title: Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium.
abstract: BACKGROUND
  Head and neck cancer (HNC) risk is elevated among lean people and reduced among overweight or obese people in some studies; however, it is unknown whether these associations differ for certain subgroups or are influenced by residual confounding from the effects of alcohol and tobacco use or by other sources of biases.
  
  
  METHODS
  We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption.
  
  
  RESULTS
  Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) < or =18.5 kg/m(2) (2.13, 1.75-2.58) and reduced for BMI >25.0-30.0 kg/m(2) (0.52, 0.44-0.60) and BMI > or =30 kg/m(2) (0.43, 0.33-0.57), compared with BMI >18.5-25.0 kg/m(2). These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI < or =18.5 kg/m(2) was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m(2) was present only in smokers and drinkers.
  
  
  CONCLUSIONS
  In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.
authors.affiliation: Department of Epidemiology and Population Health and of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Mia M
authors.initials: MM
authors.lastname: Gaudet
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Olshan
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chuang
authors.forename: Julien
authors.initials: J
authors.lastname: Berthiller
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.forename: Jolanta
authors.initials: J
authors.lastname: Lissowska
authors.forename: David
authors.initials: D
authors.lastname: Zaridze
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Winn
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.forename: Renato
authors.initials: R
authors.lastname: Talamini
authors.forename: Neolilia
authors.initials: N
authors.lastname: Szeszenia-Dabrowska
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.forename: Jose
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Joshua
authors.initials: J
authors.lastname: Muscat
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Ana
authors.initials: A
authors.lastname: Menezes
authors.forename: Elena
authors.initials: E
authors.lastname: Matos
authors.forename: Alexandru
authors.initials: A
authors.lastname: Bucur
authors.forename: Fabio
authors.initials: F
authors.lastname: Levi
authors.forename: Philip
authors.initials: P
authors.lastname: Lazarus
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Sergio
authors.initials: S
authors.lastname: Koifman
authors.forename: Karl
authors.initials: K
authors.lastname: Kelsey
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hayes
authors.forename: Silva
authors.initials: S
authors.lastname: Franceschi
authors.forename: Victor
authors.initials: V
authors.lastname: Wunsch-Filho
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernandez
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabianova
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Daudt
authors.forename: Luigino
authors.initials: L
authors.lastname: Dal Maso
authors.forename: Maria Paula
authors.initials: MP
authors.lastname: Curado
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsague
authors.forename: Simone
authors.initials: S
authors.lastname: Benhamou
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult