Sun Ming, da Silva Marisa, Bjørge Tone, Fritz Josef, Mboya Innocent B, Jerkeman Mats, Stattin Pär, Wahlström Jens, Michaëlsson Karl, van Guelpen Bethany, Magnusson Patrik K E, Sandin Sven, Yin Weiyao, Lagerros Ylva Trolle, Ye Weimin, Nwaru Bright, Kankaanranta Hannu, Lönnberg Lena, Chabok Abbas, Isaksson Karolin, Pedersen Nancy L, Elmståhl Sölve, Lind Lars, Hedman Linnea, Häggström Christel, Stocks Tanja
Department of Translational Medicine, Lund University, Malmö, Sweden.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Lancet Reg Health Eur. 2024 Aug 20;45:101034. doi: 10.1016/j.lanepe.2024.101034. eCollection 2024 Oct.
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.
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/m) vs. normal weight (BMI 18.5-24.9 kg/m) or per 5 kg/m higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related.
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/m 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).
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.
Swedish Research Council, Swedish Cancer Society, Mrs. Berta Kamprad's Cancer Foundation, Crafoord Foundation, Cancer Research Foundation at the Department of Oncology, Malmö University Hospital, and China Scholarship Council.
通过体重指数（BMI）评估的肥胖是13种癌症的既定风险因素。我们旨在识别更多潜在的与肥胖相关的癌症，并相对于既定的与肥胖相关的癌症，量化它们与BMI的关联。
我们对瑞典的4142349人（体重测量时的平均年龄为27.1岁）使用Cox回归模型，计算了BMI与122种癌症及癌症亚型风险之间关联的风险比（HR），这些癌症按部位和形态分组。对于肥胖（BMI≥30kg/m²）与正常体重（BMI 18.5 - 24.9kg/m²）相比，或BMI每升高5kg/m²，在α水平为0.05时呈正相关（即HR>1）且肥胖并非既定风险因素的癌症，被视为潜在的与肥胖相关的癌症。
经过1.002亿人年的随访，记录了332501例新发癌症病例。我们确定男性有15种癌症、女性有16种癌症为潜在的与肥胖相关的癌症。这些癌症包括头颈部、胃肠道、恶性黑色素瘤、生殖器官、内分泌器官、结缔组织和血液系统恶性肿瘤。其中，胃癌、小肠癌颈癌和淋巴瘤亚型与BMI之间存在不同关联的证据（HR异质性的P值<0.05）。对于潜在的与肥胖相关的癌症（51690例），BMI每升高5kg/m²，男性的HR（95%置信区间）为1.17（1.15 - 1.20），女性为1.13（1.11 - 1.15）；对于既定的与肥胖相关的癌症（84384例），男性的HR为1.24（1.22 - 1.26），女性为1.12（1.11 - 1.13）。
本研究表明，大量潜在的与肥胖相关的癌症可能会被添加到已确定的癌症中。重要的是，这些关联的程度与已确定的与肥胖相关的癌症的关联程度在很大程度上相当。我们还提供了一些特定癌症亚型导致与BMI存在某些关联的证据。需要开展考虑癌症特异性混杂因素的研究来证实这些发现。
瑞典研究理事会、瑞典癌症协会、贝塔·坎普拉德夫人癌症基金会、克拉福德基金会、马尔默大学医院肿瘤学系癌症研究基金会和中国国家留学基金管理委员会。
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