Cancer Causes & Control

, Volume 25, Issue 10, pp 1407–1418 | Cite as

Postdiagnosis body mass index and risk of mortality in colorectal cancer survivors: a prospective study and meta-analysis

  • Sabrina Schlesinger
  • Sabine Siegert
  • Manja Koch
  • Jessica Walter
  • Nils Heits
  • Sebastian Hinz
  • Gunnar Jacobs
  • Jochen Hampe
  • Clemens Schafmayer
  • Ute Nöthlings
Original paper



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.


Body 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.

Supplementary material

10552_2014_435_MOESM1_ESM.docx (220 kb)
Supplementary material 1 (DOCX 219 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Sabrina Schlesinger
    • 1
  • Sabine Siegert
    • 1
  • Manja Koch
    • 1
  • Jessica Walter
    • 2
  • Nils Heits
    • 2
  • Sebastian Hinz
    • 2
  • Gunnar Jacobs
    • 3
  • Jochen Hampe
    • 4
  • Clemens Schafmayer
    • 2
  • Ute Nöthlings
    • 5
    • 6
  1. 1.Institute of EpidemiologyChristian-Albrechts University of KielKielGermany
  2. 2.Department of General and Thoracic SurgeryUniversity Hospital Schleswig-HolsteinKielGermany
  3. 3.PopGen BiobankUniversity Hospital Schleswig-HolsteinKielGermany
  4. 4.Department of General Internal MedicineUniversity Hospital Schleswig-HolsteinKielGermany
  5. 5.Nutritional Epidemiology, Department of Nutrition and Food ScienceUniversity BonnBonnGermany
  6. 6.Section of Epidemiology, Institute for Experimental MedicineChristian-Albrechts University of KielKielGermany

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