Obesity and cancer risk: a danish record-linkage study

Møller, Henrik; Mellemgaard, Anders; Lindvig, K; Olsen, Jørgen H.

doi:10.1016/0959-8049(94)90254-2

Cited by 406 publications

(326 citation statements)

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“…We identified 11 eligible cohort studies (Møller et al, 1994;Wolk et al, 2001;Nair et al, 2002;Calle et al, 2003;Samanic et al, 2004Samanic et al, , 2006Batty et al, 2005;Kuriyama et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006), of which 7 on overweight (with a total of 5037 cases) (Calle et al, 2003;Batty et al, 2005;Kuriyama et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006;Samanic et al, 2006) and 10 on obesity (with a total of 6042 cases) (Møller et al, 1994;Wolk et al, 2001;Nair et al, 2002;Calle et al, 2003;Samanic et al, 2004Samanic et al, , 2006Batty et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006) were suitable for metaanalysis. Characteristics of the studies are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The outcome was incidence of liver cancer in all but two studies (Calle et al, 2003;Batty et al, 2005) in which the outcome was mortality from liver cancer. Two studies were based on standardized incidence ratio (Møller et al, 1994;Wolk et al, 2001). Two studies consisted of patients with cirrhosis (Nair et al, 2002;N'Kontchou et al, 2006).…”

Section: Resultsmentioning

confidence: 99%

“…With stratification by assessment of obesity, the summary relative risks for the association between obesity and liver cancer were 2.15 (95% CI: 1.66 -2.77) for studies based on measured or self-reported weight and height (Nair et al, 2002;Calle et al, 2003;Batty et al, 2005;Oh et al, 2005;Rapp et al, 2005;N'Kontchou et al, 2006;Samanic et al, 2006) and 1.61 (95% CI: 1.14 -2.27) for studies based on a discharge diagnosis of obesity (Møller et al, 1994;Wolk et al, 2001;Samanic et al, 2004).…”

Section: Resultsmentioning

confidence: 99%

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Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

2007

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Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis by searching MEDLINE and EMBASE databases from 1966 to June 2007 and the reference lists of retrieved articles. Results from individual studies were combined using a random-effects model. We identified 11 cohort studies, of which seven on overweight (with a total of 5037 cases) and 10 on obesity (with 6042 cases) were suitable for meta-analysis. Compared with persons of normal weight, the summary relative risks of liver cancer were 1.17 (95% confidence interval (CI): 1.02 -1.34) for those who were overweight and 1.89 (95% CI: 1.51 -2.36) for those who were obese. This meta-analysis finds that excess body weight is associated with an increased risk of liver cancer. Although relatively rare in the United States and other developed countries, liver cancer is the third most common cause of death from cancer worldwide (Parkin et al, 2005). It is rarely detected early and is often fatal within a few months of diagnosis. The 5-year survival rate is only about 6 -11% (Coleman et al, 2003;Ries et al, 2006). The age-adjusted incidence and mortality rates of liver cancer have been increasing rapidly in the United States since the mid-1980s (Ries et al, 2006). While approximately half of this increase can be attributable to hepatitis C virus infection, a minimal or no increase has been related to hepatitis B virus and alcoholic liver disease (El-Serag and Mason, 2000;Hassan et al, 2002). Given that about half of the increase in liver cancer incidence is not related to hepatitis, the major risk factor in a significant proportion of the cases has yet to be identified.Coinciding with the rising incidence of liver cancer, the prevalence of obesity has been increasing markedly over the past two decades worldwide (Larsson and Wolk, 2006). Obesity has been recognised as a risk factor for several malignancies, including cancer of the breast (in premenopausal women), endometrium, kidney (renal cell), colon, pancreas, gallbladder, and esophagus (adenocarcinoma) (IARC, 2002;. Accumulating epidemiologic evidence also indicates that excess body weight may be a risk factor for liver cancer, but the evidence has not been quantitatively summarised. We have therefore quantitatively assessed the associations of overweight and obesity with liver cancer risk in a meta-analysis of cohort studies. MATERIALS AND METHODS Study selectionA literature search was conducted in the MEDLINE and EMBASE databases for pertinent studies published in any language from 1966 to June 2007. We used the keywords 'body mass index', 'BMI', or 'obesity' in combination with 'hepatocellular carcinoma', 'liver cancer', or 'liver neoplasm'. Moreover, we manually reviewed the reference lists of retrieved articles to search for more studies.Studies were included in the meta-analysis if they fulfilled the following criteria: (1) cohort study in which liver cancer incidence or mortality was an outcome; (2) the exposure of interest was overweight and/or obesity defined by body ma...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

