Cancer Causes & Control

, Volume 12, Issue 1, pp 13–21 | Cite as

A prospective study of obesity and cancer risk (Sweden)

  • Alicja Wolk
  • Gloria Gridley
  • Malin Svensson
  • Olof Nyrén
  • Joseph K. McLaughlin
  • Joseph F. Fraumeni
  • Hans-Olov Adami


Objective: We evaluated the relation between obesity and the risks for various forms of cancer.

Methods: In a population-based cohort of 28,129 hospital patients (8165 men, 19,964 women) with any discharge diagnosis of obesity (9557 only diagnosis, 5266 primary, 13,306 secondary) during 1965–1993, cancer incidence was ascertained through 1993 by record linkage to the nationwide Swedish Cancer Registry. Cancer risk was estimated using the standardized incidence ratio (SIR, with 95% confidence interval), which is the ratio of the observed number of cancers to that expected.

Results: Overall, a 33% excess incidence of cancer was seen in obese persons, 25% in men and 37% in women. Significant risk elevations were observed for cancers of the small intestine (SIR = 2.8; 95% CI 1.6–4.5), colon (1.3; 1.1–1.5), gallbladder (1.6; 1.1–2.3), pancreas (1.5; 1.1–1.9), larynx (2.1; 1.1–3.5), renal parenchyma (2.3; 1.8–2.8), bladder (1.2; 1.0–1.6), cervix uteri (1.4; 1.1–1.9), endometrium (2.9; 2.5–3.4), ovary (1.2; 1.1–1.5), brain (1.5; 1.2–1.9), and connective tissue (1.9; 1.1–3.0), and for lymphomas (1.4; 1.0–1.7), with higher risk observed for Hodgkin's disease only in men (3.3; 1.4–6.5) and for non-Hodgkin's lymphoma only in women (1.6; 1.2–2.1). The association of obesity with risk of breast, prostate and pancreas cancers was modified by age.

Conclusions: Obesity is associated with more forms of cancer than previously reported.

