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Wang H, Zhang Z, Wu S, Zhu Y, Liang T, Huang X, Yao J. Dietary patterns suggest that dark chocolate intake may have an inhibitory effect on oral cancer: a Mendelian randomization study. Front Nutr 2024; 11:1342163. [PMID: 39027665 PMCID: PMC11255456 DOI: 10.3389/fnut.2024.1342163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/22/2024] [Indexed: 07/20/2024] Open
Abstract
Background Previous studies reported that variations in dietary intake patterns substantially impact human health, specifically tumorigenesis. However, confounding factors in previous cohort studies have obscured the relationship between dietary differences and the risk of oral cancer (OC). Materials and methods We developed an outcome dataset from genome-wide association studies (GWAS) data on three OCs within the GAME-ON project, using GWAS-META merging. We extracted 21 dietary exposures, including 10 dietary patterns, 6 vitamins, and 5 micronutrients, from the UK Biobank database, using the inverse variance weighting method as the primary statistical method. Sensitivity analysis was conducted to detect heterogeneity and pleiotropy. Serum metabolite concentrations were adjusted using multivariate Mendelian randomization. Results Of the 10 analyzed dietary patterns, 8 showed no significant association with the risk of developing OC. Consumption of dark chocolate (inverse variance weighted [IVW]: Odds ratio (OR) = 0.786, 95% confidence interval [CI]: 0.622-0.993, p = 0.044) and sweet pepper exhibited an inverse relationship with OC risk (IVW: OR = 0.757, 95% CI: 0.574-0.997, p = 0.048). Reverse MR analysis revealed no reverse causality. Furthermore, no significant correlation was observed between the intake of 6 vitamins and 5 micronutrients and the risk of developing OC. After using multivariable MR to adjust for serum caffeine, linoleate, theophylline, and theobromine metabolism levels, consuming dark chocolate was unrelated to a decreased risk of OC. After adjusting each serum metabolite individually, the observed p-values deviated from the original values to varying degrees, indicating that the components of dark chocolate could have different effects. Among these components, theophylline demonstrated the most significant inhibitory effect. Conclusion This study demonstrated a causal relationship between the intake of dark chocolate and sweet peppers and a lower risk of OC. The components of dark chocolate could have different effects.
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Affiliation(s)
- Hongwei Wang
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
- Youjiang Medical University for Nationalities, Baise, China
- Department of Tumor Pathology, The Key Laboratory of Molecular Pathology (Hepatobiliary Diseases) of Guangxi, Baise, Guangxi, China
| | - Zhaoyin Zhang
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
- Youjiang Medical University for Nationalities, Baise, China
- Department of Tumor Pathology, The Key Laboratory of Molecular Pathology (Hepatobiliary Diseases) of Guangxi, Baise, Guangxi, China
| | - Sijie Wu
- Guilin Medical University, Guilin, Guangxi, China
| | - Yuanzhi Zhu
- Youjiang Medical University for Nationalities, Baise, China
| | - Tao Liang
- Youjiang Medical University for Nationalities, Baise, China
| | - Xiong Huang
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
- Youjiang Medical University for Nationalities, Baise, China
- Department of Tumor Pathology, The Key Laboratory of Molecular Pathology (Hepatobiliary Diseases) of Guangxi, Baise, Guangxi, China
| | - Jinguang Yao
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
- Youjiang Medical University for Nationalities, Baise, China
- Department of Tumor Pathology, The Key Laboratory of Molecular Pathology (Hepatobiliary Diseases) of Guangxi, Baise, Guangxi, China
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Dos Santos TT, Mattos VS, Molena KF, de Paula-Silva FWG, de Oliveira HF, Faraoni JJ, Nelson-Filho P, de Castro Neto JC, Palma-Dibb RG, de Queiroz AM. The effects of re-irradiation on the chemical and morphological properties of permanent teeth. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:283-295. [PMID: 38625398 DOI: 10.1007/s00411-024-01068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
This study aimed to assess the in vitro effects of re-irradiation on enamel and dentin properties, simulating head and neck cancer radiotherapy retreatment. Forty-five human permanent molars were classified into five groups: non-irradiated; irradiated 60 Gy, and re-irradiated with doses of 30, 40, and 50 Gy. Raman spectroscopy, scanning electron microscopy (SEM), and energy dispersive x-ray spectroscopy (EDS) were employed for analysis. Raman spectroscopy assessed intensity, spectral area, and specific peaks comparatively. Statistical analysis involved Kolmogorov-Smirnov and One-Way ANOVA tests, with Tukey's post-test (significance level set at 5%). Significant changes in irradiated, non-irradiated, and re-irradiated enamel peaks were observed, including phosphate (438 nm), hydroxyapatite (582 nm), phosphate (960 nm), and carbonate (1070 nm) (p < 0.05). Re-irradiation affected the entire tooth (p > 0.05), leading to interprismatic region degradation, enamel prism destruction, and hydroxyapatite crystal damage. Dentin exhibited tubule obliteration, crack formation, and progressive collagen fiber fragmentation. EDX revealed increased oxygen percentage and decreased phosphorus and calcium post-reirradiation. It is concluded that chemical and morphological changes in irradiated permanent teeth were dose-dependent, exacerbated by re-irradiation, causing substantial damage in enamel and dentin.
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Affiliation(s)
- Thais Tedeschi Dos Santos
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
| | | | - Kelly Fernanda Molena
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil.
| | - Francisco Wanderley Garcia de Paula-Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Harley Francisco de Oliveira
- Centro de Tratamento Em Radio-Oncologia (CTR), Ribeirão Preto Medical School (FMRP), Universidade de São Paulo (USP)-Ribeirão Preto/SP, Hospital Márcio Cunha (HMC), Ipatinga/MG, Brasil
| | - Juliana Jendiroba Faraoni
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
| | | | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Av. Do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto, São Paulo, 14040-904, Brazil
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Morales-Berstein F, Biessy C, Viallon V, Goncalves-Soares A, Casagrande C, Hémon B, Kliemann N, Cairat M, Blanco Lopez J, Al Nahas A, Chang K, Vamos E, Rauber F, Bertazzi Levy R, Barbosa Cunha D, Jakszyn P, Ferrari P, Vineis P, Masala G, Catalano A, Sonestedt E, Borné Y, Katzke V, Bajracharya R, Agnoli C, Guevara M, Heath A, Radoï L, Mancini F, Weiderpass E, Huerta JM, Sánchez MJ, Tjønneland A, Kyrø C, Schulze MB, Skeie G, Lukic M, Braaten T, Gunter M, Millett C, Agudo A, Brennan P, Borges MC, Richmond RC, Richardson TG, Davey Smith G, Relton CL, Huybrechts I. Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. Eur J Nutr 2024; 63:377-396. [PMID: 37989797 PMCID: PMC10899298 DOI: 10.1007/s00394-023-03270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome. RESULTS During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14-1.34) and OAC (HR = 1.24, 95% CI 1.05-1.47). WHR mediated 5% (95% CI 3-10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6-53%) and 15% (95% CI 8-72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis. CONCLUSIONS We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).