2007

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“…38 We also found a positive non-significant gradient for rectal cancer, an association that has previously been suggested to be null. 39,40 Three other studies 26,41,42 have reported an excess occurrence of malignant neoplasm of the liver in overweight persons. While we made the same observation in the present study, these findings should be viewed with caution owing to the very low number of cases; a caveat that should also be applied to some of our other results.…”

Section: Discussionmentioning

confidence: 95%

Obesity and overweight in relation to organ-specific cancer mortality in London (UK): findings from the original Whitehall study

Batty

Shipley

Jarrett³

et al. 2005

Int J Obes

125

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OBJECTIVE:To examine the relation of obesity and overweight with organ-specific cancer mortality. METHODS: In the Whitehall prospective cohort study of London-based government employees, 18 403 middle-age men participated in a medical examination between 1967 and 1970. Subjects were followed up for cause-specific mortality for up to 35 y (median: interquartile range (25th-75th centile); 28.1 y: 18.6-33.8). RESULTS: There were over 3000 cancer deaths in this cohort. There was a raised risk of mortality from carcinoma of the rectum, bladder, colon, and liver, and for lymphoma in obese or overweight men following adjustment for range of covariates, which included socioeconomic position and physical activity. These relationships held after exclusion of deaths occurring in the first 20 y of follow-up. CONCLUSION: Avoidance of obesity and overweight in adult life may reduce the risk of developing some cancers.

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“…2), where study-specific risk estimates and their CIs are plotted, also indicates a heterogeneous set of studies. In particular, heterogeneity could be attributed to six cohort [2][3][4][5][6][7] and five case-control [8][9][10][11][12] studies. It would have been informative to identify which aspects of the individual studies contributed to heterogeneity.…”

Section: Heterogeneitymentioning

confidence: 99%

Comments on a recent meta‐analysis: Obesity and lung cancer

El‐Zein

Parent

Rousseau

2012

Intl Journal of Cancer

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Dear Editor,The role of body mass index (BMI) in relation to lung cancer risk has been the object of considerable interest over the years. For the most part, epidemiologists' primary concern has been to determine whether BMI has an effect on lung cancer that is independent of smoking, a key confounder. We, therefore, read with great interest the quantitative appraisal of the epidemiological evidence on obesity and incidence of lung cancer by Yang et al. 1 Their metaanalysis revealed a significant inverse relationship between BMI, used as a proxy measure of overweight and obesity, and lung cancer based on results from 20 cohort and 11 case-control studies. We would like to comment on some inter-related methodological and interpretational aspects of the analyses presented, namely, heterogeneity across studies, methodological quality of original studies and confounding by smoking. HeterogeneityAn overall estimate of association of 0.79 [95% confidence interval (CI): 0.73-0.85] was reported for excess weight (BMI 25 kg/m 2 ) compared with normal weight (BMI ¼ 18.5-24.9 kg/m 2 ) based on 31 studies. However, the inconsistency coefficient I 2 statistic, an estimate of the proportion of total variation in study estimates due to heterogeneity, was 82.9%. In the presence of such heterogeneity, a pooled estimate, even from a random-effects model, may not be justifiable as it does not provide a fair representation of overall results. Visual inspection of the Forest plot (Fig. 2), where study-specific risk estimates and their CIs are plotted, also indicates a heterogeneous set of studies. In particular, heterogeneity could be attributed to six cohort 2-7 and five case-control 8-12 studies. It would have been informative to identify which aspects of the individual studies contributed to heterogeneity. This could have entailed (1) identifying distinctive characteristics of individual studies; (2) pinpointing sources of variability between studies and thereby (3) providing guidance for presenting a valid quantitative pooled estimate of association between obesity and lung cancer.There was still a strong indication of heterogeneity in most stratified analyses across several important features defined by methodological characteristics. Results varied substantially within studies defined by study design, gender, study population, body size assessment method and smoking status. Of note, in analyses restricted to histological subtypes, heterogeneity might have tapered off as a result of the small number of studies included. Methodological Quality of Original StudiesThe synthesis of results from individual studies did not include a formal evaluation of study quality. Analyses stratified according to a score for methodological quality could have provided a way to explore the sources of heterogeneity between studies. If results of this meta-analysis were to be significantly affected by the quality of original studies, then its conclusion may be less meaningful. Moreover, although the lack of symmetry in the funnel plot (Fig. 3) could ...

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Obesity and cancer risk: a danish record-linkage study

Cited by 406 publications

References 50 publications

Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

Obesity and overweight in relation to organ-specific cancer mortality in London (UK): findings from the original Whitehall study

Comments on a recent meta‐analysis: Obesity and lung cancer

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