cohort neoplasms obesity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL (1998) Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord 33: 39-47.Google Scholar
  2. 2.
    Kuskowska-Wolk A, Bergström R (1993) Trends in body mass index and prevalence of obesity in Swedish men 1980±89. J Epidemiol Commun Health 47: 103-108.Google Scholar
  3. 3.
    Kuskowska-Wolk A, Bergström R (1993) Trends in body mass index and prevalence of obesity in Swedish women 1980±89. J Epidemiol Commun Health 47: 195-199.Google Scholar
  4. 4.
    Taubes G (1998) As obesity rates rise, experts struggle to explain why. Science 80: 1367-1368.Google Scholar
  5. 5.
    Lew EA, Garfinkel L (1979) Variations in mortality by weight among 750,000 men and women. J Chron Dis 32: 563-576.Google Scholar
  6. 6.
    Manson JE, Colditz GA, Stampler MJ, et al. (1990) A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 322: 882-889.Google Scholar
  7. 7.
    Willett WC, Manson JE, Stampfer MJ, et al. (1995) Weight, weight change, and coronary heart disease in women. Risk within the "normal'' weight range. JAMA 273: 461-465.Google Scholar
  8. 8.
    Manson JE, Willett WC, Stampfer MJ, et al. (1995) Body weight and mortality among women. N Engl J Med 333: 677-685.Google Scholar
  9. 9.
    Albanes D (1990) Energy balance, body size, and cancer. Crit Rev Oncol Hematol 10: 283-303.Google Scholar
  10. 10.
    Whittemore AS, Paffenberger RS, Anderson K, Lee JE (1985) Early precursors of site-specific cancers in college men and women. J Natl Cancer Inst 74: 43-51.Google Scholar
  11. 11.
    Möller H, Mellemgaard A, Lindvig K, Olsen JH (1994) Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer 30A: 344-350.Google Scholar
  12. 12.
    Nyrén O, McLaughlin JK, Gridley G, et al. (1995) Cancer risk after hip replacement with metal implants: a population-based cohort study in Sweden. J Natl Cancer Inst 87: 28-32.Google Scholar
  13. 13.
    Joint FAO/WHO/UNU Export Consultation (1985) Energy and Protein Requirements. Geneva: WHO. Technical Report Series, No. 724: 1-67.Google Scholar
  14. 14.
    Mattson B, Wallgren A (1984) Completeness of the Swedish Cancer Registry. Acta Radiol 23: 305-313.Google Scholar
  15. 15.
    The Cancer Registry (1995) Cancer Incidence in Sweden 1980 (and 1993) (annual publications). Stockholm: National Board of Health and Welfare.Google Scholar
  16. 16.
    Lindblad P, Chow WH, Chan J, et al. (1999) The role of diabetes mellitus in the aetiology of renal cell cancer. Diabetologica 42: 107-112.Google Scholar
  17. 17.
    Bailar JC, Ederer F (1964) Significance factors for ratio of a Poisson variable to its expectation. Biometrics 20: 639-643.Google Scholar
  18. 18.
    Breslow NE, Day NE (1987) The design and analysis of cohort studies. In: Statistical methods in Cancer Research, Vol. 2. IARC Scientific Publications No. 82. Lyon: International Agency for Research on Cancer.Google Scholar
  19. 19.
    Adami HO, Chow W-H, Nyrén O, et al. (1996) Excess risk of primary liver cancer in patients with diabetes mellitus. J Natl Cancer Inst 88: 1472-1477.Google Scholar
  20. 20.
    Hunter DH, Willett WC (1996) Nutrition and breast cancer. Cancer Causes Control 7: 56-68.Google Scholar
  21. 21.
    Andersson SO, Wolk A, Bergström R, et al. (1997) Body size and prostate cancer: a 20-year follow-up study among 135,006 Swedish construction workers. J Natl Cancer Inst 89: 385-389.Google Scholar
  22. 22.
    Hill HA, Austin H (1996) Nutrition and endometrial cancer. Cancer Causes Control 7: 19-32.Google Scholar
  23. 23.
    Fraumeni JF Jr, Devesa SS, McLaughlin JF, Stanford JL (1996) Biliary tract cancer. In: Schottenfield D, Fraumeni JJF, eds. Cancer Epidemiology and Prevention. Oxford: Oxford University Press, pp. 794-805.Google Scholar
  24. 24.
    Wolk A, Lindblad P, Adami HO (1996) Nutrition and renal cell cancer. Cancer Causes Control 7: 5-18.Google Scholar
  25. 25.
    Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst 91: 916-932.Google Scholar
  26. 26.
    Ji BT, Hatch MC, Chow WH, et al. (1996) Anthropometric and reproductive factors and the risk of pancreatic cancer: a case-control study in Shanghai, China. Int J Cancer 66: 32-37.Google Scholar
  27. 27.
    Silverman DT, Swanson CA, Gridley G, et al. (1998) Dietary and nutritional factors and pancreatic cancer: a case-control study based on direct interviews. J Natl Cancer Inst 90: 1710-1719.Google Scholar
  28. 28.
    Mack TM, Yu MC, Hanish R, Henderson BE (1986) Pancreas cancer and smoking, beverage consumption, and past medical history. J Natl Cancer Inst 76: 49-60.Google Scholar
  29. 29.
