Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC).
BACKGROUND
Body weight and body mass index (BMI) are positively related to risk of colon cancer in men, whereas weak or no associations exist in women. This discrepancy may be related to differences in fat distribution between sexes or to the use of hormone replacement therapy (HRT) in women.


METHODS
We used multivariable adjusted Cox proportional hazards models to examine the association between anthropometric measures and risks of colon and rectal cancer among 368 277 men and women who were free of cancer at baseline from nine countries of the European Prospective Investigation Into Cancer and Nutrition. All statistical tests were two-sided.


RESULTS
During 6.1 years of follow-up, we identified 984 and 586 patients with colon and rectal cancer, respectively. Body weight and BMI were statistically significantly associated with colon cancer risk in men (highest versus lowest quintile of BMI, relative risk [RR] = 1.55, 95% confidence interval [CI] = 1.12 to 2.15; P(trend) = .006) but not in women. In contrast, comparisons of the highest to the lowest quintile showed that several anthropometric measures, including waist circumference (men, RR = 1.39, 95% CI = 1.01 to 1.93; P(trend) = .001; women, RR = 1.48, 95% CI = 1.08 to 2.03; P(trend) = .008), waist-to-hip ratio (WHR; men, RR = 1.51, 95% CI = 1.06 to 2.15; P(trend) = .006; women, RR = 1.52, 95% CI = 1.12 to 2.05; P(trend) = .002), and height (men, RR = 1.40, 95% CI = 0.99 to 1.98; P(trend) = .04; women, RR = 1.79, 95% CI = 1.30 to 2.46; P(trend)<.001) were related to colon cancer risk in both sexes. The estimated absolute risk of developing colon cancer within 5 years was 203 and 131 cases per 100,000 men and 129 and 86 cases per 100,000 women in the highest and lowest quintiles of WHR, respectively. Upon further stratification, no association of waist circumference and WHR with risk of colon cancer was observed among postmenopausal women who used HRT. None of the anthropometric measures was statistically significantly related to rectal cancer.


CONCLUSIONS
Waist circumference and WHR, indicators of abdominal obesity, were strongly associated with colon cancer risk in men and women in this population. The association of abdominal obesity with colon cancer risk may vary depending on HRT use in postmenopausal women; however, these findings require confirmation in future studies.
Pischon
Tobias
T
Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. pischon@mail.dife.de
Lahmann
Petra H
PH
Boeing
Heiner
H
Friedenreich
Christine
C
Norat
Teresa
T
Tjønneland
Anne
A
Halkjaer
Jytte
J
Overvad
Kim
K
Clavel-Chapelon
Françoise
F
Boutron-Ruault
Marie-Christine
MC
Guernec
Gregory
G
Bergmann
Manuela M
MM
Linseisen
Jakob
J
Becker
Nikolaus
N
Trichopoulou
Antonia
A
Trichopoulos
Dimitrios
D
Sieri
Sabina
S
Palli
Domenico
D
Tumino
Rosario
R
Vineis
Paolo
P
Panico
Salvatore
S
Peeters
Petra H M
PH
Bueno-de-Mesquita
H Bas
HB
Boshuizen
Hendriek C
HC
Van Guelpen
Bethany
B
Palmqvist
Richard
R
Berglund
Göran
G
Gonzalez
Carlos Alberto
CA
Dorronsoro
Miren
M
Barricarte
Aurelio
A
Navarro
Carmen
C
Martinez
Carmen
C
Quirós
J Ramón
JR
Roddam
Andrew
A
Allen
Naomi
N
Bingham
Sheila
S
Khaw
Kay-Tee
KT
Ferrari
Pietro
P
Kaaks
Rudolf
R
Slimani
Nadia
N
Riboli
Elio
E
D050153:Abdominal Fat; D000328:Adult; D000368:Aged; D050218:Body Fat Distribution; D015992:Body Mass Index; D049628:Body Size; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000209:etiology; D015986:Confounding Factors, Epidemiologic; D015914:Estrogen Replacement Therapy; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D049629:Waist-Hip Ratio