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Associations of pre-diagnostic body mass index with overall and cancer-specific mortality in a large Austrian cohort

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Abstract

Purpose

Although obesity is a well-known risk factor for several cancers, its role on cancer survival is poorly understood.

Methods

Within the VHM&PP cohort, 8,673 cancer patients (42.2 % women) were followed over a median time of 11.9 years. Cox proportional hazard models were used to estimate the association of pre-diagnostic overweight (BMI 25.0–29.9 kg/m2) and obesity (BMI ≥ 30.0 kg/m2) with all-cause and cancer-specific mortality. Cubic restricted splines were additionally modeled.

Results

During 71,126 person-years, 4,571 deaths were observed. Compared to normal weight, overweight was associated with statistically significantly decreased all-cause mortality (HR 0.93; 95 % CI 0.87–0.997) and cancer-specific mortality (HR 0.91; 95 % CI 0.84–0.99). Underweight was statistically significantly associated with 28 % increased overall mortality, in particular in men [HR 2.02 (95 % CI 1.43–2.83) vs. HR 0.96 (95 % CI 0.71–1.30) in women]. J-shaped associations were found between BMI and mortality with the nadir around a BMI of 25 kg/m2. Analysis by cancer site showed though not statistically significantly that overweight was associated with reduced mortality, while obesity was associated with increased cancer-specific mortality except cancers of the upper digestive tract. In patients with local stage colorectal cancers, obesity was associated with increased all-cause (vs. normal weight HR 1.90; 95 % CI 1.03–3.52) and cancer-specific mortality (HR 3.17; 95 % CI 1.29–7.81).

Conclusion

Overweight patients have a better overall prognosis, while for obesity no association and for underweight worse prognosis were found. Our results on common cancers indicate that there are tumor- and stage-specific differences.

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Acknowledgments

We thank Elmar Stimpfl and Karin Parschalk from the aks gesundheit and Thomas Mathis from the Vorarlberg mortality registry for excellent technical support; Bernhard Klisch from the aks gesundheit; Markus Wallner, Christian Bernhard, and Gabriela Dür from the Vorarlberg State Government; and finally, all the study participants.

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Authors and Affiliations

  1. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    Katharina Reichle, Raphael S. Peter & Gabriele Nagel

  2. Agency for Preventive and Social Medicine, Rheinstraße 61, 6900, Bregenz, Austria

    Katharina Reichle, Hans Concin & Gabriele Nagel

Authors
  1. Katharina Reichle
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  2. Raphael S. Peter
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  3. Hans Concin
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Correspondence to Gabriele Nagel.

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Reichle, K., Peter, R.S., Concin, H. et al. Associations of pre-diagnostic body mass index with overall and cancer-specific mortality in a large Austrian cohort. Cancer Causes Control 26, 1643–1652 (2015). https://doi.org/10.1007/s10552-015-0658-5

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  • DOI: https://doi.org/10.1007/s10552-015-0658-5

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