Cancer Causes & Control

, Volume 7, Issue 2, pp 253–263 | Cite as

Physical activity, obesity, and risk of colorectal adenoma in women (United States)

  • Edward Giovannucci
  • Graham A. Colditz
  • Meir J. Stampfer
  • Walter C. Willett
Review Papers

The relationship between physical inactivity, body mass index (BMI) (wt[kg]/ht[m]2), and pattern of adipose distribution with risk of colorectal adenomas (precursors of cancer) was examined in 13,057 female nurses in the United States, 40 to 65 years of age in 1986, who had an endoscopy between 1986 and 1992. From 1986 to 1992, 439 participants were newly diagnosed with adenomas of the distal colorectum. After controlling for age, prior endoscopy, parental history of-colorectal cancer, smoking, aspirin, and intakes of animal fat, dietary fiber, folate, methionine, and alcohol, physical activity was associated inversely with risk of large (≥1 cm) adenomas in the distal colon (relative risk [RR]=0.57,95 percent confidence interval [CI]=0.30–1.08, comparing high and low quintiles of average weekly energy expenditure from leisure-time activities; P trend = 0.05). Much of the benefit came from activities of moderate intensity such as brisk walking. In addition, BMI was associated directly with risk of large adenomas in the distal colon (multivariate RR=2.21 [CI=1.18–4.16], P trend = 0.0001, for BMI ≥29 cf <21 kg/m2). Waist circumference and the waist-to-hip ratio (WHR) were not related significantly to adenoma independently of BMI, but women with both a high BMI and high WHR were at greater risk of large colon adenoma (multivariate RR=1.99, CI=0.98–4.05) than women with high BMI but relatively low WHR (multivariate RR=1.35, CI=0.61–2.97). BMI was not related to small (<1 cm) adenoma risk but physical activity had an inverse association with small adenomas in the distal colon (multivariate RR=0.68, CI=0.40–1.15, P trend = 0.03). The relationships between BMI or physical activity were considerably weaker and inconsistent for rectal adenomas. These results, in women, support an inverse association between physical activity and occurrence or progression of ademonas in the distal colon; obesity is associated with an elevated risk of large adenomas.