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Affiliation(s)
- Fernanda Morales-Berstein
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Vivian Viallon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Ana Goncalves-Soares
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Corinne Casagrande
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Bertrand Hémon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Nathalie Kliemann
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Cancer Research Center of Santa Catarina, CEPON, Florianópolis, Brazil
| | - Manon Cairat
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Jessica Blanco Lopez
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Aline Al Nahas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eszter Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Fernanda Rauber
- Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Renata Bertazzi Levy
- Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Diana Barbosa Cunha
- Hésio Cordeiro Institute of Social Medicine, Department of Epidemiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Italian Institute of Technology, Genoa, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Alberto Catalano
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, 10043, Orbassano, TO, Italy
| | - Emily Sonestedt
- Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Yan Borné
- Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rashmita Bajracharya
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcela Guevara
- Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - Alicia Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Loredana Radoï
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Francesca Mancini
- Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain
| | - María-José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, DK-2200, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marko Lukic
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marc Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M Carolina Borges
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
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Gui L, He X, Tang L, Yao J, Pi J. Obesity and head and neck cancer risk: a mendelian randomization study. BMC Med Genomics 2023; 16:200. [PMID: 37620971 PMCID: PMC10463997 DOI: 10.1186/s12920-023-01634-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Observational studies have reported controversial results on the association between obesity and head and neck cancer risk. This study aimed to perform a two-sample Mendelian randomization (MR) analysis to assess the causal association between obesity and head and neck cancer risk using publicly available genome-wide association studies (GWAS) summary statistics. METHODS Single-nucleotide polymorphisms (SNPs) for obesity [body mass index (BMI), waist-to-hip ratio (WHR), whole body fat mass, lean body mass, and trunk fat mass] and head and neck cancer (total head and neck cancer, oral cavity cancer, oropharyngeal cancer, and oral cavity and oropharyngeal cancer) were retrieved from published GWASs and used as genetic instrumental variables. Five methods including inverse-variance-weighted (IVW), weighted-median, MR-Egger, weighted mode, and MR-PRESSO were used to obtain reliable results, and odds ratio with 95% confidence interval (CI) were calculated. Tests for horizontal pleiotropy, heterogeneity, and sensitivity were performed separately. RESULTS Genetically predicted BMI was negatively associated with the risk of total head and neck cancer, which was significant in the IVW [OR (95%CI), 0.990 (0.984-0.996), P = 0.0005], weighted-median [OR (95%CI), 0.984 (0.975-0.993), P = 0.0009], and MR-PRESSO [OR (95%CI), 0.990 (0.984-0.995), P = 0.0004] analyses, but suggestive significant in the MR-Egger [OR (95%CI), 0.9980 (0.9968-0.9991), P < 0.001] and weighted mode [OR (95%CI), 0.9980 (0.9968-0.9991), P < 0.001] analyses. Similar, genetically predicted BMI adjust for smoking may also be negatively associated with the risk of total head and neck cancer (P < 0.05). Genetically predicted BMI may be negatively related to the risk of oral cavity cancer, oropharyngeal cancer, and oral cavity and oropharyngeal cancer (P < 0.05), but no causal association was observed for BMI adjust for smoking (P > 0.05). In addition, no causal associations were observed for other exposures and outcomes (all P > 0.05). CONCLUSION This MR analysis supported the causal association of BMI-related obesity with decreased risk of total head and neck cancer. However, the effect estimates from the MR analysis were close to 1, suggesting a slight protective effect of BMI-related obesity on head and neck cancer risk.
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Affiliation(s)
- Lin Gui
- Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Xiaohui He
- Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Le Tang
- Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jiarui Yao
- Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jinping Pi
- Department of Medical Oncology, Beijing Chao yang District San huan Cancer Hospital, Beijing, 100122, China
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Nokovitch L, Maquet C, Crampon F, Taihi I, Roussel LM, Obongo R, Virard F, Fervers B, Deneuve S. Oral Cavity Squamous Cell Carcinoma Risk Factors: State of the Art. J Clin Med 2023; 12:jcm12093264. [PMID: 37176704 PMCID: PMC10179259 DOI: 10.3390/jcm12093264] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.
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Affiliation(s)
- Lara Nokovitch
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Charles Maquet
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Frédéric Crampon
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Ihsène Taihi
- Oral Surgery Department, Rothschild Hospital, 75012 Paris, France
- URP 2496, Laboratory of Orofacial Pathologies, Imaging and Biotherapies, UFR Odontology, Health Department, Université Paris Cité, 92120 Montrouge, France
| | - Lise-Marie Roussel
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - Rais Obongo
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - François Virard
- INSERM U1052-CNRS UMR5286, Cancer Research Center, Centre Léon Bérard, University Claude Bernard Lyon 1, 69008 Lyon, France
- Faculté d'Odontologie, Hospices Civils de Lyon, University of Lyon, 69002 Lyon, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
- INSERM UMR 1296, "Radiations: Défense, Santé, Environnement", Centre Léon Bérard, 69008 Lyon, France
| | - Sophie Deneuve
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
- Quantification en Imagerie Fonctionnelle-Laboratoire d'Informatique, du Traitement de l'Information et des Systèmes Equipe d'Accueil 4108 (QuantIF-LITIS EA4108), University of Rouen, 76000 Rouen, France
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Gormley M, Dudding T, Thomas SJ, Tyrrell J, Ness AR, Pring M, Legge D, Davey Smith G, Richmond RC, Vincent EE, Bull C. Evaluating the effect of metabolic traits on oral and oropharyngeal cancer risk using Mendelian randomization. eLife 2023; 12:e82674. [PMID: 37042641 PMCID: PMC10147379 DOI: 10.7554/elife.82674] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/11/2023] [Indexed: 04/13/2023] Open
Abstract
A recent World Health Organization report states that at least 40% of all cancer cases may be preventable, with smoking, alcohol consumption, and obesity identified as three of the most important modifiable lifestyle factors. Given the significant decline in smoking rates, particularly within developed countries, other potentially modifiable risk factors for head and neck cancer warrant investigation. Obesity and related metabolic disorders such as type 2 diabetes (T2D) and hypertension have been associated with head and neck cancer risk in multiple observational studies. However, adiposity has also been correlated with smoking, with bias, confounding or reverse causality possibly explaining these findings. To overcome the challenges of observational studies, we conducted two-sample Mendelian randomization (inverse variance weighted [IVW] method) using genetic variants which were robustly associated with adiposity, glycaemic and blood pressure traits in genome-wide association studies (GWAS). Outcome data were taken from the largest available GWAS of 6034 oral and oropharyngeal cases, with 6585 controls. We found limited evidence of a causal effect of genetically proxied body mass index (BMI; OR IVW = 0.89, 95% CI 0.72-1.09, p = 0.26 per 1 standard deviation in BMI [4.81kg/m2]) on oral and oropharyngeal cancer risk. Similarly, there was limited evidence for related traits including T2D and hypertension. Small effects cannot be excluded given the lack of power to detect them in currently available GWAS.
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Affiliation(s)
- Mark Gormley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Bristol Dental Hospital and School, University of BristolBristolUnited Kingdom
| | - Tom Dudding
- Bristol Dental Hospital and School, University of BristolBristolUnited Kingdom
| | - Steven J Thomas
- Bristol Dental Hospital and School, University of BristolBristolUnited Kingdom
| | - Jessica Tyrrell
- University of Exeter Medical School, RILD Building, RD&E HospitalExeterUnited Kingdom
| | - Andrew R Ness
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of BristolBristolUnited Kingdom
| | - Miranda Pring
- Bristol Dental Hospital and School, University of BristolBristolUnited Kingdom
| | - Danny Legge
- Translational Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Translational Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Caroline Bull
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Translational Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
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7
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Fatty Liver and Risk of Head and Neck Cancer in Type 2 Diabetes Mellitus: A Nationwide Cohort Study. Cancers (Basel) 2023; 15:cancers15041209. [PMID: 36831551 PMCID: PMC9954043 DOI: 10.3390/cancers15041209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
This study is aimed at investigating the association between NAFLD and the risk of HNC separately based on cancer site using a large population-based cohort of patients with T2DM. The data used in this population-based retrospective cohort study were provided by the Korean National Health Insurance Service. The Cox proportional hazards model was used to estimate multivariable adjusted hazard ratios and 95% CIs for the association of the fatty liver index (FLI) and the risk of HNC. During the mean 6.9 years of follow-up, approximately 25.4% of the study cohort had NAFLD, defined as an FLI ≥60. A total of 3543 HNC cases were identified. Overall, patients with a higher FLI had a significantly higher risk of HNC in the oral cavity, pharynx, and larynx compared with patients with an FLI <30. An association was not observed between salivary gland cancer and FLI. There was no association between obesity and HNC. However, obese patients showed a lower risk of cancer for the oral cavity (p = 0.040), pharynx (p = 0.009), and larynx (p < 0.001) than non-obese patients with the same FLI level. Neither obesity nor smoking affected the association between FLI- and HNC-risk in stratified analyses. In T2DM patients, NAFLD was associated with an increased risk of developing HNC in the oral cavity, pharynx, and larynx, but not in the salivary gland.
