Digestive Diseases and Sciences

, Volume 62, Issue 11, pp 3177–3185 | Cite as

Changes in Adult BMI and Waist Circumference Are Associated with Increased Risk of Advanced Colorectal Neoplasia

  • Wambui G. Gathirua-Mwangi
  • Patrick Monahan
  • Yiqing Song
  • Terrell W. Zollinger
  • Victoria L. Champion
  • Timothy E. Stump
  • Thomas F. Imperiale
Original Article
  • 303 Downloads

Abstract

Background

Waist circumference (WC) is a stronger predictor of colon cancer (CRC) risk than body mass index (BMI). However, how well change in either WC or BMI predicts risk of advanced colorectal neoplasia (AN) is unclear.

Aims

To determine the relationship between change in BMI and WC from early adulthood to later age and the risk of AN and which change measure is a stronger predictor.

Methods

In 4500 adults, ages 50–80, with no previous neoplasia and undergoing screening colonoscopy, BMI and WC at age 21 and at time of screening were reported. Changes in BMI and WC were defined using universal risk cutoffs. Known CRC risk factors were controlled in the logistic models.

Results

Overall, model statistics showed WC change (omnibus test χ2 = 10.15, 2 DF, p value = 0.006) was a statistically stronger predictor of AN than BMI change (omnibus test χ2 = 5.66, 5 DF, p value = 0.34). Independent of BMI change, participants who increased WC (OR 1.44; 95% CI 1.05–1.96) or maintained a high-risk WC (OR 2.50; 95% CI 1.38–4.53) at age 21 and at screening had an increased risk of AN compared to those with a low-risk WC. Study participants who were obese at age 21 and at screening had an increased risk of AN (OR 1.87; 95% CI 1.08–3.23) compared to those who maintained a healthy BMI. Maintaining an overweight BMI or increasing BMI was not associated with AN.

Conclusions

Maintaining an unhealthy BMI and WC throughout adult life may increase risk of AN. WC change may be a better predictor of AN than BMI change.

Keywords

Obesity BMI change Waist circumference change Colorectal neoplasia Cancer Precancerous polyps 

