BACKGROUND

Determine if dual-energy X-ray absorptiometry (DXA) derived adiposity was associated with colorectal cancer (CRC) incidence and mortality in postmenopausal women from the Women's Health Initiative (WHI) DXA Cohort.

METHODS

Whole-body DXA scans estimated adiposity. Women with cancer history (except non-melanoma skin cancer) or missing baseline DXA were excluded. For 27 years of follow-up, outcomes and death were adjudicated. Descriptive statistics by CRC status were calculated. Fine and Gray's competing risks regression was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CI). Observation time was from enrollment to first CRC event or competing risk (other cancer, other cause of death); women without cancer at last follow-up were censored. Covariates included sociodemographic, clinical, and study characteristics.

RESULTS

After exclusions, 9,950 women were included, with 191 first-incident CRC and 88 CRC-related deaths identified. At baseline, mean (±SD) age was 63.3 (±7.4) years, and body mass index was 28.2 (±5.7) kg/m2. In adjusted models, baseline continuous abdominal visceral adipose tissue (VAT) (per 100cm2) and android fat (per kg) were significantly associated with a higher risk of first-incident CRC: SHR (95% CI) 1.23 (1.04-1.45) and 1.15 (1.01-1.31), respectively. There were no significant associations between adiposity and CRC mortality.

CONCLUSIONS

Higher amounts of abdominal VAT and android fat were associated with a higher risk of CRC incidence in postmenopausal women.

IMPACT

Associations between VAT and CRC, independent of BMI, support clinical assessment of body composition across weight categories. A head-to-head comparison of VAT and BMI for CRC prediction is recommended in future research.