Journal of Neuro-Oncology

, Volume 114, Issue 1, pp 79–84

Prediagnostic body weight and survival in high grade glioma

  • Erin M. Siegel
  • L. Burton Nabors
  • Reid C. Thompson
  • Jeffrey J. Olson
  • James E. Browning
  • Melissa H. Madden
  • Gang Han
  • Kathleen M. Egan
Clinical Study


Greater adiposity has been linked to an increased risk and/or poorer survival in a variety of cancers. We examined whether prediagnostic body weight 1–5 years prior to diagnosis is associated with survival in patients with high grade glioma. The analysis was based on a series of patients with high-grade glioma (N = 853) enrolled in a US-based multicenter case–control study. Subjects reported height and weight 1–5 years prior to interview and at age 21. BMI was categorized according to WHO criteria as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2) and obese (BMI ≥30 kg/m2). Proportional hazards regression was used to estimate hazard ratios (HR) and 95 % confidence intervals (CIs) for glioma-related death according to body mass index (BMI, kg/m2). Overall survival was reduced among patients underweight (median survival: 12.0 months) or obese (median: 13.6 months) when compared to patients of normal weight (median: 17.5 months) prior to glioma diagnosis (p = 0.004). In a multivariate model controlling for other prognostic factors, an excess mortality was observed in patients reporting obese body weights 1–5 years prior to study interview when compared to patients with a normal BMI (HR = 1.32; 95 % CI 1.04–1.68). Consistent patterns of association with excess body weight were observed in men and women, and all findings were similar regardless of treatment for glioma. A lower than optimal body weight was associated with a nonsignificant excess mortality in multivariate analysis. Premorbid obesity was significantly associated with a poor patient outcome independent of treatment and established prognostic factors. Excess body weight may be an adverse prognostic factor in glioma, a relationship observed across a spectrum of cancer types. The current findings linking prediagnostic body weight with mortality in high-grade glioma warrant further research.


