Obesity and renal cell cancer – a quantitative review

Abstract

Although many epidemiological studies have shown that obesity increases the risk of renal cell cancer among women, the evidence for men is considered weaker (Wolk et al, 1996;McLaughlin and Lipworth, 2000).The incidence of renal cell cancer, the predominant type of kidney cancer, has been increasing both in the US and in most Western countries (Black et al, 1997;Liu et al, 1997). Today, renal cell cancer accounts for about 2% of cancers in the US (Landis et al, 1999), as well as worldwide (Parkin, 1998), with 30 000 cases occurring in the US in 1999 (Landis et al, 1999). The incidence varies more than 10-fold over the world. The highest rates are found in North America and Europe and the lowest in Asia (Parkin, 1998). Renal cell cancer occurs about twice as often among men, as among women.Obesity has also been increasing throughout the world. More than half of the adult US population is considered to have an excess weight (body mass index, BMI ≥ 25.0 kg m -2 ) and nearly one quarter are clinically obese (BMI ≥ 30.0 kg m -2 ) (Flegal et al, 1998). The increasing prevalence of obesity might therefore, at least partly, explain the increasing incidence of renal cell cancer.The purpose of this review was to evaluate the existing evidence that obesity increases the risk of renal cell cancer among both men and women. We conducted a quantitative summary analysis to estimate the magnitude of the association taking into account sex and different study characteristics, such as study design and size. We also investigated the possible effect modification between obesity and these factors. MATERIALS AND METHODS Literature reviewWe identified studies investigating the relation between obesity and kidney cancer, available in MEDLINE 1966 through 1998. We used the MeSH-terms 'kidney neoplasms' plus 'obesity', 'body weight' or 'body mass index' and selected original epidemiological studies. Additional studies were identified from systematical examinations of the list of references in the identified articles and previous reviews (Wolk et al, 1996;McLaughlin and Lipworth, 2000). Inclusion criteriaIn adults, cancer of the kidney is classified as either cancer of the parenchyma (renal cell) or the renal pelvis. In many descriptive and some analytic studies tumours of the renal parenchyma and the renal pelvis are combined and the term kidney cancer is used. Since renal cell cancer is the predominant type, responsible for more than 80% of all adult kidney neoplasms (Devesa et al, 1990), studies unable to disentangle the 2 entities were included in our review.In total, we identified 30 studies on obesity and renal cell cancer risk published between 1966 and 1998 for our review. Each studybase was eligible only once. When multiple reports were available for the same study-base we chose the one analysing incident renal cell cancer as outcome, and/or defining obesity in terms of body mass index (BMI, kg m -2 ) and in more detail and/or with the greater number of cases. We excluded 6 studies (Whittemore et al, 1985;Lindblad et al, 1994;Mel...

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