Importance:
Colorectal cancer incidence and mortality among individuals under age 50 (young-onset CRC) are rising. The reasons for such increase are largely unknown, although the surging prevalence of obesity may be partially responsible.
Objective:
To investigate prospectively the association between obesity and weight gain since early adulthood with risk of young-onset CRC.
Design:
Prospective cohort.
Setting:
U.S.-based Nurses’ Health Study II.
Participants:
85,256 women aged 25 to 44 years free of cancer and inflammatory bowel disease at enrollment were followed from 1989 to 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially.
Exposures:
Current body mass index (BMI), BMI at age 18, and weight gain since age 18.
Main Outcomes and Measures:
Relative risk (RR) for incident young-onset CRC.
Results:
We documented 114 cases of young-onset CRC during 1,196,452 person-years of follow-up. Compared to women with BMI 18.5–22.9 kg/m2, the multivariable RR was 1.37 [95% confidence interval (CI): 0.81–2.30] for overweight women (BMI 25–29.9 kg/m2) and 1.93 (95% CI: 1.15–3.25) for obese women (BMI ≥ 30 kg/m2). The RR for each 5 kg/m2 increment in BMI was 1.20 (95% CI: 1.05–1.38, P-trend=0.01). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at age 18 and weight gain since age 18 contributed to this observation. Compared to women with BMI 18.5–20.9 kg/m2 at age 18, the RR of young-onset CRC was 1.63 (95% CI: 1.01–2.61) for women with BMI ≥ 23 kg/m2 at age 18 (P-trend=0.66). Similarly, compared to women who had gained < 5 kg or had lost weight, the RR of young-onset CRC was 2.15 (95% CI: 1.01–4.55) for women with ≥ 40 kg weight gain since age 18 (P-trend=0.007).
Conclusion and Relevance:
Obesity was associated with an increased risk of young-onset CRC among women. Further investigations among men and to elucidate underlying biological mechanisms are warranted.