title: Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC).
abstract: 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.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. pischon@mail.dife.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Pischon
authors.forename: Petra H
authors.initials: PH
authors.lastname: Lahmann
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Christine
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authors.lastname: Friedenreich
authors.forename: Teresa
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authors.lastname: Norat
authors.forename: Anne
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authors.lastname: Tjønneland
authors.forename: Jytte
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authors.lastname: Halkjaer
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Françoise
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authors.lastname: Clavel-Chapelon
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Gregory
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authors.lastname: Guernec
authors.forename: Manuela M
authors.initials: MM
authors.lastname: Bergmann
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
authors.forename: Nikolaus
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authors.lastname: Becker
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Bethany
authors.initials: B
authors.lastname: Van Guelpen
authors.forename: Richard
authors.initials: R
authors.lastname: Palmqvist
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Gonzalez
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.forename: Carmen
authors.initials: C
authors.lastname: Martinez
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Andrew
authors.initials: A
authors.lastname: Roddam
authors.forename: Naomi
authors.initials: N
authors.lastname: Allen
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
mesh_terms: 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