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8
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Perim Galvão De Podestá O, Salaroli LB, Cattafesta M, Peres SV, De Podestá JRV, von Zeidler SLV, de Oliveira JC, Kowalski LP, Ikeda MK, Brennan P, Curado MP. Changes in Body Mass Index Are Associated with Squamous Cell Carcinomas of Oral Cavity, Oropharynx and Larynx: A Case-Control Study in Brazil. Nutr Cancer 2022; 75:599-609. [PMID: 36426640 DOI: 10.1080/01635581.2022.2143535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022]
Abstract
Head and neck cancer (HNC) significantly impacts nutritional status because the tumor limits swallowing function. In this sense, it is important to monitor the nutritional status throughout the life of any individual. A multicenter case-control study was carried out to analyze the BMI at 30 years of age, two years before diagnosis and at the time of diagnosis of individuals with oral cavity, oropharynx, and larynx cancers. It was observed that a 5% reduction in BMI during the two years before enrollment was associated with an increased risk of the oral cavity (OR = 3.73), oropharyngeal OR = 5.25), and laryngeal (OR = 5.22). Reduced BMI of more than 5% over two years before diagnosis was associated with HNC. Weight loss remained significant at diagnosis, but it is not possible to exclude reverse causality since most cases are at an advanced stage. BMI monitoring of individuals at potential risk for HNC can promote early diagnosis and nutritional interventions for HNC.
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Affiliation(s)
- Olívia Perim Galvão De Podestá
- Research Group on Epidemiology, Healf and Nutrition, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Sciences of Fundacion Antonio Prudente, A C Camargo Cancer Center, São Paulo, São paulo, Brazil
| | - Luciane Bresciani Salaroli
- Graduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Graduate Program in Nutrition and Health, Vitória, Espírito Santo, Brazil
| | - Mônica Cattafesta
- Research Group on Epidemiology, Healf and Nutrition, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Stela Verzinhasse Peres
- Onconcenter Foundation of São Paulo - Deputy Director of Information and Epidemiology, São paulo, Brazil
| | | | | | | | - Luiz Paulo Kowalski
- Sciences of Fundacion Antonio Prudente, A C Camargo Cancer Center, São Paulo, São paulo, Brazil
| | - Mauro Kasuo Ikeda
- Sciences of Fundacion Antonio Prudente, A C Camargo Cancer Center, São Paulo, São paulo, Brazil
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Maria Paula Curado
- Sciences of Fundacion Antonio Prudente, A C Camargo Cancer Center, São Paulo, São paulo, Brazil
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9
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Fan Y, Chen Q, Wang Y, Wang J, Li Y, Wang S, Weng Y, Yang Q, Chen C, Lin L, Qiu Y, Chen F, Wang J, He B, Liu F. Mediation analysis of erythrocyte lipophilic index on the association between BMI and risk of oral cancer. Lipids Health Dis 2022; 21:96. [PMID: 36209108 PMCID: PMC9547469 DOI: 10.1186/s12944-022-01704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Aims To explore the relationship between the fatty acid lipophilic index (LI) of the erythrocyte membrane and oral cancer risk, as well as to evaluate the possibility of LI acting as a mediator of the association between body mass index (BMI) and oral cancer. Method Twenty-three fatty acids (FAs) of the erythrocyte membrane were measured using gas chromatography in 380 patients with oral cancer and 387 control subjects. The LI was calculated based on the FA proportion and FA melting points. The association of BMI and erythrocyte LI with oral cancer risk was analysed using logistic regression. The mediation effect of LI on the association between BMI and oral cancer risk was evaluated using mediation analysis. Results Among the control group, 46.0% were overweight or obese, which was significantly higher than that of oral cancer patients (29.5%). Significant differences in erythrocyte membrane saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) were observed between the patient and control groups. The proportion of C18:1 n-9 from the MUFA family increased in oral cancer patients (12.67%) compared with controls (12.21%). While the total proportion of n-3 PUFAs decreased in oral cancer patients compared with controls, with C20:5 n-3 decreasing from 0.66 to 0.47%, and C22:6 n-3 decreasing from 5.82 to 4.86%. The LI was lower in the control participants (M = 27.6, IQR: 27.3–27.9) than in the oral cancer patients (M = 28.2, IQR: 27.9–28.5). BMI was inversely associated with oral cancer risk with a fully adjusted OR of 0.59 (95% CI: 0.43–0.83), while LI was positively associated with oral cancer risk with a fully adjusted OR of 1.99 (95% CI:1.36–2.94). LI explained 7% of the variance in the relationship between BMI and oral cancer risk. Conclusions The distribution of the FA profile in erythrocyte membranes differed between the oral cancer patients and the control group. The LI derived from the profile of FAs was positively associated with the risk of oral cancer, and the associations between BMI and oral cancer risk can be explained, at least in part, by LI. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-022-01704-z.
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Affiliation(s)
- Yi Fan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Qing Chen
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yaping Wang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Yanni Li
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Sijie Wang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Yanfeng Weng
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Qiujiao Yang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Chen Chen
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Lisong Lin
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yu Qiu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China
| | - Jing Wang
- Laboratory Center, The Major Subject of Environment and Health of Fujian Key Universities, School of Public Health, Fujian Medical University, Fujian, China
| | - Baochang He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China. .,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China.
| | - Fengqiong Liu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350122, China. .,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, China.
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10
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Hobday S, Armache M, Paquin R, Nurimba M, Baddour K, Linder D, Kouame G, Tharrington S, Albergotti WG, Mady LJ. The Body Mass Index Paradox in Head and Neck Cancer: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 75:48-60. [PMID: 35959747 DOI: 10.1080/01635581.2022.2102659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The body mass index (BMI) paradox describes that among patients with certain cancers, higher pretreatment BMI may be associated with improved survival. We examine the impact of BMI on overall survival (OS) in head and neck squamous cell carcinoma (HNSCC) patients. A literature search was performed, and articles using hazard ratios to describe the prognostic impact of BMI on OS in HNSCC were included. Random-effects DerSimonian and Laird methods were employed for meta-analysis. Meta-analysis of OS indicated a lower hazards of death in the overweight (BMI: 25 kg/m2-30 kg/m2) compared to the normal weight (BMI: 18.5 kg/m2-25 kg/m2). This protective relationship loses significance when BMI exceeds 30 kg/m2. Underweight patients (BMI < 18.5 kg/m2) demonstrate higher hazards of death compared to normal weight patients. Compared to HNSCC patients with normal weight, being overweight up to a BMI of 30 kg/m2 is a positive predictor of OS, while being underweight confers a prognostic disadvantage. Further studies are needed to determine the mechanisms by which increased body mass influences survival outcomes in HNSCC.