Key words

Body mass index colorectal adenomas colorectal cancer obesity physical activity United States women 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Vena JE, Graham S, Zielezny M, et al. Occupational exercise and risk of cancer. Am J Clin Nutr 1987; 45: 318–27.Google Scholar
  2. 2.
    Peters RK, Garabrant DH, Yu MC, et al. A case-control study of occupational and dietary factors in colorectal cancer in young men by subsite. Cancer Res 1989; 49: 5459–68.Google Scholar
  3. 3.
    Garabrant DH, Peters JM, Mack TM, et al. Job activity and colon cancer risk. Am J Epidemiol 1984; 119: 1005–14.Google Scholar
  4. 4.
    Vena JE, Graham S, Zielezny M, et al. Lifetime occupational exercise and colon cancer. Am J Epidemiol 1985; 122: 357–65.Google Scholar
  5. 5.
    Brownson RC, Zahm SH, Change JC, et al. Occupational risk of colon cancer. An analysis by anatomic subsite. Am J Epidemiol 1989; 130: 675–87.Google Scholar
  6. 6.
    Fredriksson M, Bengtsson NO, Hardell L, et al. Colon cancer, physical activity, and occupational exposures. A case-control study. Cancer 1989; 63: 1838–42.Google Scholar
  7. 7.
    Gerhardsson M, Norell SE, Kiviranta H, et al. Sedentary jobs and colon cancer risk. Am J Epidemiol 1986; 123: 775–80.Google Scholar
  8. 8.
    Paffenbarger RSJr, Hyde RT, Wing AL. Physical activity and incidence of cancer in diverse populations: A preliminary report. Am J Clin Nutr 1987; 45: 312–7.Google Scholar
  9. 9.
    Fraser G, Pearce N. Occupational physical activity and risk of cancer of the colon and rectum in New Zealand males. Cancer Causes Control 1993; 4: 45–50.Google Scholar
  10. 10.
    Lynge E, Thygesen L. Use of surveillance systems for occupational cancer: data from the Danish national system. Int J Epidemiol 1988; 17: 493–500.Google Scholar
  11. 11.
    Wu AH, Paganini-Hill A, Ross RK, et al. Alcohol, physical activity, and other risk factors for colorectal cancer: A prospective study. Br J Cancer 1987; 55: 687–94.Google Scholar
  12. 12.
    Polednak AP. College athletics, body size, and cancer mortality. Cancer 1976; 38: 382–7.Google Scholar
  13. 13.
    Slattery ML, Schumacher MC, Smith KR, et al. Physical activity, diet and risk of colon cancer in Utah. Am J Epidemiol 1988; 128: 989–99.Google Scholar
  14. 14.
    Gerhardsson M, Floderus B, Norell SE. Physical activity and colon cancer risk. Int J Epidemiol 1988; 7: 743–6.Google Scholar
  15. 15.
    Gerhardsson de Verdier M, Steineck G, Hagman U, et al. Physical activity and colon cancer: A case-referent study in Stockholm. Int J Cancer 1990; 46: 985–9.Google Scholar
  16. 16.
    Severson RK, Nomura AMY, Grove JS, Stemmermann GN. A prospective analysis of physical activity and cancer. Am J Epidemiol 1989; 130: 522–9.Google Scholar
  17. 17.
    Albanes D, Blair A, Taylor PR. Physical activity and risk of cancer in the NHANES I population. Am J Public Health 1989; 79: 744–50.Google Scholar
  18. 18.
    Ballard-Barbash R, Schatzkin A, Albanes D, et al. Physical activity and risk of large bowel cancer in the Framingham Study. Cancer Res 1990; 50: 3610–3.Google Scholar
  19. 19.
    Kato I, Tominaga S, Matsuura A, Yoshii Y, Shirai M, Kobayashi S. A comparative case-control study of colorectal cancer and adenoma. Jpn J Cancer Res 1990; 81: 1101–8.Google Scholar
  20. 20.
    Whittemore AS, Wu-Williams AH, Lee M, et al. Diet, physical activity, and colorectal cancer among Chinese in North America and China. JNCI 1990; 82: 915–26.Google Scholar
  21. 21.
    Lee IM, Paffenbarger RSJr, Hsieh C-c. Physical activity and risk of developing colorectal cancer among college alumni. JNCI 1991; 83: 1324–9.Google Scholar
  22. 22.
    Longnecker MP, Gerhardsson de Verdier M, Frumkin H, Carpenter C. A case-control study in physical activity in relation to risk of cancer of the right colon and rectum in men. Int J Epidemiol 1995; 24: 42–50.Google Scholar
  23. 23.
    Thun MJ, Calle E, Namboodiri MM, et al. Risk factors for fatal colon cancer in a large prospective study. JNCI 1992; 84: 1491–500.Google Scholar
  24. 24.
    Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Int Med 1995; 122: 327–34.Google Scholar
  25. 25.
    Bostick RM, Potter JD, Kushi LH, et al. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 1994; 5: 38–52.Google Scholar
  26. 26.
    Muto T, Bussey HJR, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975; 36: 2251–70.Google Scholar
  27. 27.
    Kono S, Shinchi K, Ikeda N, Yanai F, Imanishi K. Physical activity, dietary habits and adenomatous polyps of the sigmoid colon: a study of self-defense officials in Japan. J Clin Epidemiol 1991; 44: 1255–61.Google Scholar
  28. 28.
