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Original Investigation
October 11, 2018

Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women

Author Affiliations
  • 1Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
  • 2Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
  • 4Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
  • 5Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston
  • 6Yale Cancer Center, New Haven, Connecticut
  • 7Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 8Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 9Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
  • 10Broad Institute of MIT and Harvard, Cambridge, Massachusetts
  • 11Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 12Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 13Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
  • 14Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
JAMA Oncol. 2019;5(1):37-44. doi:10.1001/jamaoncol.2018.4280
Key Points

Question  Is obesity associated with early-onset colorectal cancer, which may have etiologic differences from late-onset colorectal cancer?

Findings  In a prospective cohort study of 85 256 women, those with obesity (body mass index ≥30) had a nearly doubled risk of early-onset colorectal cancer compared with women with a body mass index of 18.5 to 22.9.

Meaning  The findings suggest that obesity is associated with an increased risk of early-onset colorectal cancer; further investigations are needed to identify whether this association is causal.

Abstract

Importance  Colorectal cancer (CRC) incidence and mortality among individuals younger than 50 years (early-onset CRC) are increasing. The reasons for such increases are largely unknown, although the increasing prevalence of obesity may be partially responsible.

Objective  To investigate prospectively the association between obesity and weight gain since early adulthood with the risk of early-onset CRC.

Design, Setting, and Participants  The Nurses’ Health Study II is a prospective, ongoing cohort study of US female nurses aged 25 to 42 years at study enrollment (1989). A total of 85 256 women free of cancer and inflammatory bowel disease at enrollment were included in this analysis, with follow-up through December 31, 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially. Statistical analysis was performed from June 12, 2017, to June 28, 2018.

Exposures  Current body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), BMI at 18 years of age, and weight gain since 18 years of age.

Main Outcomes and Measures  Relative risk (RR) for incident early-onset CRC.

Results  Among the 85 256 women studied, 114 cases of early-onset CRC were documented (median age at diagnosis, 45 years; interquartile range, 41-47 years) during 1 196 452 person-years of follow-up. Compared with women with a BMI of 18.5 to 22.9, the multivariable RR was 1.37 (95% CI, 0.81-2.30) for overweight women (BMI, 25.0-29.9) and 1.93 (95% CI, 1.15-3.25) for obese women (BMI, ≥30.0). The RR for each 5-unit increment in BMI was 1.20 (95% CI, 1.05-1.38; P = .01 for trend). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at 18 years of age and weight gain since 18 years of age contributed to this observation. Compared with women with a BMI of 18.5 to 20.9 at 18 years of age, the RR of early-onset CRC was 1.32 (95% CI, 0.80-2.16) for women with a BMI of 21.0 to 22.9 and 1.63 (95% CI, 1.01-2.61) for women with a BMI of 23.0 or greater at 18 years of age (P = .66 for trend). Compared with women who had gained less than 5.0 kg or had lost weight, the RR of early-onset CRC was 1.65 (95% CI, 0.96-2.81) for women gaining 20.0 to 39.9 kg and 2.15 (95% CI, 1.01-4.55) for women gaining 40.0 kg or more (P = .007 for trend).

Conclusions and Relevance  Obesity was associated with an increased risk of early-onset CRC among women. Further investigations among men and to elucidate the underlying biological mechanisms are warranted.

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