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Affiliation(s)
- Sara Hobday
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Armache
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Paquin
- Department of Otolaryngology-Head and Neck Surgery, Augusta University, Augusta, GA, USA
| | - Margaret Nurimba
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Khalil Baddour
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Linder
- Division of Biostatistics and Data Science, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gail Kouame
- Greenblatt Library, Augusta University, Augusta, GA, USA
| | | | - William G Albergotti
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Leila J Mady
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA.,Cancer Risk and Control (CRiC) Program of Excellence, Sidney Kimmel Cancer Center, Philadelphia, PA, USA
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11
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Associations of Body Mass Index and Waist Circumference with the Risk of Head and Neck Cancer: A National Population-Based Study. Cancers (Basel) 2022; 14:cancers14163880. [PMID: 36010881 PMCID: PMC9405652 DOI: 10.3390/cancers14163880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 12/26/2022] Open
Abstract
Background: We investigated the association between BMI and HNC subtype incidence in a cohort study of ten million people, adjusting for the effect of smoking and drinking. We also investigated the relationship between waist circumference (WC) and HNC subtype. Methods: All data used in this study originated from the Korean National Health Insurance Service database. We analysed subjects who had undergone health check-ups in 2009 and monitored subjects until 2018 (n = 10,585,852). Finally, 9,598,085 subjects were included after exclusions. We collected variables that could affect the risk of HNC. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The overall incidence of HNC was higher in the low BMI category (BMI < 18.5 according to WHO recommendations for Asian people) (HR: 1.322; 95% CI: 1.195−1.464) compared with the normal BMI category. Among the HNC cases, the incidence rates of laryngeal (HR: 1.3; 95% CI: 1.085−1.558), oral cavity (HR: 1.277; 95% CI: 1.011−1.611), and oropharyngeal (HR: 1.584; 95% CI: 1.25−2.008) cancers were higher in the low BMI category compared with the normal BMI category. No significant association was detected between low BMI and sinus cancer, salivary gland cancer, or nasopharyngeal cancer. The low WC category (<80 cm in men and <75 cm in women) was related to a risk of hypopharyngeal (HR: 1.268; 95% CI: 1.061−1.514) and laryngeal (HR: 1.118; 95% CI: 1.007−1.241) cancers. The HR for occurrence of HNC was high in underweight participants according to smoking status (1.219 for never smoker vs. 1.448 for ever smoker, p for interaction = 0.0015) and drinking status (1.193 for never drinker vs. 1.448 for ever drinker, p for interaction = 0.0044). Conclusions: Low BMI was associated with the risk of some types of HNC. The results of this study could assist etiological investigations and prevention strategies.
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12
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Metabolic Diseases and Risk of Head and Neck Cancer: A Cohort Study Analyzing Nationwide Population-Based Data. Cancers (Basel) 2022; 14:cancers14133277. [PMID: 35805048 PMCID: PMC9265067 DOI: 10.3390/cancers14133277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to investigate the association between metabolic diseases and the risk of head and neck cancer (HNC) using nationwide population-based big data. This retrospective cohort study was conducted using the Korean National Health Insurance Service health checkup database. A total of 4,575,818 participants aged >40 years who received a health checkup in 2008 were enrolled, and we studied the incidence of HNC until 2019. We analyzed the risk of HNC according to the presence of metabolic diseases, such as obesity, dyslipidemia, hypertension, and diabetes. Although metabolic syndrome itself was not associated with HNC, each component of metabolic syndrome was associated with HNC. Underweight and diabetes were risk factors for HNC (HR: 1.694). High total cholesterol and high low-density lipoprotein cholesterol levels were factors that decreased the risk (HR 0.910 and 0.839). When we analyzed men and women separately, low total cholesterol level, low low-density lipoprotein cholesterol level, and hypertension were risk factors only in men. In addition, pre-obesity, obesity, and central obesity decreased the risk only in men. Each metabolic disease affects HNC in different ways. Underweight and diabetes increased the risk of HNC, whereas high total cholesterol and high low-density lipoprotein cholesterol levels decreased the risk of HNC.
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13
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Conti GB, de Lima Oliveira RF, Amorim AA, de Oliveira HF, Pires-de-Souza FDCP, de Queiroz AM. Color stability and microhardness alteration of irradiated dental enamel treated with a high fluoride concentration toothpaste. Clin Oral Investig 2022; 26:5885-5892. [PMID: 35590118 DOI: 10.1007/s00784-022-04546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Radiotherapy (RT) is a kind of head and neck cancer (HNC) treatment, which is associated to the habit of smoking and can develop collateral effects in the oral cavity, such as the increase of caries prevalence. This study evaluated the color alteration, the microhardness, and the remineralizing potential of high fluoride concentration toothpastes on irradiated teeth. MATERIALS AND METHODS Forty bovine teeth were used (6 × 6 × 2 mm) and after color (EasyShade, VITA) and microhardness initial readings were separated into two groups: exposed to cigarette smoke and non-exposed. All samples were submitted to RT (30 Gy) and to cariogenic challenge. New color and microhardness readings were done. After RT (60 Gy), the samples were submitted to simulated toothbrushing (73,000 cycles = 5 years of brushing) with two different toothpastes: conventional (1450 ppm) and high fluoride concentration (5000 ppm). Final color and microhardness readings were done after brushing. Data were analyzed with 2-way ANOVA with repeated measures and Tukey's test (p < .05). RESULTS There was no color difference after RT, nor after brushing (p > .05). However, after brushing, microhardness values increased for the samples treated with high fluoride concentration toothpaste (p < .05). CONCLUSION Radiotherapy did not influence the teeth color, and the high fluoride concentration toothpaste presented remineralizing potential; therefore, it could be used on the caries prevention related to HNC radiation. CLINICAL RELEVANCE Considering its remineralizing potential, toothpastes with high fluoride concentration could be a proper alternative for caries prevention in patients undergoing radiotherapy.
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Affiliation(s)
- Giulia Battistini Conti
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Rebeca Franco de Lima Oliveira
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Ayodele Alves Amorim
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | | | - Fernanda de Carvalho Panzeri Pires-de-Souza
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
- Faculty of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
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14
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Gormley A, Richards C, Spiga F, Gray E, Hooper J, Main B, Vincent EE, Richmond R, Higgins J, Gormley M. Metabolic disorders and the risk of head and neck cancer: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e058392. [PMID: 35508337 PMCID: PMC9073393 DOI: 10.1136/bmjopen-2021-058392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Head and neck cancer squamous cell carcinoma (HNSCC) is the sixth most common cancer internationally. Established risk factors include smoking, alcohol and presence of human papillomavirus (HPV). The incidence rate of new disease continues to rise, despite falls in alcohol consumption and a reduction in smoking, the rising rates are unlikely to be solely attributed to HPV status alone. Obesity and its associated conditions such as type 2 diabetes (T2D) are implicated in the risk and progression of a variety of cancers, but there is paucity of evidence regarding its role in HNSCC. METHODS AND ANALYSIS A systematic review of cohort studies, reporting a risk of incident HNSCC, will be included. A systematic search strategy has been developed, multiple databases will be searched from January 1966 to November 2021, including Cochrane Library, OVID SP versions of Medline and EMBASE. The primary outcome will be incident HNSCC based on exposures of T2D, obesity, dyslipidaemia and hypertension as defined by the WHO. A combined risk effect across studies will be calculated using meta-analysis, although depending on the heterogeneity in study design, exposure and outcome reporting this may not be possible. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review. The review will be published in a relevant peer-review journal and findings will be presented at scientific meetings in both poster and oral presentation form. PROSPERO REGISTRATION NUMBER DETAILS This study has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) with study registration number CRD42021250520. This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance statement.
