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Int J Cancer. 2015 Aug 1;137(3):646-57. doi: 10.1002/ijc.29432. Epub 2015 Feb 9.

General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition.

Author information

1
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
2
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
3
CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
4
Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
5
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
6
Cancer Registry of Norway, Oslo, Norway.
7
Samfundet Folkhalsan, Helsinki, Finland.
8
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
9
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
10
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.
11
Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
12
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
13
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
14
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
15
Dipartmento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
16
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
17
Cancer Registry and Histopathology Unit, "Civic-M.P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy.
18
Human Genetics Foundation (HuGeF), Torino, Italy.
19
Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, Vitoria, Spain.
20
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
21
Navarre Public Health Institute, Pamplona, Spain.
22
Public Health Directorate, Asturias, Spain.
23
Division of Internal Medicine, Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
24
Department for Biobank Research, Umeå University, Umeå, Sweden.
25
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
26
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
27
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
28
Danish Cancer Society Research Center, Copenhagen, Denmark.
29
Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France.
30
Univ Paris Sud, Villejuif, France.
31
IGR, Villejuif, France.
32
Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
33
University of Cambridge, Cambridge, United Kingdom.
34
MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
35
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
36
Department of Epidemiology, Harvard School of Public Health, Boston, MA.
37
Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
38
Hellenic Health Foundation, Athens, Greece.
39
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
40
Unit of Nutrition, Environment and Cancer, Programme of Epidemiological Research, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain.

Abstract

General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.

KEYWORDS:

abdominal obesity; body mass index; esophageal cancer; gastric cancer; general obesity; waist circumference

PMID:
25598323
DOI:
10.1002/ijc.29432
[Indexed for MEDLINE]
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