Cancer Diagnoses After Recent Weight Loss

Wang, Qiao-Li; Babic, Ana; Rosenthal, Michael H.; Lee, Alice A.; Zhang, Yin; Zhang, Xuehong; Song, Mingyang; Rezende, Leandro F. M.; Lee, Dong Hoon; Biller, Leah; Ng, Kimmie; Giannakis, Marios; Chan, Andrew T.; Meyerhardt, Jeffrey A.; Fuchs, Charles S.; Eliassen, A. Heather; Birmann, Brenda M.; Stampfer, Meir J.; Giovannucci, Edward L.; Kraft, Peter; Nowak, Jonathan A.; Yuan, Chen; Wolpin, Brian M.

doi:10.1001/jama.2023.25869

Cited by 12 publications

(1 citation statement)

References 29 publications

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“…Another limitation is that the direction of BW increase or decrease was not assessed in this study. Since weight loss may be associated with cancer [ 29 ], future studies should be done with more details, such as excluding cancer comorbidities. The next limitation is that dementia was defined based on the ICD-10 code, which, owing to the nature of the claims data, might induced some overestimation.…”

Section: Discussionmentioning

confidence: 99%

Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study

Park,

Kim,

Ryu

et al. 2024

Alz Res Therapy

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Background Given the rising awareness of health-related lifestyle modifications, the impact of changes in body weight (BW) on cognitive function and dementia generates significant concern. This study aimed to investigate the association between BW changes and dementia in a middle-aged Korean population. Methods A retrospective, population-based longitudinal study was conducted utilizing data from the National Health Insurance Service (NHIS) database. Participants aged 40 years or older in 2011 who underwent at least five health checkups between 2002 and 2011 were followed-up for dementia until 2020. A total of 3,635,988 dementia-free Korean aged < 65 at baseline were examined. We analyzed the association between BW variability independent of the mean (VIM) with BW cycle, defined as either an upward or a downward direction of BW, and the risk of incident dementia. Results The results showed an increased risk of dementia in the highest quartile of VIM quartile (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.47–1.58) compared to the lowest quartile of VIM. Additionally, the results showed an even higher increased risk of dementia in the highest BW cycle (≥ 2 cycles of 10% BW = HR 2.00, 95% CI 1.74–1.29). Notably, the combined concept of VIM with BW cycle showed an even higher dementia risk (highest quartile of VIM with ≥ 2 cycles of 10% BW = HR 2.37, 95% CI 2.05–2.74) compared to the baseline group (lowest quartile of VIM with < 3% BW cycle). Conclusions The present study highlights the importance of considering BW changes with BW variability along with the BW cycle to assess dementia risk in detail, providing valuable insights for preventive strategies.

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Section: Discussionmentioning

confidence: 99%

Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study

Park,

Kim,

Ryu

et al. 2024

Alz Res Therapy

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Diagnosis of Cancer After Recent Weight Loss

Hung,

Lu,

Hsieh

2024

JAMA

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To the Editor A recent study 1 provided valuable insights into the complex relationship between weight loss and cancer risk. In addition to the limitations mentioned by the authors, we have some concerns about the study methods and the interpretation of the results.First, the number of visits to the clinic may affect the rate of cancer diagnosis. Because most types of cancer are diagnosed after evaluation of symptoms during a health care visit, assessing how the frequency of these visits influences the early detection of cancer cases could provide a valuable perspective. An increased number of health care visits might enhance opportunities for clinicians to identify and investigate unexplained weight loss promptly. We suggest that the authors could have assessed the number of medical visits in different groups to increase the credibility of the study.Second, some important weight loss variations have not been assessed. For example, medical conditions such as thyroid disorders 2 or rheumatic diseases. 3 These prevalent conditions 4,5 may contribute to unintentional weight loss and could serve as confounding factors when interpreting weight loss patterns. A more nuanced exploration of these variables could contribute to a more comprehensive understanding of the observed weight loss and its potential associations with underlying health issues.Third, potential associations of covariates might affect the comparability of studies. Although the authors assessed comorbidity and covariates, we recommend application of propensity score matching to adjust for potentially confounding variables. Propensity score matching could improve comparability between groups, thereby enhancing the validity of the results.

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Diagnosis of Cancer After Recent Weight Loss—Reply

Wang,

Yuan,

Wolpin

2024

JAMA

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COMMENT & RESPONSEIn Reply We thank Mr Hung and colleagues for their interest in our recent article. 1 In response to their first comment, it is important to note that body weights in this study were selfreported by participants approximately every 2 years and were not measured at clinic visits. Therefore, the frequency of clinic visits did not dictate the availability of weight data or the ability to assess recent weight change prior to a cancer diagnosis. However, we agree that outside this study, 1 frequency of clinic visits could affect how promptly clinicians are informed of recent weight changes and when cancer-directed evaluations are initiated.We agree with Hung and colleagues that other medical conditions aside from cancer can cause weight loss. If these conditions were identified as the cause of recent weight loss, then such patients might not require cancer-directed evaluations. In our study, 1 we made a concerted effort to consider common conditions other than cancer that can cause weight loss. However, we did not have available data for all medical conditions that might lead to weight loss, such that additional studies of weight loss in relation to thyroid disorders and rheumatic diseases will be needed.Our study 1 used a prospective cohort design, whereby individuals were enrolled during a specified time interval, followed up prospectively over several decades, and longitudinally queried for exposure information at defined time intervals. This design allowed for direct calculation of the main outcome measure of the study, 12-month absolute cancer risk by categories of recent weight change. We included time-varying exposures and covariates in the analyses to calculate both age-adjusted and multivariable-adjusted relative risks, noting little change in the relative risks after multivariable adjustment. Given the prospective cohort design, large sample size, and well-balanced covariate distribution between groups, propensity score matching was unlikely to substantially change the relative risk calculations; the limitations of this approach have been recognized. 2,3

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Cancer Diagnoses After Recent Weight Loss

Cited by 12 publications

References 29 publications

Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study

Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study

Diagnosis of Cancer After Recent Weight Loss

Diagnosis of Cancer After Recent Weight Loss—Reply

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