Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis
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Aim of this study was to investigate the association between postdiagnosis body mass index (BMI) and all-cause mortality in colorectal cancer (CRC) survivors in a prospective study and meta-analysis.
We conducted a prospective cohort study on 2,143 CRC survivors in Germany. Participants were recruited to the study on average 4 years after diagnosis, and postdiagnosis BMI was assessed at recruitment using a self-administered questionnaire. CRC survivors were followed up for a mean time of 3.5 years. The association between BMI and all-cause mortality was investigated using multivariable Cox proportional hazards models. Additionally, we performed a meta-analysis of studies on postdiagnosis BMI and all-cause mortality (n = 5, including this study) by applying random-effects models.
In the prospective analysis, 349 participants died. BMI was not statistically significantly associated with all-cause mortality. Compared to normal weight survivors, the hazard ratios (HRs) [95 % confidence interval (CI)] for all-cause mortality in underweight, overweight and obese survivors were 1.65 (0.79–3.45), 0.80 (0.62–1.03) and 0.84 (0.62–1.14), respectively. In the meta-analysis, individuals with underweight were at increased risk for all-cause mortality [HR (95 % CI) 1.72 (1.18–2.49)], whereas individuals with overweight had a lower risk [HR (95 % CI) 0.79 (0.71–0.88)], compared to normal weight subjects. For obesity, the risk of mortality was also reduced with only borderline significance [HR (95 % CI) 0.88 (0.77–1.00)].
While the present study as well as single previously published studies showed that overweight was associated with a non-significant reduced risk for all-cause mortality, our meta-analysis indicated a decreased mortality risk among overweight CRC survivors.
KeywordsBody mass index Colorectal neoplasms Mortality Survivors
We thank all participants for their contribution to the study, and Kathrin Dümichen and Lukas Tittmann of the PopGen biobank for data collection and management. Sabrina Schlesinger was funded by a grant from the German Research Foundation (DFG Excellence Cluster Inflammation at Interfaces EXC306 and EXC306/2). PopGen 2.0 network is supported by a grant from the German Ministry for Education and Research (01EY1103). We are thankful to Dr Desquilbet for kindly providing the SAS macro of the restricted cubic spline functions and to Drs Baade, Chin and Phipps for kindly providing additional information for the meta-analysis.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.World Cancer Research Fund/American Institute for Cancer Research (2011) Continuous update project report. Food, nutrition, physical activity, and the prevention of colorectal cancer. AICR, Washington, DCGoogle Scholar
- 5.World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DCGoogle Scholar
- 8.Meyerhardt JA, Niedzwiecki D, Hollis D et al (2008) Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 26:4109–4115PubMedCentralPubMedCrossRefGoogle Scholar
- 15.World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ tech rep ser. 894: i–xii, 1–253Google Scholar
- 18.R Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. ISBN: 3-900051-07-0Google Scholar
- 19.Schwarzer G (2013) Meta: meta-analysis with R. R package version 2.2-1. http://CRAN.R-project.org/package=meta
- 36.Mensink GB, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C (2013) Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:786–794PubMedCrossRefGoogle Scholar