患癌症和 2 型糖尿病（T2D）的风险。儿童时期持续暴露于肥胖可能会进一步增加癌症风险。我们研究了儿童时期纵向 BMI 轨迹是否与成人肥胖相关癌症相关，以及成人 T2D 在这些关联中的作用。
从哥本哈根学校健康记录登记处获取了 301927 名 6-15 岁儿童（149325 名女孩）的 5 种性别特异性潜在类别 BMI 轨迹信息。肥胖相关癌症和 T2D 的信息来自国家健康登记处。使用泊松回归估计发病率比（IRR）、累积发生率和置信区间（CI）。
与平均儿童 BMI 轨迹（包含约 40%的个体）相比，女性中较高的儿童 BMI 轨迹与肥胖相关癌症（不包括乳腺癌）的发病率增加有关。最高的发生率发生在超重（IRR=1.27，95%CI=1.17 至 1.38）和肥胖（IRR=1.79，95%CI=1.53 至 2.08）BMI 轨迹中。在男性中也观察到类似的模式。相比之下，具有肥胖儿童 BMI 轨迹的女性绝经前和绝经后乳腺癌的发病率最低（IRR=0.59，95%CI=0.43 至 0.80，IRR=0.41，95%CI=0.30 至 0.57）。对于所有轨迹，成人 T2D 与肥胖相关癌症的累积风险增加。
一致的儿童超重或肥胖可能会增加成人肥胖相关癌症的发病率，并降低乳腺癌的发病率。成人 T2D 为肥胖相关癌症带来了额外的风险，但这种影响在儿童 BMI 轨迹中没有差异。
