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Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis

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Abstract

Purpose

Aim of this study was to investigate the association between postdiagnosis body mass index (BMI) and all-cause mortality in colorectal cancer (CRC) survivors in a prospective study and meta-analysis.

Methods

We conducted a prospective cohort study on 2,143 CRC survivors in Germany. Participants were recruited to the study on average 4 years after diagnosis, and postdiagnosis BMI was assessed at recruitment using a self-administered questionnaire. CRC survivors were followed up for a mean time of 3.5 years. The association between BMI and all-cause mortality was investigated using multivariable Cox proportional hazards models. Additionally, we performed a meta-analysis of studies on postdiagnosis BMI and all-cause mortality (n = 5, including this study) by applying random-effects models.

Results

In the prospective analysis, 349 participants died. BMI was not statistically significantly associated with all-cause mortality. Compared to normal weight survivors, the hazard ratios (HRs) [95 % confidence interval (CI)] for all-cause mortality in underweight, overweight and obese survivors were 1.65 (0.79–3.45), 0.80 (0.62–1.03) and 0.84 (0.62–1.14), respectively. In the meta-analysis, individuals with underweight were at increased risk for all-cause mortality [HR (95 % CI) 1.72 (1.18–2.49)], whereas individuals with overweight had a lower risk [HR (95 % CI) 0.79 (0.71–0.88)], compared to normal weight subjects. For obesity, the risk of mortality was also reduced with only borderline significance [HR (95 % CI) 0.88 (0.77–1.00)].

Conclusions

While the present study as well as single previously published studies showed that overweight was associated with a non-significant reduced risk for all-cause mortality, our meta-analysis indicated a decreased mortality risk among overweight CRC survivors.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. de Moor JS, Mariotto AB, Parry C et al (2013) Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev 22:561–570

    Article  Google Scholar 

  3. Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H (2007) Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer 121:395–400

    Article  CAS  PubMed  Google Scholar 

  4. World Cancer Research Fund/American Institute for Cancer Research (2011) Continuous update project report. Food, nutrition, physical activity, and the prevention of colorectal cancer. AICR, Washington, DC

  5. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DC

    Google Scholar 

  6. Demark-Wahnefried W, Platz EA, Ligibel JA et al (2012) The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomark Prev 21:1244–1259

    Article  Google Scholar 

  7. Vrieling A, Kampman E (2010) The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 92:471–490

    Article  CAS  PubMed  Google Scholar 

  8. Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 26:4109–4115

    Article  PubMed Central  PubMed  Google Scholar 

  9. Baade PD, Meng X, Youl PH, Aitken JF, Dunn J, Chambers SK (2011) The impact of body mass index and physical activity on mortality among patients with colorectal cancer in Queensland, Australia. Cancer Epidemiol Biomark Prev 20:1410–1420

    Article  Google Scholar 

  10. Campbell PT, Newton CC, Dehal AN, Jacobs EJ, Patel AV, Gapstur SM (2012) Impact of body mass index on survival after colorectal cancer diagnosis: the Cancer Prevention Study-II Nutrition Cohort. J Clin Oncol 30:42–52

    Article  PubMed  Google Scholar 

  11. Kuiper JG, Phipps AI, Neuhouser ML et al (2012) Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer Causes Control 23:1939–1948

    Article  PubMed Central  PubMed  Google Scholar 

  12. Anderson AS, Steele R, Coyle J (2013) Lifestyle issues for colorectal cancer survivors-perceived needs, beliefs and opportunities. Support Care Cancer 21:35–42

    Article  PubMed  Google Scholar 

  13. Krawczak M, Nikolaus S, von Eberstein H, Croucher PJ, El Mokhtari NE, Schreiber S (2006) PopGen: population-based recruitment of patients and controls for the analysis of complex genotype–phenotype relationships. Community Genet 9:55–61

    Article  PubMed  Google Scholar 

  14. Schafmayer C, Buch S, Volzke H et al (2009) Investigation of the colorectal cancer susceptibility region on chromosome 8q24.21 in a large German case–control sample. Int J Cancer 124:75–80

    Article  CAS  PubMed  Google Scholar 

  15. World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ tech rep ser. 894: i–xii, 1–253

  16. Desquilbet L, Mariotti F (2010) Dose–response analyses using restricted cubic spline functions in public health research. Stat Med 29:1037–1057

    PubMed  Google Scholar 

  17. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  18. R Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. ISBN: 3-900051-07-0

