Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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 χ 2 = 10.15, 2 DF, p value = 0.006) was a statistically stronger predictor of AN than BMI change (omnibus test χ 2 = 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67:177–193.

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.

    Article  PubMed  Google Scholar 

  3. De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes. 2013;2013:291546.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  5. Renehan AG, Dive C. Obesity, insulin and chemoresistance in colon cancer. J Gastrointest Oncol. 2011;2:8–10.

    PubMed  PubMed Central  Google Scholar 

  6. Giovannucci E. Obesity, gender, and colon cancer. Gut. 2002;51:147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  9. Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013;62:933–947.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Alley DE, Chang VW. Metabolic syndrome and weight gain in adulthood. J Gerontol A Biol Sci Med Sci. 2010;65:111–117.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  33. Johnson CM, Wei C, Ensor JE, et al. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control. 2013;24:1207–1222.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons, Inc.; 2013.

    Book  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  41. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief. 2013:1–8.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Financial support

Dr. Gathirua-Mwangi is a postdoctoral appointee funded by a supplemental grant under R01CA196243 (PIs: Drs. Champion and Paskett). Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers 3R01CA196243-02S1, R25 CA117865-07S1 and K05CA175048. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA

    Wambui G. Gathirua-Mwangi, Yiqing Song & Terrell W. Zollinger

  2. Center for Nursing Research, School of Nursing, Indiana University, 600 Barnhill Dr. NU 317C, Indianapolis, IN, 46202, USA

    Wambui G. Gathirua-Mwangi & Victoria L. Champion

  3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Patrick Monahan & Timothy E. Stump

  4. Division of Gastroenterology and Hepatology, Departments of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas F. Imperiale

  5. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Thomas F. Imperiale

  6. Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA

    Thomas F. Imperiale

Authors
  1. Wambui G. Gathirua-Mwangi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Monahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yiqing Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Terrell W. Zollinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Victoria L. Champion
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timothy E. Stump
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas F. Imperiale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wambui G. Gathirua-Mwangi.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gathirua-Mwangi, W.G., Monahan, P., Song, Y. et al. Changes in Adult BMI and Waist Circumference Are Associated with Increased Risk of Advanced Colorectal Neoplasia. Dig Dis Sci 62, 3177–3185 (2017). https://doi.org/10.1007/s10620-017-4778-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4778-5

Keywords

Search

Navigation