Body Mass Index and Long-Term Outcomes in Patients With Colorectal Cancer

Abstract

Background: The association between body mass index (BMI) and colorectal cancer is unique. There are several patient- and tumor-related factors that affect this and associations are not entirely clear. The primary aim of this study is to examine the association between BMI and survival after colorectal cancer diagnosis.Methods: Among 26,908 Mayo Clinic patients diagnosed with colorectal cancer between 1972 and 2017, 3,799 patients had information on BMI within 6 months prior to cancer diagnosis. Multivariable Cox regression models were used to assess the differences in overall survival between BMI groups in each cancer stage, controlling for age, gender, year of diagnosis, and cancer location. The impact of change of BMI at 30, 60, and 90 days on survival afterwards were also analyzed.Results: Among 3,799 patients included in the study, there were 29% normal weight, 2% underweight, 36% overweight, and 33% obese patients. With all stages combined together, the overall 5-years survival rates for underweight, normal weight, overweight, and obese patients were 33, 56, 60, and 65%, respectively (p < 0.001). The results show that, the difference in overall survival was not statistically significant when underweight, overweight, and obese patients were compared to normal weight patients in stage 1 and stage 2, although there was a trend that overweight patients had better survival than normal weight group in stage 2 cancer patients (HR = 0.8, p = 0.086). In stage 3 and 4 patients combined, underweight group demonstrated a significant disadvantage (HR = 1.96, p = 0.007) for overall survival compared to the normal weight group. Additionally, post-diagnosis BMI drop more than 10% from either a previous time (HR = 1.88, p = 0.002) or pre-diagnosis time (HR = 1.61, p < 0.001) was associated with worse overall survival after adjusting for baseline variables.Conclusions: BMI is an important consideration in patients with colorectal cancer. Outcomes are stage-dependent where in some situations obesity maybe an advantage. More importantly, being underweight is a significant negative predictor of outcome. The impact of drop in BMI or weight, on survival of CRC patients, needs to be studied further since this is potentially an actionable variable and a dynamic biomarker that may help improve outcome in these patients.

Dietary Patterns and Empirical Dietary Inflammatory Index in Southern Brazil and Risk of Colorectal Cancer: A Case-Control Study

“…In response to endocrine and metabolic signals, adipose tissue releases innumerable hormones such as leptin, adiponectin and resistin, in addition to cytokines such as TNFα, which promote a state of chronic inflammation and insulin resistance, a condition associated with increased IGF-1 synthesis, the carcinogenic potential for increased cell proliferation [33] [34]. The high prevalence of overweight individuals was associated with an increased risk for CRC, corroborating the findings of an investigation conducted in Arizona-USA [35] and Australia [36], in which patients with CRC were evaluated and overweight was diagnosed in more than 68% of the individuals, with a higher prevalence among males.…”

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study

“…This may explain the observed mortality advantage among the overweight surgical population. Another study done on 26,908 Mayo Clinic colorectal cancer patients demonstrated a significant disadvantage in overall survival amongst underweight patients as compared to both the normal and overweight patient groups [22]. We believe that it is underweight patients at risk of malnutrition who have a significant survival disadvantage rather than a high BMI actually being protective.…”

Prognostic Significance of Incidental Deep Vein Thrombosis in Patients with Cancer Presenting with Incidental Pulmonary Embolism

“…The associations between weight, body mass index (BMI), and survival outcomes have previously been shown in other studies [33][34][35][36]. A meta-analysis that examined almost 100 studies involving >2.88 million patients confirmed that being overweight (BMI 25-30 kg/m 2 ) was associated with a lower risk of all-cause mortality [33].…”