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Affiliation(s)
- Alexander Gormley
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Francesca Spiga
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Emily Gray
- Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Joanna Hooper
- Library and Information Services, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Barry Main
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- School of Cellular and Molecular Medicine, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Rebecca Richmond
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Julian Higgins
- Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Mark Gormley
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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15
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Peng J, Hu Q, Chen X, Wang C, Zhang J, Ren X, Wang Y, Tao X, Li H, Song M, Cheng B, Wu T, Xia J. Diet-induced obesity accelerates oral carcinogenesis by recruitment and functional enhancement of myeloid-derived suppressor cells. Cell Death Dis 2021; 12:946. [PMID: 34650054 PMCID: PMC8516872 DOI: 10.1038/s41419-021-04217-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 12/31/2022]
Abstract
Although obesity has been associated with an increased risk and aggressiveness of many types of carcinoma, whether it promotes squamous cell carcinoma remains unclear. To reveal the role of obesity in oral squamous cell carcinoma (OSCC) initiation and development, we used 4NQO-induced OSCC model mice to examine the impact of dietary obesity on carcinogenesis. The results showed that high-fat diet (HFD)-induced obesity significantly promoted the incidence of OSCC and altered the local immune microenvironment with the expansion of CD11b+Gr1+ myeloid-derived suppressor cells (MDSCs). The underlying mechanism that induced an immunosuppressive local microenvironment in obesity was the recruitment of MDSCs through the CCL9/CCR1 axis and enhancement of MDSC immunosuppressive function via intracellular fatty acid uptake. Furthermore, clinical samples verified the increase in infiltrated CD33+ (a marker of human MDSCs) cells in obese OSCC patients, and data from the TCGA dataset confirmed that CD33 expression was positively correlated with local adipocytes in OSCC. Survival analysis showed that enrichment of adipocytes and high expression of CD33 were associated with poor prognosis in OSCC patients. Strikingly, depletion of MDSCs significantly ameliorated HFD-promoted carcinogenesis in 4NQO-induced model mice. These findings indicate that obesity is also an important risk factor for OSCC, and cancer immunotherapy, especially targeting MDSCs, may exhibit greater antitumor efficacy in obese patients.
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Affiliation(s)
- Jianmin Peng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Qinchao Hu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xijuan Chen
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Chunyang Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jiayu Zhang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xianyue Ren
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yun Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Xiaoan Tao
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Huan Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ming Song
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Department of Head and Neck Surgery, Sun Yat‑sen University Cancer Center, Guangzhou, China
| | - Bin Cheng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
| | - Tong Wu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
| | - Juan Xia
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China.
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16
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Christakoudi S, Tsilidis KK, Evangelou E, Riboli E. A Body Shape Index (ABSI), hip index, and risk of cancer in the UK Biobank cohort. Cancer Med 2021; 10:5614-5628. [PMID: 34196490 PMCID: PMC8366087 DOI: 10.1002/cam4.4097] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
Abdominal size is associated positively with the risk of some cancers but the influence of body mass index (BMI) and gluteofemoral size is unclear because waist and hip circumference are strongly correlated with BMI. We examined associations of 33 cancers with A Body Shape Index (ABSI) and hip index (HI), which are independent of BMI by design, and compared these with waist and hip circumference, using multivariable Cox proportional hazards models in UK Biobank. During a mean follow-up of 7 years, 14,682 incident cancers were ascertained in 200,289 men and 12,965 cancers in 230,326 women. In men, ABSI was associated positively with cancers of the head and neck (hazard ratio HR = 1.14; 95% confidence interval 1.03-1.26 per one standard deviation increment), esophagus (adenocarcinoma, HR = 1.27; 1.12-1.44), gastric cardia (HR = 1.31; 1.07-1.61), colon (HR = 1.18; 1.10-1.26), rectum (HR = 1.13; 1.04-1.22), lung (adenocarcinoma, HR = 1.16; 1.03-1.30; squamous cell carcinoma [SCC], HR = 1.33; 1.17-1.52), and bladder (HR = 1.15; 1.04-1.27), while HI was associated inversely with cancers of the esophagus (adenocarcinoma, HR = 0.89; 0.79-1.00), gastric cardia (HR = 0.79; 0.65-0.96), colon (HR = 0.92; 0.86-0.98), liver (HR = 0.86; 0.75-0.98), and multiple myeloma (HR = 0.86; 0.75-1.00). In women, ABSI was associated positively with cancers of the head and neck (HR = 1.27; 1.10-1.48), esophagus (SCC, HR = 1.37; 1.07-1.76), colon (HR = 1.08; 1.01-1.16), lung (adenocarcinoma, HR = 1.17; 1.06-1.29; SCC, HR = 1.40; 1.20-1.63; small cell, HR = 1.39; 1.14-1.69), kidney (clear-cell, HR = 1.25; 1.03-1.50), and post-menopausal endometrium (HR = 1.11; 1.02-1.20), while HI was associated inversely with skin SCC (HR = 0.91; 0.83-0.99), post-menopausal kidney cancer (HR = 0.77; 0.67-0.88), and post-menopausal melanoma (HR = 0.90; 0.83-0.98). Unusually, ABSI was associated inversely with melanoma in men (HR = 0.89; 0.82-0.96) and pre-menopausal women (HR = 0.77; 0.65-0.91). Waist and hip circumference reflected associations with BMI, when examined individually, and provided biased risk estimates, when combined with BMI. In conclusion, preferential positive associations of ABSI or inverse of HI with several major cancers indicate an important role of factors determining body shape in cancer development.
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Affiliation(s)
- Sofia Christakoudi
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonNorfolk Place, LondonUK
- MRC Centre for TransplantationKing’s College LondonLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonNorfolk Place, LondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Evangelos Evangelou
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonNorfolk Place, LondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonNorfolk Place, LondonUK
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17
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Wood AM, Jonsson H, Nagel G, Häggström C, Manjer J, Ulmer H, Engeland A, Zitt E, Jochems SHJ, Ghaderi S, Stattin P, Bjørge T, Stocks T. The Inverse Association of Body Mass Index with Lung Cancer: Exploring Residual Confounding, Metabolic Aberrations and Within-Person Variability in Smoking. Cancer Epidemiol Biomarkers Prev 2021; 30:1489-1497. [PMID: 34162656 DOI: 10.1158/1055-9965.epi-21-0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers. METHODS We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants. RESULTS Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85-0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44-1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI. CONCLUSIONS The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking. IMPACT Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.
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Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | - Håkan Jonsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria.,Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Sara Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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18
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Recalde M, Davila-Batista V, Díaz Y, Leitzmann M, Romieu I, Freisling H, Duarte-Salles T. Body mass index and waist circumference in relation to the risk of 26 types of cancer: a prospective cohort study of 3.5 million adults in Spain. BMC Med 2021; 19:10. [PMID: 33441148 PMCID: PMC7807518 DOI: 10.1186/s12916-020-01877-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC. METHODS Prospective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites. RESULTS After a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m2 increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers. CONCLUSIONS In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity.