Glioma Glioblastoma BMI Survival prediagnostic body weight 


  1. 1.
    (2012) American Cancer Societiy Facts and Figures 2012. ACS, AtlantaGoogle Scholar
  2. 2.
    Stupp R, Hegi ME, Gilbert MR, Chakravarti A (2007) Chemoradiotherapy in malignant glioma: standard of care and future directions. J clin oncol 25:4127–4136. doi:10.1200/JCO.2007.11.8554 PubMedCrossRefGoogle Scholar
  3. 3.
    Demark-Wahnefried W, Platz EA, Ligibel JA, Blair CK, Courneya KS, Meyerhardt JA, Ganz PA, Rock CL, Schmitz KH, Wadden T, Philip EJ, Wolfe B, Gapstur SM, Ballard-Barbash R, McTiernan A, Minasian L, Nebeling L, Goodwin PJ (2012) The role of obesity in cancer survival and recurrence. Cancer epidemiol, biomarkers prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 21:1244–1259. doi:10.1158/1055-9965.EPI-12-0485 CrossRefGoogle Scholar
  4. 4.
    Sinicrope FA, Dannenberg AJ (2010) Obesity and breast cancer prognosis: weight of the evidence. J Clin Oncol 29:4–7. doi:JCO.2010.32.175210.1200/JCO.2010.32.1752 PubMedCrossRefGoogle Scholar
  5. 5.
    Sinicrope FA, Foster NR, Sargent DJ, O’Connell MJ, Rankin C (2010) Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res 16:1884–1893. doi:1078-0432.CCR-09-263610.1158/1078-0432.CCR-09-2636 PubMedCrossRefGoogle Scholar
  6. 6.
    Hsing AW, Sakoda LC, Chua S Jr (2007) Obesity, metabolic syndrome, and prostate cancer. Am J clin nutr 86:s843–s857PubMedGoogle Scholar
  7. 7.
    Jones LW, Ali-Osman F, Lipp E, Marcello JE, McCarthy B, McCoy L, Rice T, Wrensch M, Il’yasova D (2010) Association between body mass index and mortality in patients with glioblastoma mutliforme. Cancer Causes Control 21:2195–2201. doi:10.1007/s10552-010-9639-x PubMedCrossRefGoogle Scholar
  8. 8.
    Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC (2012) Type 2 diabetes mellitus and obesity are independent risk factors for poor outcome in patients with high-grade glioma. J Neurooncol 106:383–389. doi:10.1007/s11060-011-0676-4 PubMedCrossRefGoogle Scholar
  9. 9.
    Flegal KM, Graubard BI, Williamson DF, Cooper RS (2011) Reverse causation and illness-related weight loss in observational studies of body weight and mortality. Am J Epidemiol 173:1–9. doi:10.1093/aje/kwq341 PubMedCrossRefGoogle Scholar
  10. 10.
    Little RB, Madden MH, Thompson RC, Olson JJ, Larocca RV, Pan E, Browning JE, Egan KM, Nabors LB (2013) Anthropometric factors in relation to risk of glioma. Cancer Causes Control. doi:10.1007/s10552-013-0178-0 PubMedGoogle Scholar
  11. 11.
    Egan KM, Thompson RC, Nabors LB, Olson JJ, Brat DJ, Larocca RV, Brem S, Moots PL, Madden MH, Browning JE, Ann Chen Y (2011) Cancer susceptibility variants and the risk of adult glioma in a US case-control study. J Neurooncol. doi:10.1007/s11060-010-0506-0 Google Scholar
  12. 12.
    WHO (1995) Physical status: the use and interpretation of anthropometry. World Health Organization Technical Report Series. WHO, Geneva, pp 1–47Google Scholar
  13. 13.
    van Kruijsdijk RC, van der Wall E, Visseren FL (2009) Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev 18:2569–2578. doi:1055-9965.EPI-09-037210.1158/1055-9965.EPI-09-0372 PubMedCrossRefGoogle Scholar
  14. 14.
    Warburg O (1956) On the origin of cancer cells. Science 123:309–314PubMedCrossRefGoogle Scholar
  15. 15.
    Bensinger SJ, Christofk HR (2012) New aspects of the Warburg effect in cancer cell biology. Semin Cell Dev Biol 23:352–361. doi:10.1016/j.semcdb.2012.02.003 PubMedCrossRefGoogle Scholar
  16. 16.
    Jelluma N, Yang X, Stokoe D, Evan GI, Dansen TB, Haas-Kogan DA (2006) Glucose withdrawal induces oxidative stress followed by apoptosis in glioblastoma cells but not in normal human astrocytes. Mol Cancer Res 4:319–330. doi:10.1158/1541-7786.MCR-05-0061 PubMedCrossRefGoogle Scholar
  17. 17.
    Oudard S, Arvelo F, Miccoli L, Apiou F, Dutrillaux AM, Poisson M, Dutrillaux B, Poupon MF (1996) High glycolysis in gliomas despite low hexokinase transcription and activity correlated to chromosome 10 loss. Br J Cancer 74:839–845PubMedCrossRefGoogle Scholar
  18. 18.
    Seyfried TN, Kiebish MA, Marsh J, Shelton LM, Huysentruyt LC, Mukherjee P (2011) Metabolic management of brain cancer. Biochim Biophys Acta 1807:577–594. doi:10.1016/j.bbabio.2010.08.009 PubMedCrossRefGoogle Scholar
  19. 19.
    Derr RL, Ye X, Islas MU, Desideri S, Saudek CD, Grossman SA (2009) Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma. J clin oncol 27:1082–1086. doi:10.1200/JCO.2008.19.1098 PubMedCrossRefGoogle Scholar
  20. 20.
    McGirt MJ, Chaichana KL, Gathinji M, Attenello F, Than K, Ruiz AJ, Olivi A, Quinones-Hinojosa A (2008) Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas. Neurosurgery 63:286–291; discussion 291 doi:10.1227/01.NEU.0000315282.61035.48 Google Scholar
  21. 21.
    Chaichana KL, McGirt MJ, Woodworth GF, Datoo G, Tamargo RJ, Weingart J, Olivi A, Brem H, Quinones-Hinojosa A (2010) Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas. Neurol Res 32:442–448. doi:10.1179/174313209X431101 PubMedCrossRefGoogle Scholar
  22. 22.
    Sato A, Sunayama J, Okada M, Watanabe E, Seino S, Shibuya K, Suzuki K, Narita Y, Shibui S, Kayama T, Kitanaka C (2012) Glioma-initiating cell elimination by metformin activation of FOXO3 via AMPK. Stem cells transl med 1:811–824. doi:10.5966/sctm.2012-0058 PubMedCrossRefGoogle Scholar
  23. 23.
    Ramao A, Gimenez M, Laure HJ, Izumi C, Vida RC, Oba-Shinjo S, Marie SK, Rosa JC (2012) Changes in the expression of proteins associated with aerobic glycolysis and cell migration are involved in tumorigenic ability of two glioma cell lines. Proteome sci 10:53. doi:10.1186/1477-5956-10-53 PubMedCrossRefGoogle Scholar
  24. 24.
    Wildiers H, Reiser M (2011) Relative dose intensity of chemotherapy and its impact on outcomes in patients with early breast cancer or aggressive lymphoma. Critical rev oncol/hematol 77:221–240. doi:10.1016/j.critrevonc.2010.02.002 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Erin M. Siegel
    • 1
  • L. Burton Nabors
    • 2
  • Reid C. Thompson
    • 3
  • Jeffrey J. Olson
    • 4
  • James E. Browning
    • 1
  • Melissa H. Madden
    • 1
  • Gang Han
    • 5
  • Kathleen M. Egan
    • 1
  1. 1.Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  2. 2.Neuro-oncology ProgramUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of NeurosurgeryEmory University School of MedicineAtlantaUSA
  5. 5.Department of BiostatisticsH. Lee Moffitt Cancer Center and Research InstituteTampaUSA

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