Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany.
JAMA Netw Open. 2023 Apr 3;6(4):e239556. doi: 10.1001/jamanetworkopen.2023.9556.
IMPORTANCE: Overweight and obesity, conditions with rising prevalence in many countries, are associated with increased colorectal cancer (CRC) risk. However, many patients with CRC lose weight before diagnosis, which may lead the association to be underestimated. OBJECTIVE: To evaluate the association of body mass index (BMI) and weight change with CRC risk when considering BMI at different time frames, with the intention to account for prediagnostic weight loss. DESIGN, SETTING, AND PARTICIPANTS: This population-based case-control study was conducted in southwestern Germany between 2003 and 2021. Cases with a first diagnosis of CRC and controls (frequency matched by age, sex, and county) with comprehensive risk factor information and self-reported weight at different time points were included. Data were analyzed between October 2022 and March 2023. EXPOSURE: BMI and weight change at different time frames before the time of diagnosis (cases) or recruitment (controls). MAIN OUTCOMES AND MEASURES: Association of BMI and weight change at various points in time before and up to diagnosis with CRC, assessed by multivariable logistic regression with comprehensive confounder adjustment. RESULTS: A total of 11 887 participants (6434 CRC cases, 5453 controls; median [IQR] age, 69 [61-77] years; 7173 male [60.3%]) were included. At the time of diagnosis, 3998 cases (62.1%) and 3601 controls (66.0%) were overweight or obese, suggesting an inverse association between excess weight and CRC risk. Conversely, we found significant positive associations of overweight (adjusted odds ratio [aOR], 1.27; 95% CI, 1.03-1.56), obesity (aOR, 2.09; 95% CI, 1.61-2.70), and a 5-unit increase in BMI (aOR, 1.35; 95% CI, 1.21-1.50) with CRC risk when using BMI measured 8 to 10 years before diagnosis. High BMI as a risk factor for CRC was increased as earlier periods before diagnosis were examined, with the association being particularly pronounced using BMI at least 8 years before diagnosis. An opposite trend was found for the association of weight loss (at or exceeding 2 kg) with CRC, with the greatest effect sizes occurring for weight loss within 2 years before diagnosis (aOR, 7.52; 95% CI, 5.61-10.09), and gradually decreased for earlier intervals. CONCLUSIONS AND RELEVANCE: In this population-based case-control study, accounting for substantial prediagnostic weight loss further highlighted the association of overweight and obesity with CRC risk.
重要性：在许多国家，超重和肥胖的患病率呈上升趋势，与结直肠癌（CRC）风险增加有关。然而，许多 CRC 患者在诊断前会减轻体重，这可能导致对该关联的低估。
目的：评估 BMI 和体重变化与 CRC 风险之间的关联，同时考虑不同时间点的 BMI，旨在考虑到诊断前的体重减轻。
设计、地点和参与者：这是一项基于人群的病例对照研究，在 2003 年至 2021 年期间在德国西南部进行。纳入了首次诊断为 CRC 的病例和具有全面风险因素信息和不同时间点自我报告体重的按年龄、性别和县匹配的对照（频率匹配）。数据分析于 2022 年 10 月至 2023 年 3 月进行。
暴露：诊断前不同时间点的 BMI 和体重变化（病例）或招募时（对照）。
主要结果和测量：通过多变量逻辑回归，在综合混杂因素调整后，评估不同时间点 BMI 和体重变化与 CRC 的相关性。
结果：共纳入 11887 名参与者（6434 例 CRC 病例，5453 名对照；中位[IQR]年龄，69[61-77]岁；7173 名男性[60.3%]）。在诊断时，3998 例（62.1%）和 3601 例（66.0%）为超重或肥胖，这表明超重与 CRC 风险呈负相关。相反，我们发现超重（调整后的优势比[OR]，1.27；95%CI，1.03-1.56）、肥胖（OR，2.09；95%CI，1.61-2.70）和 BMI 增加 5 个单位（OR，1.35；95%CI，1.21-1.50）与 CRC 风险呈显著正相关，当使用诊断前 8-10 年测量的 BMI 时。随着检查诊断前更早的时期，BMI 作为 CRC 的危险因素呈上升趋势，当使用至少 8 年前的 BMI 时，这种关联尤其明显。体重减轻（2 公斤或以上）与 CRC 的关联呈现出相反的趋势，在诊断前 2 年内体重减轻的影响最大（OR，7.52；95%CI，5.61-10.09），而较早的间隔则逐渐减少。
结论和相关性：在这项基于人群的病例对照研究中，考虑到大量的诊断前体重减轻，进一步强调了超重和肥胖与 CRC 风险之间的关联。
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