    Olsen GW, Mandel JS, Gibson RW, Wattenberg LW, Schuman LM (1991) Nutrients and pancreatic cancer: a population-based case-control study. Cancer Causes Control 2: 291-297.Google Scholar
  30. 30.
    Howe GR, Ghadirian P, Bueno de Mesquita HB, et al. (1992) A collaborative case-control study of nutrient intake and pancreatic cancer within the SEARCH programme. Int J Cancer 51: 365-372.Google Scholar
  31. 31.
    Zahm SH, Blair A, Holmes FF, Boysen CD, Robel RJ, Fraumeni JF Jr (1989) A case-control study of soft-tissue sarcoma. Am J Epidemiol 130: 665-674.Google Scholar
  32. 32.
    Waaler HT (1984) Height, weight and mortality. The Norwegian experience. Acta Med Scand Suppl. 1: 679.Google Scholar
  33. 33.
    Nomura A, Heilbrun LK, Stemmermann GN (1985) Body mass index as a predictor of cancer in men. J Natl Cancer Inst 74: 319.Google Scholar
  34. 34.
    Kolonel LN, Hankin JH, Wilkens LR, Fukunaga FH, Hinds MW (1990) An epidemiologic study of thyroid cancer in Hawaii. Cancer Causes Control 1: 223-234.Google Scholar
  35. 35.
    Ron E, Kleinerman RA, Boice JD Jr, LiVolsi VA, Flannery JT, Fraumeni JF Jr (1987) A population-based case-control study of thyroid cancer. J Natl Cancer Inst 1: 1-12.Google Scholar
  36. 36.
    Friedman GD, Herrinton LJ (1994) Obesity and multiple myeloma. Cancer Causes Control 5: 479-483.Google Scholar
  37. 37.
    Paffenbarger RS Jr, Wing AL, Hyde RT (1977) Brief communication: Characteristics in youth indicative of adult-onset Hodg-kin's disease. J Natl Cancer Inst 58: 1489-1491.Google Scholar
  38. 38.
    Chow W-H, Linet MS, McLaughlin JK, Hsing AW, Co Chien HT, Blot WJ (1993) Risk factors for small intestine cancer. Cancer Causes Control 4: 163-169.Google Scholar
  39. 39.
    Negri E, Bosetti C, La Vecchia C, Fioretti F, Conti E, Franceschi S (1999) Risk factors for adenocarcinoma of the small intestine. Int J Cancer 82: 171-174.Google Scholar
  40. 40.
    Jones ME, Swerdlov AJ (1998) Bias in the standardized mortality ratio when using general population rates to estimate expected number of deaths. Am J Epidemiol 148: 1012-1017.Google Scholar
  41. 41.
    Kuskowska-Wolk A, Rössner S (1992) Self-reported weight and height considerably affect the weight distribution of a population. Letter to the Editor. Scand J Soc Med 20: 188-189.Google Scholar
  42. 42.
    Berkson J (1946) Limitations of the application of fourfold table analysis to hospital data. Biomet Bull 2: 47-53.Google Scholar
  43. 43.
    Wolk A, Rössner S (1995) Effects of smoking and physical activity on body weight: development in Sweden between 1980 and 1989. J Intern Med 237: 287-291.Google Scholar
  44. 44.
    Istvan J, Murray R, Voelker H (1995) The relationship between patterns of alcohol consumption and body weight. Int J Epidemiol 24: 543-546.Google Scholar
  45. 45.
    Willett WC, Trichopoulos D (1996) Nutrition and cancer: a summary of the evidence. Cancer Causes Control 7: 178-180.Google Scholar
  46. 46.
    Adami HO, McLaughlin JK, Hsing AW, et al. (1992) Alcoholism and cancer risk: a population-based cohort study. Cancer Causes Control 3: 419-425.Google Scholar
  47. 47.
    Preston-Martin S, Pike MC, Ross RK, Jones PA, Henderson BE (1990) Increased cell division as a cause of human cancer. Cancer Res 50: 7415-7421.Google Scholar
  48. 48.
    Farber E (1995) Cell proliferation as a major risk factor for cancer: a concept of doubtful validity. Cancer Res 55: 3759-3762.Google Scholar
  49. 49.
    Flyvbjerg A, Orskov H (1990) Growth hormone, insulin-like growth factors and diabetes. In: Alberti KGMM, Krall LP, eds, The Diabetes Annual 5. Amsterdam: Elsevier, pp. 642-656.Google Scholar
  50. 50.
    Lorenzi M, Cagliero E (1991) Pathobiology of endothelial and other vascular cells in diabetes mellitus. Diabetes 40: 653-659.Google Scholar
  51. 51.
    Kahn CR, White MF (1995) Molecular mechanism of insulin action. In: DeGroot LJ, ed. Endocrinology. Philadelphia: WB Saunders, pp. 1373-1388.Google Scholar
  52. 52.
    Russel WE, Van Wyk JJ (1995) Peptide growth factors. In: DeGroot LJ, ed. Endocrinology. Philadelphia: WB Saunders, pp. 2590-2623.Google Scholar
  53. 53.
    Tabor E (1994) Tumor suppressor genes, growth factor genes, and oncogenes in hepatitis B virus-associated hepatocellular carcino-ma. J Med Virol 42: 357-365.Google Scholar
  54. 54.
    McKeigue PM, Laws A, Chen YD, Marmot MG, Reaven GM (1993) Relation of plasma triglyceride and apo-B levels to insulin-mediated suppression of nonesterified fatty acids. Arterioscler Thromb 13: 1187-1192.Google Scholar
  55. 55.
    Ferrara A, Barrett-Connor E, Wingard DL, Edelstein AL (1995) Sex differences in insulin level in older adults and the effect of body size, estrogen replacement therapy, and glucose tolerance status. Diabetes Care 18: 220-225.Google Scholar