    Little J, Logan RFA, Hawtin PG, Hardcastle JD, Turner ID. Colorectal adenomas and energy intake, body size and physical activity: a case-control study of subjects participating in the Nottingham faecal occult blood screening programme. Br J Cancer 1993; 67: 177–84.Google Scholar
  29. 29.
    Stemmermann GN, Heilbrun LK, Nomura AMY. Association of diet and other factors with adenomatous polyps of the large bowel: a prospective autopsy study. Am J Clin Nutr 1988; 47: 312–7.Google Scholar
  30. 30.
    Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chron Dis 1979; 32: 563–76.Google Scholar
  31. 31.
    Waaler HT. Height, weight and mortality: the Norwegian experience. Acta Med Scand Suppl 1984; 679: 1–56.Google Scholar
  32. 32.
    Phillips RL, Snowden DA. Dietary relationships with fatal colorectal cancer among Seventh-day Adventists. JNCI 1985; 74: 307–17.Google Scholar
  33. 33.
    Garland C, Barrett-Connor E, Rossof AH, et al. Dietary vitamin D and calcium and risk of colorectal cancer. A 19 year prospective study in men. Lancet 1985; i: 307–9.Google Scholar
  34. 34.
    Klatsky AL, Armstrong MA, Friedman GD, Hiatt RA. The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988; 128: 1007–15.Google Scholar
  35. 35.
    Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992; 37: 1350–5.Google Scholar
  36. 36.
    Le Marchand, Wilkins LR, Mi MP. Obesity in youth and middle age and risk of colorectal cancer in men. Cancer Causes Control 1992; 3: 349–54.Google Scholar
  37. 37.
    Nomura A, Heilbrun LK, Stemmermann GN. Body mass index as a predictor of cancer in men. JNCI 1985; 74: 319–23.Google Scholar
  38. 38.
    Chute CG, Willett WC, Colditz GA, et al. A prospective study of body mass index, height, and smoking on risk of colorectal cancer in women. Cancer Causes Control 1991; 2: 117–24.Google Scholar
  39. 39.
    Kune GA, Kune S, Watson LF. Body weight and physical activity as predictors of colorectal cancer risk. Nutr Cancer 1990; 13: 9–17.Google Scholar
  40. 40.
    Graham S, Marshall J, Haughey B, et al. Dietary epidemiology of cancer of the colon in western New York. Am J Epidemiol 1988; 128: 490–503.Google Scholar
  41. 41.
    West DW, Slattery ML, Robison LM, et al. Dietary intake and colon cancer: sex and anatomic site-specific associations. Am J Epidemiol 1989; 130: 883–94.Google Scholar
  42. 42.
    Gerhardsson de Verdier M, Hagman U, Steineck G, et al. Diet, body mass index and colorectal cancer: A case-referent study in Stockholm. Int J Cancer 1990; 46: 832–8.Google Scholar
  43. 43.
    Dietz AT, Newcomb PA, Marcus PM, Storer BE. The association of body size and large bowel cancer risk in Wisconsin (United States) women. Cancer Causes Control 1995; 6: 30–6.Google Scholar
  44. 44.
    Neugut AI, Lee WC, Garbowski GC, et al. Obesity and colorectal adenomatous polyps. JNCI 1991; 83: 359–61.Google Scholar
  45. 45.
    Shinchi K, Kono S, Honjo S, et al. Obesity and adenomatous polyps of the sigmoid colon. Jpn J Cancer Res 1994; 85: 479–84.Google Scholar
  46. 46.
    Bayerdorffer E, Mannes GA, Ochsenkuhn T, Kopcke W, Wiebecke B, Paumgartner G. Increased risk of ‘high-risk’ colorectal adenomas in overweight men. Gastroenterology 1993; 104: 137–44.Google Scholar
  47. 47.
    Sandler RS, Lyles CM, McAuliffe C, Woosley JT, Kupper LL. Cigarette smoking, alcohol, and the risk of colorectal adenomas. Gastroenterology 1993; 104: 1445–51.Google Scholar
  48. 48.
    Willett WC, Stampfer MJ, Colditz GA, et al. Dietary fat and the risk of breast cancer. N Engl J Med 1987; 316: 22–8.Google Scholar
  49. 49.
    Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. Am J Epidemiol 1984; 119: 837–9.Google Scholar
  50. 50.
    Giovannucci E, Stampfer MJ, Colditz GA, et al. Folate, methionine and alcohol intake and risk of colorectal adenoma. JNCI 1993; 85: 875–84.Google Scholar
  51. 51.
    Siconolfi SF, Lasater TM, Snow RCK, et al. Self reported physical activity compared with maximal oxygen uptake. Am J Epidemiol 1985; 122: 101–5.Google Scholar
  52. 52.
    Albanes D, Conway JM, Taylor PR, et al. Validation and comparison of eight physical activity questionnaires. Epidemiology 1990; 1: 65–71.Google Scholar
  53. 53.
    Hopkins WG, Wilson NC, Russel DG. Validation of the physical activity instrument for the Life in New Zealand national survey. Am J Epidemiol 1991; 133: 73–82.Google Scholar
  54. 54.
    Wolf A, Hunter D, Colditz GA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 1994; 23: 991–9.Google Scholar
  55. 55.
    Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80.Google Scholar
  56. 56.
    Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin L, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology 1990; 1: 466–73.Google Scholar
  57. 57.
