We evaluated prospectively the association between body mass index (BMI), height, recreational physical activity and the risk of bladder cancer among US adults. Data were used from 2 ongoing cohorts, the Health Professionals Follow-up Study and the Nurses' Health Study, with 3,542,012 years of follow-up and 866 incident bladder cancer cases (men 5 507; women 5 359) for the anthropometric analysis and 1,890,476 years of follow-up and 706 incident bladder cancer cases (men 5 502; women 5 204) for the physical activity analysis. Cox proportional hazard models were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI) between BMI, height, physical activity and bladder cancer risk adjusting for age, pack-years of cigarette smoking and current smoking. Estimates from each cohort were pooled using a random-effects model. We observed no association between baseline BMI and bladder cancer risk, even when we compared a BMI of 30 kg/m 2 to a BMI of 18-22.9 Key words: body mass index; physical activity; bladder cancer; prospective studies; epidemiology An estimated 65% of adults in the US are currently overweight [a body mass index (BMI) between 25.0 and 29.9 kg/m 2 ] or obese (BMI of 30.0 kg/m 2 or greater). 1 Overweight and obesity are associated with heart disease, stroke, diabetes, altered mental status, respiratory problems and various digestive and musculoskeletal disorders. 2 There is growing evidence that obesity is associated with overall cancer and several site-specific cancer sites including breast (in postmenopausal women), colon, esophagus, kidney and endometrium 2 ; however, the relation between obesity and the risk of bladder cancer remains speculative.Data from studies examining weight or BMI, 3-13 height, 14,15 physical activity 8,9,16 and the subsequent risk of bladder cancer are inconsistent. The lack of consistency may be attributable to uncontrolled or residual confounding by cigarette smoking, 3,[6][7][8]14 potential recall or selection bias in case-control studies, 4,10,12,14 measurement error in the physical activity assessment 7,9 or small numbers of bladder cancer cases. 3,6,8,9,11,16 Furthermore, some studies that have investigated the association of these factors with bladder cancer risk have focused on men only 7,12,16 or have included few women. 3,8,11,13,14 Given the limitations of previous studies evaluating the role of anthropometric characteristics, physical activity and the risk of bladder cancer, including limited data on women, we conducted a prospective investigation in 2 large cohort studies of men and women.
Material and methods
Study populationsThe Nurses' Health Study (NHS) was initiated in 1976 when 121,700 registered US female nurses, aged 30-55 years, returned a mailed questionnaire that assessed information on lifestyle factors, medical and smoking histories. Similarly, the Health Professionals Follow-Up Study (HPFS) is a cohort of 51,529 US male dentists, optometrists, osteopaths, podiatrists, pharmacists and veterinarians who were 40-75 years of age a...