  56. 56.
    MacDonald PC, Siiteri PK (1974) The relationship between the extraglandular production of estrone and the occurrence of endometrial neoplasia. Gynecol Oncol 2: 259-263.Google Scholar
  57. 57.
    Folsom AR, Kaye SA, Potter JD, Prineas RJ (1989) Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women's Health Study. Cancer Res 49: 6828-6831.Google Scholar
  58. 58.
    Austin H, Austin JM Jr, Partridge EE, Hatch KD, Shingleton HM (1991) Endometrial cancer, obesity, and body fat distribution. Cancer Res 51: 568-572.Google Scholar
  59. 59.
    Judd HL, Lucas WE, Yen SS (1976) Serum 17 beta-estradiol and estrone levels in postmenopausal women with and without endometrial cancer. J Clin Endocrinol Metab 43: 272-278.Google Scholar
  60. 60.
    Davidson BJ, Gambone JC, Lagasse LD, et al. (1981) Free estradiol in postmenopausal women with and without endometrial cancer. J Clin Endocrinol Metab 52: 404-408.Google Scholar
  61. 61.
    Field AE, Colditz GA, Willett WC, Longcope C, McKinley JB (1994). The relation of smoking, age, relative weight, and dietary intake to serum adrenal steroids, sex hormones, and sex hormone-binding globulin in middle-aged men. J Clin Endocrinol Metab 79: 1310-1316.Google Scholar
  62. 62.
    Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MY (1996) A prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 88: 1118-1126.Google Scholar
  63. 63.
    Hsing AW, Comstock GW (1993) Serological precursors of cancer: serum hormones and risk of subsequent prostate cancer. Cancer Epidemiol Biomarkers Prev 2: 27-32.Google Scholar
  64. 64.
    Wolk A, Andersson SO, Bergström R (1997) Re: Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 89: 56.Google Scholar
  65. 65.
    Gerhardsson M, Floderus B, Norell S (1988) Physical activity and colon cancer risk. Int J Epidemiol 17: 743-746.Google Scholar
  66. 66.
    Lee IM, Paffenbarger RS Jr, Hsieh CC (1992) Physical activity and risk of prostatic cancer among college alumni. Am J Epidemiol 135: 169-179.Google Scholar
  67. 67.
    Hsing AW, McLaughlin JK, Zheng W, Gao YT, Blot WJ (1994) Occupation, physical activity and risk of prostate cancer in Shanghai, People's Republic of China. Cancer Causes Control 5: 136-140.Google Scholar
  68. 68.
    Bernstein L, Henderson BE, Hanisch R, Sullivan-Hally J, Ross RK (1994) Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 86: 1403-1408.Google Scholar
  69. 69.
    Moradi T, Nyrén O, Bergström R, et al. (1998) Risk for endometrial cancer in relation to occupational physical activity; a nationwide cohort study in Sweden. Int J Cancer 76: 665-670.Google Scholar
  70. 70.
    Andersson SO, Baron J, Wolk A, Lindgren C, Bergström R, Adami HO (1995) Early life risk factors for prostate cancer. A population-based case-control study in Sweden. Cancer Epidemiol Biomarkers Prev 4: 187-192.Google Scholar
  71. 71.
    Longnecker MP, Gerhardsson de Verdier M, Frumkin H, Carpenter C (1995) A case-control study of physical activity in relation to risk of cancer of the right colon and rectum in men. Int J Epidemiol 24: 42-50.Google Scholar
  72. 72.
    D'Avanzo B, Nanni O, LaVecchia C, et al. (1996) Physical activity and breast cancer risk. Cancer Epidemiol Biomarkers Prev 5: 155-160.Google Scholar
  73. 73.
    Thune I, Lund E (1996) Physical activity and risk of colorectal cancer in men and women. Br J Cancer 73: 1134-1140.Google Scholar
  74. 74.
    Drewnowski A, Kurth C, Holden-Wiltse J, Saari J (1992) Food preferences in human obesity: carbohydrates versus fats. Appetite 18: 207-221.Google Scholar
  75. 75.
    Hotzel D (1986) Suboptimal nutritional status in obesity. Bibl Nutr Dieta 37: 36-41.Google Scholar
  76. 76.
    Moor de Burgos A, Wartanowicz M, Ziemlanski S (1992) Blood vitamin and lipid levels in overweight and obese women. Eur J Clin Nutr 46: 803-806.Google Scholar
  77. 77.
    Wolk A, Rössner S (1996) Obesity and self-perceived health in Sweden. Int J Obes 20: 369-372.Google Scholar
  78. 78.
    Chandra RK (1997) Nutrition and the immune system: an introduction. Am J Clin Nutr 66: 460S-463S.Google Scholar
  79. 79.
    Stallone DD (1994) The influence of obesity and its treatment on the immune system. Nutr Rev 52: 37-50.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Alicja Wolk
    • 1
  • Gloria Gridley
    • 2
  • Malin Svensson
    • 1
  • Olof Nyrén
    • 1
  • Joseph K. McLaughlin
    • 3
  • Joseph F. Fraumeni
    • 2
  • Hans-Olov Adami
    • 1
  1. 1.Department of Medical EpidemiologyKarolinska InstitutetStockholmSweden
  2. 2.Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaUSA
  3. 3.International Epidemiology Institute Ltd.RockvilleUSA

Personalised recommendations