Cancer risk in relation to body fat distribution, evaluated by DXA-scans, in postmenopausal women – the Prospective Epidemiological Risk Factor (PERF) study

Abstract

Studies with direct measures of body fat distribution are required to explore the association between central and general obesity to cancer risk in postmenopausal women. This study investigates the association between central obesity and general obesity to overall/site-specific cancer risk in postmenopausal women. The analysis included 4,679 Danish postmenopausal women. Body fat distribution was evaluated by whole-body dual-energy X-ray absorptiometry scanners. Cancer diagnoses were extracted from the Danish Cancer Registry and multivariable Cox regression models explored the association between cancer risk and central obesity after adjusting for BMI. Our results showed that high central obese women had a 50% increased risk of overall cancer relative to low central obese women (Q1vs.Q4: [HR:1.50, CI:1.20–1.88]). For site-specific cancers, central obesity was significantly associated with Respiratory (Q1vs.Q4: [HR:2.01, CI:1.17–3.47]), Gastrointestinal (Q1vs.Q4: [HR:1.55, CI:0.99–2.41]) and Female genital organs (Q1vs.Q4: [HR:1.95, CI:1.00–3.78]) cancer diagnoses. Sub-analyses stratified by smoking-habits found a significant association between central obesity and a cancer diagnosis for current (Q1vs.Q4: [HR:1.93, CI:1.25–2.99]) and former smokers (Q1vs.Q4: [HR:1.90, CI:1.23–2.94]). These analyses suggest that central obesity is associated with some cancers in postmenopausal women independent of BMI.

Visceral obesity and incident cancer and cardiovascular disease: An integrative review of the epidemiological evidence

“…Similarly to the findings with breast cancer, visceral obesity was associated with increased risk of endometrial cancer in postmenopausal women independently of their BMI. 23,34,35,38 Pancreatic cancer was also positively associated with visceral obesity, measured by WC and WHR, in a systematic review. 13,39 Similar association was observed for WHR but not for WC in the Women's Health Initiative study.…”

“…A few prospective studies have investigated the association between multicancer sites and visceral adiposity. Two cohorts, one in Europe and another in the United States, 6,23 analysed the association T A B L E 1 Epidemiological evidence on the association between visceral obesity and incidence of specific types of cancer in adults and/or older adults Several studies analysed the association between colorectal cancer and visceral obesity using body composition, 25,26 anthropometric measures such as WC and WHR 27,28 or both 29,30 methods (Table 1).…”

Obesity and the Risk of Malignancy: An Evolving Saga

“…This is particularly relevant to hormone sensitive cancers, including those of the breast, endometrium and prostate. 3,16 Figure 1 Hyperinsulinemia and cancer risk IGFBP-1 = insulin like growth factor binding protein 1; IGF-1 = insulin like growth factor 1; SHBG = sex hormone binding globulin In other cases, the risk is increased secondary to the diseases that can result from obesity, such as type 2 diabetes mellitus (T2DM), which has been shown to increase the likelihood of certain cancers. 3,7 Aside from its role in energy metabolism, insulin has mitogenic properties meaning it can induce cell division.…”

“…The same study which recruited a large number of postmenopausal women noted a signifi cant association between breast cancer and BMI, but fail to show a signifi cant relationship with central obesity. 16 Furthermore, it was noted that obesity may be linked to some cancers independent of BMI. Gold standard measures such as dual energy X-ray absorptiometry (DXA) scanning should be used to determine the distribution of lean and fat masses throughout the body and would be more appropriate if available.…”

“…Gold standard measures such as dual energy X-ray absorptiometry (DXA) scanning should be used to determine the distribution of lean and fat masses throughout the body and would be more appropriate if available. 16 Similarly, another study that looked at the size of individuals throughout life and endometrial cancer risk, identifi ed a weakness in using BMI as a single marker for obesity. It recognised the importance of looking at other measurements, including waist circumference and WHR, in conjunction with BMI to identify links between obesity and lifetime cancer risk, which are also cheaper and more readily available than DXA scanning.…”