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Affiliation(s)
- Martina Recalde
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Campus de Bellaterra, 08193 Bellaterra, Spain
| | - Veronica Davila-Batista
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Yesika Díaz
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Isabelle Romieu
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Hubert Department of Global Health, Emory University, Atlanta, GA USA
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
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19
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Silveira EA, Kliemann N, Noll M, Sarrafzadegan N, de Oliveira C. Visceral obesity and incident cancer and cardiovascular disease: An integrative review of the epidemiological evidence. Obes Rev 2021; 22:e13088. [PMID: 32692447 PMCID: PMC7757158 DOI: 10.1111/obr.13088] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
Evidence shows a strong relationship between obesity, cancer and cardiovascular disease (CVD) risk. However, there is not enough evidence of the role of visceral obesity on both CVD and cancer. Visceral obesity may be more pro-oncogenic than total body fat. Therefore, it is important to know whether abdominal obesity can lead to both CVD and cancer. The present integrative review aimed at evaluating epidemiological evidence on the potential connection of visceral obesity in the occurrence of cancer and CVD. The following databases were searched: SCOPUS, PubMed, Science Direct, Lilacs, SciELO, Google Scholar, Web of Science, Scopus and ProQuest. The presence of visceral obesity can increase the risk of some specific cancer types, but there is controversial evidence about CVD risk based on sex-specific and ageing analyses. There is enough evidence that visceral obesity increases the risk of colorectal, pancreatic and gastro-oesophageal cancer. However, for some types of cancer such as breast, endometrial and renal, visceral obesity is a risk only in post-menopausal women. Regarding prostate cancer, the evidence is controversial. Despite the risk of visceral obesity being consistently associated with CVD in adults, this association disappears in sex-specific and older adults analyses. Moreover, in older adults, the results are controversial due to the use of different measures such as waist circumference and visceral adipose tissue. However, the evidence showing visceral obesity as a risk factor to CVD remains controversial. Sex differences, ageing and body mass index (BMI) category can potentially modify this association. Therefore, further epidemiological studies with analyses stratified by sex and samples including older adults aged 65 and older are needed.
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Affiliation(s)
- Erika Aparecida Silveira
- Affiliate Academic at the Department of Epidemiology & Public Health, Institute of Epidemiology & Health CareUniversity College LondonLondonUK
- Postgraduate Program in Health Sciences, Faculty of MedicineFederal University of GoiásGoiâniaBrazil
| | - Nathalie Kliemann
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on CancerWorld Health OrganizationLyonFrance
| | - Matias Noll
- Instituto Federal GoianoPublic Health DeptCeresBrasil
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
- School of Population and Public Health, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health CareUniversity College LondonLondonUK
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20
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Gormley M, Dudding T, Sanderson E, Martin RM, Thomas S, Tyrrell J, Ness AR, Brennan P, Munafò M, Pring M, Boccia S, Olshan AF, Diergaarde B, Hung RJ, Liu G, Davey Smith G, Richmond RC. A multivariable Mendelian randomization analysis investigating smoking and alcohol consumption in oral and oropharyngeal cancer. Nat Commun 2020; 11:6071. [PMID: 33247085 PMCID: PMC7695733 DOI: 10.1038/s41467-020-19822-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
The independent effects of smoking and alcohol in head and neck cancer are not clear, given the strong association between these risk factors. Their apparent synergistic effect reported in previous observational studies may also underestimate independent effects. Here we report multivariable Mendelian randomization performed in a two-sample approach using summary data on 6,034 oral/oropharyngeal cases and 6,585 controls from a recent genome-wide association study. Our results demonstrate strong evidence for an independent causal effect of smoking on oral/oropharyngeal cancer (IVW OR 2.6, 95% CI = 1.7, 3.9 per standard deviation increase in lifetime smoking behaviour) and an independent causal effect of alcohol consumption when controlling for smoking (IVW OR 2.1, 95% CI = 1.1, 3.8 per standard deviation increase in drinks consumed per week). This suggests the possibility that the causal effect of alcohol may have been underestimated. However, the extent to which alcohol is modified by smoking requires further investigation.
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Affiliation(s)
- Mark Gormley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK.
- Bristol Dental Hospital and School, University of Bristol, Bristol, BS1 2LY, UK.
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK.
| | - Tom Dudding
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Bristol Dental Hospital and School, University of Bristol, Bristol, BS1 2LY, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
| | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS1 3NU, UK
| | - Steven Thomas
- Bristol Dental Hospital and School, University of Bristol, Bristol, BS1 2LY, UK
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS1 3NU, UK
| | - Jessica Tyrrell
- RD&E Hospital, University of Exeter Medical School, RILD Building, Exeter, UK
| | - Andrew R Ness
- University Hospitals Bristol and Weston NHS Foundation Trust National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, BS1 3NU, UK
| | - Paul Brennan
- Genetic Epidemiology Group, World Health Organization, International Agency for Research on Cancer, Lyon, France
| | - Marcus Munafò
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, BS8 1TL, UK
| | - Miranda Pring
- Bristol Dental Hospital and School, University of Bristol, Bristol, BS1 2LY, UK
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, PA, 15260, USA
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TL, UK
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21
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He Y, Liang D, Li D, Shan B, Zheng R, Zhang S, Wei W, He J. Incidence and mortality of laryngeal cancer in China, 2015. Chin J Cancer Res 2020; 32:10-17. [PMID: 32194300 PMCID: PMC7072018 DOI: 10.21147/j.issn.1000-9604.2020.01.02] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015. Methods Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area (urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for age-standardized. Results The percentage of cases morphological verified (MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases (DCO%) was 2.10%. And the mortality to incidence (M/I) ratio was 0.55. About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000 (males and females were 3.20 and 0.42 per 100,000, respectively). Age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate (0−74 years old) was 0.15%. The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate (0−74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas. Conclusions The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.
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Affiliation(s)
- Yutong He
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | - Di Liang
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | - Daojuan Li
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | - Baoen Shan
- Cancer Institute, the Fourth Hospital of Hebei Medical University/the Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | - Rongshou Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021, China
| | - Siwei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021, China
| | - Wenqiang Wei
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021, China
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021, China
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22
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Wang K, Yu XH, Tang YJ, Tang YL, Liang XH. Obesity: An emerging driver of head and neck cancer. Life Sci 2019; 233:116687. [PMID: 31348948 DOI: 10.1016/j.lfs.2019.116687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 02/05/2023]
Abstract
Obesity has become pandemic and emerged as one of the most critical global health care problems worldwide since last century. Recent studies have demonstrated that there may be a causal link between obesity and higher risks and mortality of cancers, including prostate, breast, colon, and thyroid cancers, head and neck cancer (HNC). This review focuses on the relationship between obesity and HNC, and the molecular mechanism of abnormal lipid metabolism in HNC. Elucidating the mechanism may open up new possibilities for strategies to reduce risk and mortality of HNC in an increasingly obese population.