    Rothman KJ. Modern Epidemiology. Boston, MA (USA): Little Brown, 1986.Google Scholar
  58. 58.
    Evans DJ, Hoffmann RG, Kalkhoff RK, Kissebah AH. Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women. Metabolism 1984; 33: 68–75.Google Scholar
  59. 59.
    Kearney J, Giovannucci E, Rimm EB, et al. Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control 1995; 6: 45–56.Google Scholar
  60. 60.
    Hirsch J, Ahrens EH, Blankenhorn DH. Measurement of the human intestinal length in vivo and some causes of variation. Gastroenterology 1956; 31: 274–84.Google Scholar
  61. 61.
    Albanes D, Winich W. Are cell numbers and cell proliferation risk factors for cancer? JNCI 1988; 80: 772–5.Google Scholar
  62. 62.
    Kritchevsky D. Colorectal cancer: the role of dietary fat and caloric restriction. Mutation Res 1993; 290: 63–70.Google Scholar
  63. 63.
    Kritchevsky D. Influence of caloric restriction and exercise on tumorigenesis in rats. Proc Soc Exp Biol Med 1990; 193: 35–8.Google Scholar
  64. 64.
    Watkins LF, Lewis LR, Levine AE. Characterization of the synergistic effects of insulin and transferrin and the regulation of their receptors on a human colon carcinoma cell line. Int J Cancer 1990; 45: 372–5.Google Scholar
  65. 65.
    Koenuma M, Yamori T, Tsuruo T. Insulin and insulin-like growth factor 1 stimulate proliferation of metastatic variants of colon carcinoma 26. Jpn J Cancer Res 1989; 80: 51–8.Google Scholar
  66. 66.
    Bjork J, Nilsson J, Hultcrantz R, Johansson C. Growth-regulatory effects of sensory neuropeptides, epidermol growth factor, insulin, and somatostatin on the non-transformed intestinal epithelial cell line IEC-6 and the colon cancer cell line HT 29. Scand J Gastroenterol 1993; 28: 879–84.Google Scholar
  67. 67.
    Koivisto VA, Yki-Jarvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1988; 1: 445–81.Google Scholar
  68. 68.
    Regensteiner JG, Mayer EJ, Shetterly SM, et al. Relationship between habitual physical activity and insulin levels among nondiabetic men and women. Diabetes Care 1991; 14: 1066–74.Google Scholar
  69. 69.
    Ruggeri BA, Klurfeld DM, Kritchevsky D, Furlanetto RW. Caloric restriction and 7,12-dimethylbenz(a)anthracene-induced mammary tumor growth in rats: alterations in circulating insulin,insulin-like growth factors I and II, and epidermal growth factor. Cancer Res 1989; 49: 4130–4.Google Scholar
  70. 70.
    Bjorntorp P. Metabolic implications of body fat distribution. Diabetes Care 1991; 14: 1132–43.Google Scholar
  71. 71.
    Kissebah AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54: 254–60.Google Scholar
  72. 72.
    Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U. Impact of obesity on metabolism in men and women: importance of regional adipose distribution. J Clin Invest 1983; 72: 1150–62.Google Scholar
  73. 73.
    Donahue RP, Abbott RD, Bloom E, Reed DM, Yano K. Central obesity and coronary heart disease in men. Lancet 1987; 1: 882–4.Google Scholar
  74. 74.
    Cohen ND, Hilf R. Influence of insulin on growth and metabolism of 7,12-dimethylbenz[a]anthracene-induced mammary tumors. Cancer Res 1974; 34: 3245–52.Google Scholar
  75. 75.
    Klurfeld DM, Lloyd LM, Welch CB, Davis MJ, Tulp OL, Kritchevsky D. Reduction of enhanced mammary carcinogenesis in LA/N-cp (Corpulent) rats by energy restriction. Proc Soc Exp Bio Med 1991; 196: 381–4.Google Scholar
  76. 76.
    Shafie SM, Hilf R. Relationship between insulin and estrogen binding to growth response in 7,12-dimethylbenz(a)anthracene-induced rat mammary tumors. Cancer Res 1978; 38: 759–64.Google Scholar
  77. 77.
    Giovannucci E. Insulin and colon cancer. Cancer Causes Control 1995; 6: 164–79.Google Scholar
  78. 78.
    Lampe JW, Fredstrom SB, Slavin JL, Potter JD. Sex difference in colonic function: a randomised trial. Gut 1993; 34: 531–6.Google Scholar
  79. 79.
    Hyams DE. Gastrointestinal problems in the old. Br Med J 1974; 1: 107–10.Google Scholar
  80. 80.
    Milne JS, Williamson J. Bowel habit in older people. Gerontol Clin 1972; 14: 56–60.Google Scholar
  81. 81.
    Bingham SA, Cummings JH. Effect of exercise and physical fitness on large bowel intestinal function. Gastroenterology 1989; 97: 1389–99.Google Scholar
  82. 82.
    Oettle GJ. Effect of moderate exercise on bowel habit. Gut 1991; 32: 941–3.Google Scholar
  83. 83.
    Coenen C, Wegener M, Wedmann B, Schmidt G, Hoffmann S. Does physical exercise influence bowel transit time in healthy young men? Am J Gastroenterol 1992; 87: 292–5.Google Scholar

Copyright information

© Rapid Science Publishers 1996

Authors and Affiliations

  • Edward Giovannucci
  • Graham A. Colditz
  • Meir J. Stampfer
  • Walter C. Willett

There are no affiliations available

Personalised recommendations