title: Behavioural and metabolic risk factors for mortality from colon and rectum cancer: analysis of data from the Asia-Pacific Cohort Studies Collaboration.
abstract: BACKGROUND
  Colorectal cancer has several modifiable behavioural risk factors but their relationship to the risk of colon and rectum cancer separately and between countries with high and low incidence is not clear.
  
  
  METHODS
  Data from participants in the Asia Pacific Cohort Studies Collaboration (APCSC) were used to estimate mortality from colon (International Classification of Diseases, revision 9 (ICD-9) 153, ICD-10 C18) and rectum (ICD-9 154, ICD-10 C19-20) cancers. Data on age, body mass index (BMI), serum cholesterol, height, smoking, physical activity, alcohol and diabetes mellitus were entered into Cox proportional hazards models.
  
  
  RESULTS
  600,427 adults contributed 4,281,239 person-years follow-up. The mean ages (SD) for Asian and Australia/New Zealand cohorts were 44.0 (9.5) and 53.4 (14.5) years, respectively. 455 colon and 158 rectum cancer deaths were observed. Increasing age, BMI and attained adult height were associated with increased hazards of death from colorectal cancer, and physical activity was associated with a reduced hazard. After multiple adjustment, any physical activity was associated with a 28% lower hazard of colon cancer mortality (HR 0.72, 95%CI 0.53-0.96) and lower rectum cancer mortality (HR 0.75, 95%CI 0.45-1.27). A 2cm increase in height increased colon and all colorectal cancer mortality by 7% and 6% respectively.
  
  
  CONCLUSIONS
  Physical inactivity and greater BMI are modifiable risk factors for colon cancer in both Western and Asian populations. Further efforts are needed to promote physical activity and reduce obesity while biological research is needed to understand the mechanisms by which they act to cause cancer mortality.
authors.affiliation: West of Scotland Cancer Surveillance Unit, University of Glasgow, Scotland. david.morrison@glasgow.ac.uk
authors.forename: David Stewart
authors.initials: DS
authors.lastname: Morrison
authors.forename: Christine Louise
authors.initials: CL
authors.lastname: Parr
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.forename: Hyeon Chang
authors.initials: HC
authors.lastname: Kim
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Jee
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Graham
authors.initials: G
authors.lastname: Giles
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fang
authors.forename: Federica
authors.initials: F
authors.lastname: Barzi
authors.forename: George David
authors.initials: GD
authors.lastname: Batty
authors.forename: Rachel Rita
authors.initials: RR
authors.lastname: Huxley
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001827:Body Height; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D002784:Cholesterol