  19. Schwarzer G (2013) Meta: meta-analysis with R. R package version 2.2-1. http://CRAN.R-project.org/package=meta

  20. Pischon T, Nöthlings U, Boeing H (2008) Obesity and cancer. Proc Nutr Soc 67:128–145

    Article  PubMed  Google Scholar 

  21. Field AE, Coakley EH, Must A et al (2001) Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 161:1581–1586

    Article  CAS  PubMed  Google Scholar 

  22. Ma Y, Yang Y, Wang F et al (2013) Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One 8:e53916

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Romero-Corral A, Montori VM, Somers VK et al (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368:666–678

    Article  PubMed  Google Scholar 

  24. Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309:71–82

    Article  CAS  PubMed  Google Scholar 

  25. Heymsfield SB, Cefalu WT (2013) Does body mass index adequately convey a patient’s mortality risk? JAMA 309:87–88

    Article  CAS  PubMed  Google Scholar 

  26. Viña J, Borras C, Gomez-Cabrera MC (2013) Overweight, obesity, and all-cause mortality. JAMA 309:1679

    Article  PubMed  Google Scholar 

  27. Doehner W (2013) Overweight, obesity, and all-cause mortality. JAMA 309:1679–1680

    Article  CAS  PubMed  Google Scholar 

  28. Ramos-Esquivel A (2013) Overweight, obesity, and all-cause mortality. JAMA 309:1680

    Article  CAS  PubMed  Google Scholar 

  29. Abhyankar S, McDonald CJ (2013) Overweight, obesity, and all-cause mortality. JAMA 309:1680–1681

    Article  CAS  PubMed  Google Scholar 

  30. Willett WC, Hu FB, Thun M (2013) Overweight, obesity, and all-cause mortality. JAMA 309:1681

    Article  CAS  PubMed  Google Scholar 

  31. Meyerhardt JA, Tepper JE, Niedzwiecki D et al (2004) Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from intergroup trial 0114. J Clin Oncol 22:648–657

    Article  PubMed  Google Scholar 

  32. Meyerhardt JA, Catalano PJ, Haller DG et al (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98:484–495

    Article  PubMed  Google Scholar 

  33. Thoresen L, Frykholm G, Lydersen S et al (2013) Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results. Clin Nutr 32:65–72

    Article  CAS  PubMed  Google Scholar 

  34. Martin L, Birdsell L, Macdonald N et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547

    Article  PubMed  Google Scholar 

  35. Pischon T, Boeing H, Hoffmann K et al (2008) General and abdominal adiposity and risk of death in Europe. N Engl J Med 359:2105–2120

    Article  CAS  PubMed  Google Scholar 

  36. Mensink GB, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C (2013) Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:786–794

    Article  CAS  PubMed  Google Scholar 

  37. Hakimi AA, Furberg H, Zabor EC et al (2013) An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma. J Natl Cancer Inst 105:1862–1870

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

We thank all participants for their contribution to the study, and Kathrin Dümichen and Lukas Tittmann of the PopGen biobank for data collection and management. Sabrina Schlesinger was funded by a grant from the German Research Foundation (DFG Excellence Cluster Inflammation at Interfaces EXC306 and EXC306/2). PopGen 2.0 network is supported by a grant from the German Ministry for Education and Research (01EY1103). We are thankful to Dr Desquilbet for kindly providing the SAS macro of the restricted cubic spline functions and to Drs Baade, Chin and Phipps for kindly providing additional information for the meta-analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Epidemiology, Christian-Albrechts University of Kiel, Campus UKSH, Arnold-Heller-Str. 3, Haus 1, 24105, Kiel, Germany

    Sabrina Schlesinger, Sabine Siegert & Manja Koch

  2. Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany

    Jessica Walter, Nils Heits, Sebastian Hinz & Clemens Schafmayer

  3. PopGen Biobank, University Hospital Schleswig-Holstein, Kiel, Germany

    Gunnar Jacobs

  4. Department of General Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany

    Jochen Hampe

  5. Nutritional Epidemiology, Department of Nutrition and Food Science, University Bonn, Bonn, Germany

    Ute Nöthlings

  6. Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel, Germany

    Ute Nöthlings

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  1. Sabrina Schlesinger
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  2. Sabine Siegert
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  4. Jessica Walter
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Correspondence to Sabrina Schlesinger.

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Schlesinger, S., Siegert, S., Koch, M. et al. Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis. Cancer Causes Control 25, 1407–1418 (2014). https://doi.org/10.1007/s10552-014-0435-x

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  • DOI: https://doi.org/10.1007/s10552-014-0435-x

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