Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort.
The etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC.



We investigated overall obesity and abdominal adiposity in relation to SIC in the European Prospective Investigation into Cancer and Nutrition (EPIC), a large prospective cohort of approximately half a million men and women from ten European countries. Overall obesity and abdominal obesity were assessed by body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression modeling was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Stratified analyses were conducted by sex, BMI, and smoking status.



During an average of 13.9 years of follow-up, 131 incident cases of SIC (including 41 adenocarcinomas, 44 malignant carcinoid tumors, 15 sarcomas and 10 lymphomas, and 21 unknown histology) were identified. WC was positively associated with SIC in a crude model that also included BMI (HR per 5-cm increase = 1.20, 95 % CI 1.04, 1.39), but this association attenuated in the multivariable model (HR 1.18, 95 % CI 0.98, 1.42). However, the association between WC and SIC was strengthened when the analysis was restricted to adenocarcinoma of the small intestine (multivariable HR adjusted for BMI = 1.56, 95 % CI 1.11, 2.17). There were no other significant associations.



WC, rather than BMI, may be positively associated with adenocarcinomas but not carcinoid tumors of the small intestine.



Abdominal obesity is a potential risk factor for adenocarcinoma in the small intestine.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK. yunxia.lu@imperial.ac.uk.
Yunxia
Y
Lu
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Amanda J
AJ
Cross
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Neil
N
Murphy
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Heinz
H
Freisling
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Ruth C
RC
Travis
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Pietro
P
Ferrari
Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Verena A
VA
Katzke
Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Rudolf
R
Kaaks
Department of Surgery, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden.
Åsa
Å
Olsson
Department of Odontology, Umeå University, Umeå, Sweden.|Department of Biobank Research, Umeå University, Umeå, Sweden.
Ingegerd
I
Johansson
Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Skåne University Hospital Malmö, Malmö, Sweden.|Department of Biobank Research, Umeå University, Umeå, Sweden.
Frida
F
Renström
Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
Salvatore
S
Panico
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
Valeria
V
Pala
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute ISPO, Florence, Italy.
Domenico
D
Palli
Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Italy.
Rosario
R
Tumino
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Petra H
PH
Peeters
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
Peter D
PD
Siersema
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
H B
HB
Bueno-de-Mesquita
Hellenic Health Foundation, 23 Alexandroupoleos, 115 27, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, 13 Kaisareias Street, 115 27, Athens, Greece.|Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi, 115 27, Athens, Greece.
Antonia
A
Trichopoulou
Hellenic Health Foundation, 23 Alexandroupoleos, 115 27, Athens, Greece.
Eleni
E
Klinaki
Hellenic Health Foundation, 23 Alexandroupoleos, 115 27, Athens, Greece.
Christos
C
Tsironis
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Av. Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Spain.
Antonio
A
Agudo
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.|Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.|Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
Carmen
C
Navarro
Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.|Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
María-José
MJ
Sánchez
Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.|Navarre Public Health Institute, Pamplona, Spain.
Aurelio
A
Barricarte
Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, 94805, Villejuif, France.|Université Paris Sud, UMRS 1018, 94805, Villejuif, France.|Institut Gustave Roussy, 94805, Villejuif, France.
Marie-Christine
MC
Boutron-Ruault
Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, 94805, Villejuif, France.|Université Paris Sud, UMRS 1018, 94805, Villejuif, France.|Institut Gustave Roussy, 94805, Villejuif, France.
Guy
G
Fagherazzi
Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, 94805, Villejuif, France.|Université Paris Sud, UMRS 1018, 94805, Villejuif, France.|Institut Gustave Roussy, 94805, Villejuif, France.
Antoine
A
Racine
Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, University of Tromsø, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland.
Elisabete
E
Weiderpass
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Marc J
MJ
Gunter
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Elio
E
Riboli
D000230:Adenocarcinoma / Q000453:epidemiology*; D050154:Adiposity; D000328:Adult; D000368:Aged; D001827:Body Height; D015992:Body Mass Index; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio; D044465:White People
Abdominal obesity; Cancer; Obesity; Small intestine