Supplementary material

10620_2017_4778_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67:177–193.CrossRefPubMedGoogle Scholar
  2. 2.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.CrossRefPubMedGoogle Scholar
  3. 3.
    De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes. 2013;2013:291546.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Zeng H, Lazarova DL. Obesity-related colon cancer: dietary factors and their mechanisms of anticancer action. Clin Exp Pharmacol Physiol. 2012;39:161–167.CrossRefPubMedGoogle Scholar
  5. 5.
    Renehan AG, Dive C. Obesity, insulin and chemoresistance in colon cancer. J Gastrointest Oncol. 2011;2:8–10.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Giovannucci E. Obesity, gender, and colon cancer. Gut. 2002;51:147.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sinicrope FA, Foster NR, Sargent DJ, O’Connell MJ, Rankin C. Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res. 2010;16:1884–1893.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nock NL, Thompson CL, Tucker TC, Berger NA, Li L. Associations between obesity and changes in adult BMI over time and colon cancer risk. Obesity (Silver Spring). 2008;16:1099–1104.CrossRefGoogle Scholar
  9. 9.
    Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013;62:933–947.CrossRefPubMedGoogle Scholar
  10. 10.
    Moore LL, Bradlee ML, Singer MR, et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord. 2004;28:559–567.CrossRefPubMedGoogle Scholar
  11. 11.
    Stein B, Anderson JC, Rajapakse R, Alpern ZA, Messina CR, Walker G. Body mass index as a predictor of colorectal neoplasia in ethnically diverse screening population. Dig Dis Sci. 2010;55:2945–2952.CrossRefPubMedGoogle Scholar
  12. 12.
    Stang J, Story M. Guidelines for Adolescent Nutrition Services. Minneapolis, MN: University of Minnesota; 2005. http://www.epi.umn.edu/let/pubs/adol_book.shtm.
  13. 13.
    Despres JP, Lemieux I, Bergeron J, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28:1039–1049.CrossRefPubMedGoogle Scholar
  14. 14.
    Alley DE, Chang VW. Metabolic syndrome and weight gain in adulthood. J Gerontol A Biol Sci Med Sci. 2010;65:111–117.CrossRefPubMedGoogle Scholar
  15. 15.
    Chen Q, Wang J, Yang J, et al. Association between adult weight gain and colorectal cancer: a dose-response meta-analysis of observational studies. Int J Cancer. 2015;136:2880–2889.CrossRefPubMedGoogle Scholar
  16. 16.
    Karahalios A, English DR, Simpson JA. Weight change and risk of colorectal cancer: a systematic review and meta-analysis. Am J Epidemiol. 2015;181:832–845.CrossRefPubMedGoogle Scholar
  17. 17.
    Keum N, Greenwood DC, Lee DH et al. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst. 2015. doi:10.1093/jnci/djv088.CrossRefGoogle Scholar
  18. 18.
    Bird CL, Frankl HD, Lee ER, Haile RW. Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum. Am J Epidemiol. 1998;147:670–680.CrossRefPubMedGoogle Scholar
  19. 19.
    Kono S, Handa K, Hayabuchi H, et al. Obesity, weight gain and risk of colon adenomas in Japanese men. Jpn J Cancer Res. 1999;90:805–811.CrossRefPubMedGoogle Scholar
  20. 20.
    Thygesen LC, Gronbaek M, Johansen C, Fuchs CS, Willett WC, Giovannucci E. Prospective weight change and colon cancer risk in male US health professionals. Int J Cancer. 2008;123:1160–1165.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Steins Bisschop CN, van Gils CH, Emaus MJ, et al. Weight change later in life and colon and rectal cancer risk in participants in the EPIC-PANACEA study. Am J Clin Nutr. 2014;99:139–147.CrossRefPubMedGoogle Scholar
  22. 22.
    Bassett JK, Severi G, English DR, et al. Body size, weight change, and risk of colon cancer. Cancer Epidemiol Biomarkers Prev. 2010;19:2978–2986.CrossRefPubMedGoogle Scholar
  23. 23.
    Laake I, Thune I, Selmer R, Tretli S, Slattery ML, Veierod MB. A prospective study of body mass index, weight change, and risk of cancer in the proximal and distal colon. Cancer Epidemiol Biomarkers Prev. 2010;19:1511–1522.CrossRefPubMedGoogle Scholar
  24. 24.
    Song M, Hu FB, Spiegelman D, et al. Adulthood weight change and risk of colorectal cancer in the Nurses’ Health Study and Health Professionals Follow-up Study. Cancer Prev Res (Phila). 2015;8:620–627.CrossRefGoogle Scholar
  25. 25.
    Renehan AG, Flood A, Adams KF, et al. Body mass index at different adult ages, weight change, and colorectal cancer risk in the National Institutes of Health-AARP Cohort. Am J Epidemiol. 2012;176:1130–1140.CrossRefPubMedGoogle Scholar
  26. 26.
    Aleksandrova K, Pischon T, Buijsse B, et al. Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Eur J Cancer. 2013;49:3526–3536.CrossRefPubMedGoogle Scholar
  27. 27.
    Karahalios A, Simpson JA, Baglietto L, et al. Change in weight and waist circumference and risk of colorectal cancer: results from the Melbourne Collaborative Cohort Study. BMC Cancer. 2016;16:157.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Song M, Hu FB, Spiegelman D, et al. Long-term status and change of body fat distribution, and risk of colorectal cancer: a prospective cohort study. Int J Epidemiol. 2016;45:871–883.CrossRefPubMedGoogle Scholar
  29. 29.
    Imperiale TF, Monahan PO, Stump TE, Glowinski EA, Ransohoff DF. Derivation and validation of a scoring system to stratify risk for advanced colorectal neoplasia in asymptomatic adults: a cross-sectional study. Ann Intern Med. 2015;163:339–346.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Technical Report Series 2000;894:i–xii, 1–253.Google Scholar
  31. 31.
    Gathirua-Mwangi WG, Zollinger TW, Murage MJ, Pradhan KR, Champion VL. Adult BMI change and risk of breast cancer: National Health and Nutrition Examination Survey (NHANES) 2005–2010. Breast Cancer. 2015;22:648–656.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–1645.CrossRefPubMedGoogle Scholar
  33. 33.
    Johnson CM, Wei C, Ensor JE, et al. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control. 2013;24:1207–1222.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons, Inc.; 2013.CrossRefGoogle Scholar
  35. 35.
    Blake-Gumbs L, Chen Z, Thompson CL, Berger NA, Tucker TC, Li L. Adult BMI change and risk of colon cancer in postmenopausal women. J Obes. 2012;2012:857510.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ryan MC, Fenster Farin HM, Abbasi F, Reaven GM. Comparison of waist circumference versus body mass index in diagnosing metabolic syndrome and identifying apparently healthy subjects at increased risk of cardiovascular disease. Am J Cardiol. 2008;102:40–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Huang LH, Liao YL, Hsu CH. Waist circumference is a better predictor than body mass index of insulin resistance in type 2 diabetes. Obes Res Clin Pract. 2012;6:e263–e346.CrossRefGoogle Scholar
  38. 38.
    Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79:379–384.PubMedGoogle Scholar
  39. 39.
    Zhu S, Heshka S, Wang Z, et al. Combination of BMI and waist circumference for identifying cardiovascular risk factors in Whites. Obes Res. 2004;12:633–645.CrossRefPubMedGoogle Scholar
  40. 40.
    National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. 1998;6:51S–209S.CrossRefGoogle Scholar
  41. 41.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief. 2013:1–8.Google Scholar
  42. 42.
    Fillenbaum GG, Kuchibhatla MN, Whitson HE, et al. Accuracy of self-reported height and weight in a community-based sample of older African Americans and whites. J Gerontol A Biol Sci Med Sci. 2010;65:1123–1129.CrossRefPubMedGoogle Scholar
  43. 43.
    Stevens J, Keil JE, Waid LR, Gazes PC. Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol. 1990;132:1156–1163.CrossRefPubMedGoogle Scholar
  44. 44.
    Ligibel JA, Alfano CM, Courneya KS, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014;32:3568–3574.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Zhang X, Wu K, Giovannucci EL, et al. Early life body fatness and risk of colorectal cancer in U.S. Women and men-results from two large cohort studies. Cancer Epidemiol Biomarkers Prev. 2015;24:690–697.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Epidemiology, Richard M. Fairbanks School of Public HealthIndiana UniversityIndianapolisUSA
  2. 2.Center for Nursing Research, School of NursingIndiana UniversityIndianapolisUSA
  3. 3.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  4. 4.Division of Gastroenterology and Hepatology, Departments of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Regenstrief Institute, Inc.IndianapolisUSA
  6. 6.Center for Innovation, Health Services Research and DevelopmentRichard L. Roudebush VA Medical CenterIndianapolisUSA

Personalised recommendations