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Affiliation(s)
- Ke Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral And Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiang-Hua Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral And Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ya-Jie Tang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China; Hubei Key Laboratory of Industrial Microbiology, Hubei Provincial Cooperative Innovation Center of Industrial Fermentation, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China.
| | - Ya-Ling Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Xin-Hua Liang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral And Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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23
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Chen Y, Lee YCA, Li S, Li Q, Chen CJ, Hsu WL, Lou PJ, Zhu C, Pan J, Shen H, Ma H, Cai L, He B, Wang Y, Zhou X, Ji Q, Zhou B, Wu W, Ma J, Kawakita D, Boffetta P, Zhang ZF, Dai M, Hashibe M. Body mass index and the risk of head and neck cancer in the Chinese population. Cancer Epidemiol 2019; 60:208-215. [DOI: 10.1016/j.canep.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 12/24/2022]
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Sung H, Siegel RL, Torre LA, Pearson-Stuttard J, Islami F, Fedewa SA, Goding Sauer A, Shuval K, Gapstur SM, Jacobs EJ, Giovannucci EL, Jemal A. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin 2019; 69:88-112. [PMID: 30548482 DOI: 10.3322/caac.21499] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of excess body weight and the associated cancer burden have been rising over the past several decades globally. Between 1975 and 2016, the prevalence of excess body weight in adults-defined as a body mass index (BMI) ≥ 25 kg/m2 -increased from nearly 21% in men and 24% in women to approximately 40% in both sexes. Notably, the prevalence of obesity (BMI ≥ 30 kg/m2 ) quadrupled in men, from 3% to 12%, and more than doubled in women, from 7% to 16%. This change, combined with population growth, resulted in a more than 6-fold increase in the number of obese adults, from 100 to 671 million. The largest absolute increase in obesity occurred among men and boys in high-income Western countries and among women and girls in Central Asia, the Middle East, and North Africa. The simultaneous rise in excess body weight in almost all countries is thought to be driven largely by changes in the global food system, which promotes energy-dense, nutrient-poor foods, alongside reduced opportunities for physical activity. In 2012, excess body weight accounted for approximately 3.9% of all cancers (544,300 cases) with proportion varying from less than 1% in low-income countries to 7% or 8% in some high-income Western countries and in Middle Eastern and Northern African countries. The attributable burden by sex was higher for women (368,500 cases) than for men (175,800 cases). Given the pandemic proportion of excess body weight in high-income countries and the increasing prevalence in low- and middle-income countries, the global cancer burden attributable to this condition is likely to increase in the future. There is emerging consensus on opportunities for obesity control through the multisectoral coordinated implementation of core policy actions to promote an environment conducive to a healthy diet and active living. The rapid increase in both the prevalence of excess body weight and the associated cancer burden highlights the need for a rejuvenated focus on identifying, implementing, and evaluating interventions to prevent and control excess body weight.
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Affiliation(s)
- Hyuna Sung
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Lindsey A Torre
- Scientist, Surveillance and Health Services Research, American Cancer Society, Scientist, Atlanta, GA
| | | | - Farhad Islami
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kerem Shuval
- Senior Principal Scientist, Physical Activity and Nutrition Research, Economic and Health Policy Research Program, Atlanta, GA
| | - Susan M Gapstur
- Senior Vice President, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Eric J Jacobs
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Edward L Giovannucci
- Professor, Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Lee KR, Seo MH, Do Han K, Jung J, Hwang IC. Waist circumference and risk of 23 site-specific cancers: a population-based cohort study of Korean adults. Br J Cancer 2018; 119:1018-1027. [PMID: 30327562 PMCID: PMC6203821 DOI: 10.1038/s41416-018-0214-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Large waist circumference (WC) is a risk factor for several site-specific cancers, but a large-scale systematic investigation across all common cancers adjusted for potential confounders has not been conducted. This study aimed to evaluate the possible links between WC and common cancers. METHODS We prospectively examined the association between WC and the risk of cancers in a 7-year cohort study of nearly 22.9 million Korean adults. Using the claims database merged with the national health check-up data, we fitted proportional hazard models to investigate associations between WC and 23 of the most common cancers, with adjustment for potential confounders, including body mass index (BMI). We also evaluated the modification of BMI on the relationships between WC and the incidence of cancer. RESULTS A total of 769,871 cancer cases were identified. WC was positively associated with 18 of 23 cancers, and the effects varied substantially by site in each sex. The modification of BMI on the WC-cancer association also varied across the cancer site; in most cases it mitigated the association. For cancers of the oral cavity, larynx, oesophagus, lung, and premenopausal breast, the BMI adjustment reversed the association toward being positive (all Ptrend < 0.001). CONCLUSIONS Central obesity, independent of general obesity, was associated with the risk of several cancers. The heterogeneity in the mediating effects of BMI suggests that different mechanisms are associated with different cancer sites. Based upon these findings, active strategies to monitor and prevent central obesity should be implemented.
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Affiliation(s)
- Kyu Rae Lee
- Department of Family Medicine, Gachon University Dong Incheon Gil Hospital, Incheon, South Korea
| | - Mi Hae Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gumi Sonnchunhyang Hospital, Gumi, South Korea
| | - Kyung Do Han
- Department of Biostatistics, Catholic University College of Medicine, Seoul, South Korea
| | - Jinhyung Jung
- Department of Biostatistics, Catholic University College of Medicine, Seoul, South Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Behrens*1 G, Gredner*1 T, Stock C, F. Leitzmann M, Brenner*2 H, Mons*2 U. Cancers Due to Excess Weight, Low Physical Activity, and Unhealthy Diet. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:578-585. [PMID: 30236216 PMCID: PMC6206246 DOI: 10.3238/arztebl.2018.0578] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Excess weight, low physical activity, low intakes of dietary fiber, fruits, and vegetables, and high meat and salt intake increase cancer risk. METHODS Numbers and proportions (population-attributable fractions, PAF) of incident cancer cases in Germany in 2018 attributable to these factors were estimated by sex and age groups for ages 35 to 84 years using population projections, national cancer incidence and exposure data, and published risk estimates. RESULTS Estimated numbers (percentages) of attributable cancers were 30 567 (7%) for excess weight, 27 081 (6%) for low physical activity, 14 474 (3%) for low dietary fiber intake, 9447 (2%) for low fruit and vegetable consumption, 9454 (2%) and 1687 (0.4%) for processed meat and high red meat consumption, respectively, and 1204 (0.3%) for high salt intake. Excess weight substantially contributed to endometrial, renal, and liver cancer (PAF = 24 to 35%). Low physical activity contributed to endometrial, renal, and lung cancer (PAF = 15 to 19%), and dietary factors mainly contributed to colorectal, breast, and lung cancer (PAF = 9 to 16%). CONCLUSION A considerable proportion of cancer cases are attributable to excess weight, physical inactivity, and unhealthy dietary habits. Major prevention efforts are needed to reduce the cancer incidence attributable to these avoidable factors.
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Affiliation(s)
- Gundula Behrens*1
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Thomas Gredner*1
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg
| | - Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Michael F. Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg
| | - Hermann Brenner*2
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg
| | - Ute Mons*2
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg
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Ward HA, Wark PA, Muller DC, Steffen A, Johansson M, Norat T, Gunter MJ, Overvad K, Dahm CC, Halkjær J, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, Mesrine S, Brennan P, Freisling H, Li K, Kaaks R, Trichopoulou A, Lagiou P, Panico S, Grioni S, Tumino R, Vineis P, Palli D, Peeters PHM, Bueno-de-Mesquita HB, Weiderpass E, Agudo A, Quirós JR, Larrañaga N, Ardanaz E, Huerta JM, Sánchez MJ, Laurell G, Johansson I, Westin U, Wallström P, Bradbury KE, Wareham NJ, Khaw KT, Pearson C, Boeing H, Riboli E. Measured Adiposity in Relation to Head and Neck Cancer Risk in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev 2017; 26:895-904. [PMID: 28183827 PMCID: PMC5540168 DOI: 10.1158/1055-9965.epi-16-0886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/10/2017] [Accepted: 01/15/2017] [Indexed: 12/25/2022] Open
Abstract
Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer. However, most studies have used self-reported anthropometry which is prone to error.Methods: Among 363,094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of head and neck cancer. Head and neck cancer risk was examined in relation to body mass index (BMI) [lean: <22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: ≥30 kg/m2], waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) using Cox proportional hazards models.Results: Among men, a BMI < 22.5 kg/m2 was associated with higher head and neck cancer risk [HR 1.62; 95% confidence interval (CI), 1.23-2.12)]; BMI was not associated with head and neck cancer among women. WC and WHR were associated with greater risk of head and neck cancer among women (WC per 5 cm: HR, 1.08; 95% CI, 1.02-1.15; WHR per 0.1 unit: HR, 1.64; 95% CI, 1.38-1.93). After stratification by smoking status, the association for WHR was present only among smokers (Pinteraction = 0.004). Among men, WC and WHR were associated with head and neck cancer only upon additional adjustment for BMI (WC per 5 cm: HR 1.16; 95% CI, 1.07-1.26; WHR per 0.1 unit: HR, 1.42; 95% CI, 1.21-1.65).Conclusions: Central adiposity, particularly among women, may have a stronger association with head and neck cancer risk than previously estimated.Impact: Strategies to reduce obesity may beneficially impact head and neck cancer incidence. Cancer Epidemiol Biomarkers Prev; 26(6); 895-904. ©2017 AACR.
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Affiliation(s)
- Heather A Ward
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom.
| | - Petra A Wark
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - David C Muller
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Annika Steffen
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Mattias Johansson
- International Agency for Research on Cancer (IARC-WHO), Lyon, Cedex, France
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Teresa Norat
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Marc J Gunter
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- International Agency for Research on Cancer (IARC-WHO), Lyon, Cedex, France
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jytte Halkjær
- Danish Cancer Society Research Centre, Diet, Genes and Environment, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Centre, Diet, Genes and Environment, Copenhagen, Denmark
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, INSERM, CESP, Generations and Health, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Guy Fagherazzi
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, INSERM, CESP, Generations and Health, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Sylvie Mesrine
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, INSERM, CESP, Generations and Health, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC-WHO), Lyon, Cedex, France
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, Cedex, France
| | - Kuanrong Li
- International Agency for Research on Cancer (IARC-WHO), Lyon, Cedex, France
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Pagona Lagiou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Salavatore Panico
- Department of Clinical Medicine and Surgery, Section of Endocrinology, Federico II University, Naples, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS National Cancer Institute, Milano, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic-M.P.Arezzo Hospital, Contrada Rito, ASP Ragusa, Italy
| | - Paolo Vineis
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- HuGeF Foundation, Torino, Italy
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute ISPO, Florence, Italy
| | - Petra H M Peeters
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | - H Bas Bueno-de-Mesquita
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Cancer Registry of Norway-Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Nerea Larrañaga
- Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, Donostia, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - José María Huerta
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - María-José Sánchez
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalucian School of Public Health, Research Institute Biosanitary Granada, Universitario de Cartuja, Granada, Spain
| | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, University Hospital, Uppsala, Sweden
| | | | - Ulla Westin
- Ear Nose and Throat Department, Lund University, Department of Otorhinolaryngology, University Hospital, Malmö, Sweden
| | - Peter Wallström
- Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kathryn E Bradbury
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- University of Cambridge, Clinical Gerontology Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Clare Pearson
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- Cancer Research UK/Public Health England, London, United Kingdom
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Elio Riboli
- School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
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28
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Freisling H, Arnold M, Soerjomataram I, O'Doherty MG, Ordóñez-Mena JM, Bamia C, Kampman E, Leitzmann M, Romieu I, Kee F, Tsilidis K, Tjønneland A, Trichopoulou A, Boffetta P, Benetou V, Bueno-de-Mesquita HB, Huerta JM, Brenner H, Wilsgaard T, Jenab M. Comparison of general obesity and measures of body fat distribution in older adults in relation to cancer risk: meta-analysis of individual participant data of seven prospective cohorts in Europe. Br J Cancer 2017; 116:1486-1497. [PMID: 28441380 PMCID: PMC5520086 DOI: 10.1038/bjc.2017.106] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/03/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We evaluated the associations of anthropometric indicators of general obesity (body mass index, BMI), an established risk factor of various cancer, and body fat distribution (waist circumference, WC; hip circumference, HC; and waist-to-hip ratio, WHR), which may better reflect metabolic complications of obesity, with total obesity-related and site-specific (colorectal and postmenopausal breast) cancer incidence. METHODS This is a meta-analysis of seven prospective cohort studies participating in the CHANCES consortium including 18 668 men and 24 751 women with a mean age of 62 and 63 years, respectively. Harmonised individual participant data from all seven cohorts were analysed separately and alternatively for each anthropometric indicator using multivariable Cox proportional hazards models. RESULTS After a median follow-up period of 12 years, 1656 first-incident obesity-related cancers (defined as postmenopausal female breast, colorectum, lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney) had occurred in men and women. In the meta-analysis of all studies, associations between indicators of adiposity, per s.d. increment, and risk for all obesity-related cancers combined yielded the following summary hazard ratios: 1.11 (95% CI 1.02-1.21) for BMI, 1.13 (95% CI 1.04-1.23) for WC, 1.09 (95% CI 0.98-1.21) for HC, and 1.15 (95% CI 1.00-1.32) for WHR. Increases in risk for colorectal cancer were 16%, 21%, 15%, and 20%, respectively per s.d. of BMI, WC, HC, and WHR. Effect modification by hormone therapy (HT) use was observed for postmenopausal breast cancer (Pinteraction<0.001), where never HT users showed an ∼20% increased risk per s.d. of BMI, WC, and HC compared to ever users. CONCLUSIONS BMI, WC, HC, and WHR show comparable positive associations with obesity-related cancers combined and with colorectal cancer in older adults. For postmenopausal breast cancer we report evidence for effect modification by HT use.
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Affiliation(s)
- Heinz Freisling
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Mark George O'Doherty
- UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, University Road, Belfast BT7 1NN, UK
| | - José Manuel Ordóñez-Mena
- Network Aging Research (NAR), Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford OX2 6GG, UK
| | - Christina Bamia
- Hellenic Health Foundation, 13 Kaisareias & Alexandroupoleos, Athens 115 27, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens 115 27, Greece
| | - Ellen Kampman
- Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Isabelle Romieu
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, University Road, Belfast BT7 1NN, UK
| | - Konstantinos Tsilidis
- Hellenic Health Foundation, 13 Kaisareias & Alexandroupoleos, Athens 115 27, Greece
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, DK 2100 Copenhagen Ø Denmark
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias & Alexandroupoleos, Athens 115 27, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens 115 27, Greece
| | - Paolo Boffetta
- Hellenic Health Foundation, 13 Kaisareias & Alexandroupoleos, Athens 115 27, Greece
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, USA
| | - Vassiliki Benetou
- Hellenic Health Foundation, 13 Kaisareias & Alexandroupoleos, Athens 115 27, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens 115 27, Greece
| | - H B(as) Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid 28029, Spain
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
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Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016; 353:i2156. [PMID: 27146380 PMCID: PMC4856854 DOI: 10.1136/bmj.i2156] [Citation(s) in RCA: 491] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. DATA SOURCES PubMed and Embase databases searched up to 23 September 2015. STUDY SELECTION Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. DATA SYNTHESIS Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. RESULTS 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I(2)=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I(2)=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I(2)=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I(2)=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years' follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. CONCLUSION Overweight and obesity is associated with increased risk of all cause mortality and the nadir of the curve was observed at BMI 23-24 among never smokers, 22-23 among healthy never smokers, and 20-22 with longer durations of follow-up. The increased risk of mortality observed in underweight people could at least partly be caused by residual confounding from prediagnostic disease. Lack of exclusion of ever smokers, people with prevalent and preclinical disease, and early follow-up could bias the results towards a more U shaped association.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Abhijit Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College, London, UK
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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