Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Body mass index and lung cancer risk: a pooled analysis based on nested case-control studies from four cohort studies

Authors: Harinakshi Sanikini, Jian-Min Yuan, Lesley M. Butler, Woon-Puay Koh, Yu-Tang Gao, Annika Steffen, Mattias Johansson, Paolo Vineis, Gary E. Goodman, Matt J. Barnett, Rayjean J. Hung, Chu Chen, Isabelle Stücker

Published in: BMC Cancer | Issue 1/2018

Login to get access

Abstract

Background

Obesity has been proposed as a potential protective factor against lung cancer. We examined the association between BMI and lung cancer risk in a pooled analysis based on nested case-control studies from four cohort studies.

Methods

A case-control study was nested within four cohorts in USA, Europe, China and Singapore that included 4172 cases and 8471 control subjects. BMI at baseline was calculated as weight in kilograms divided by height in meters squared (kg/m2), and classified into 4 categories: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (≥30). Odds ratios (ORs) and 95% confidence intervals (CIs) for BMI-lung cancer associations were estimated using unconditional logistic regression, adjusting for potential confounders.

Results

Considering all participants, and using normal weight as the reference group, a decreased risk of lung cancer was observed for those who were overweight (OR 0.77, 95% CI: 0.68–0.86) and obese (OR 0.69, 95% CI: 0.59–0.82). In the stratified analysis by smoking status, the decreased risk for lung cancer was observed among current, former and never smokers (P for interaction 0.002). The adjusted ORs for overweight and obese groups were 0.79 (95% CI: 0.68–0.92) and 0.75 (95% CI: 0.60–0.93) for current smokers, 0.70 (95% CI: 0.53–0.93) and 0.55 (95% CI: 0.37–0.80) for former smokers, 0.77 (95% CI: 0.59–0.99), and 0.71 (95% CI: 0.44–1.14) for never smokers, respectively. While no statistically significant association was observed for underweight subjects who were current smokers (OR 1.24, 95% CI: 0.98–1.58), former smokers (OR 0.27, 95% CI: 0.12–0.61) and never smokers (OR 0.83, 95% CI: 0.5.-1.28).

Conclusion

The results of this study provide additional evidence that obesity is associated with a decreased risk of lung cancer. Further biological studies are needed to address this association.
Appendix
Available only for authorised users
Literature
1.
GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase no. 11 [internet]. Lyon, France: International Agency for Research on Cancer; 2013 [available from: http://​globocan.​iarc.​fr, ].
2.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMed
3.
Janssen-Heijnen ML, Coebergh JW. Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe. Lung cancer (Amsterdam, Netherlands). 2001;31(2–3):123–37.CrossRef
4.
5.
Youlden DR, Cramb SM, Baade PD. The international epidemiology of lung cancer: geographical distribution and secular trends. J Thorac Oncol: Official Publ Int Assoc Study Lung Cancer. 2008;3(8):819–31.CrossRef
6.
Bray FI, Weiderpass E. Lung cancer mortality trends in 36 European countries: secular trends and birth cohort patterns by sex and region 1970-2007. Int J Cancer. 2010;126(6):1454–66.PubMed
7.
Thun M, Peto R, Boreham J, Lopez AD. Stages of the cigarette epidemic on entering its second century. Tob Control. 2012;21(2):96–101.CrossRefPubMed
8.
Devesa SS, Bray F, Vizcaino AP, Parkin DM. International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising. Int J Cancer. 2005;117(2):294–9.CrossRefPubMed
9.
IARC: Tobacco smoke and involuntary smoking. IARC monographs on the evaluation of carcinogenic risks to humans/World Health Organization, Int Agency Res Cancer 2004, 83:1–1438.
10.
Straif K, Cohen A, Samet J: Air Pollution and Cancer: IARC Scientific Publication No. 161. International Agency for Research on Cancer, Lyon, France 2013.
11.
Duan P, Quan C, Hu C, Zhang J, Xie F, Hu X, Yu Z, Gao B, Liu Z, Zheng H, et al. Nonlinear dose-response relationship between radon exposure and the risk of lung cancer: evidence from a meta-analysis of published observational studies. Eur J Cancer Prev: Official J Eur Cancer Prev Organ (ECP). 2015;24(4):267–77.CrossRef
12.
IARC: A Review of Human Carcinogens: Arsenic, Metals, Fibres, and Dusts. Lyon, France: International Agency for Research on Cancer; 2012. IARC Monogr Eval Carcinog Risks Hum 2012, 100.
13.
IARC: Man-made mineral fibres and radon. IARC Monogr Eval Carcinog Risks Hum 1988, 43.
14.
Wang Y, Li F, Wang Z, Qiu T, Shen Y, Wang M. Fruit and vegetable consumption and risk of lung cancer: a dose-response meta-analysis of prospective cohort studies. Lung cancer (Amsterdam, Netherlands). 2015;88(2):124–30.CrossRef
15.
Vieira AR, Abar L, Vingeliene S, Chan DS, Aune D, Navarro-Rosenblatt D, Stevens C, Greenwood D, Norat T. Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis. Ann Oncol: Official J Eur Soc Med Oncol/ESMO. 2016;27(1):81–96.CrossRef
16.
17.
Machova L, Cizek L, Horakova D, Koutna J, Lorenc J, Janoutova G, Janout V. Association between obesity and cancer incidence in the population of the district Sumperk, Czech Republic. Onkologie. 2007;30(11):538–42.PubMed
18.
Kollarova H, Machova L, Horakova D, Cizek L, Janoutova G, Janout V. Is obesity a preventive factor for lung cancer? Neoplasma. 2008;55(1):71–3.PubMed
19.
Tarnaud C, Guida F, Papadopoulos A, Cenee S, Cyr D, Schmaus A, Radoi L, Paget-Bailly S, Menvielle G, Buemi A, et al. Body mass index and lung cancer risk: results from the ICARE study, a large, population-based case-control study. Cancer causes & control : CCC. 2012;23(7):1113–26.CrossRefPubMed
20.
El-Zein M, Parent ME, Nicolau B, Koushik A, Siemiatycki J, Rousseau MC. Body mass index, lifetime smoking intensity and lung cancer risk. Int J Cancer. 2013;133(7):1721–31.CrossRefPubMed
21.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.CrossRefPubMed
22.
Kabat GC, Miller AB, Rohan TE. Body mass index and lung cancer risk in women. Epidemiol (Cambridge, Mass). 2007;18(5):607–12.CrossRef
23.
Kabat GC, Kim M, Hunt JR, Chlebowski RT, Rohan TE. Body mass index and waist circumference in relation to lung cancer risk in the Women's Health Initiative. Am J Epidemiol. 2008;168(2):158–69.CrossRefPubMedPubMedCentral
24.
Smith L, Brinton LA, Spitz MR, Lam TK, Park Y, Hollenbeck AR, Freedman ND, Gierach GL. Body mass index and risk of lung cancer among never, former, and current smokers. J Natl Cancer Inst. 2012;104(10):778–89.CrossRefPubMedPubMedCentral
25.
Bethea TN, Rosenberg L, Charlot M, O'Connor GT, Adams-Campbell LL, Palmer JR. Obesity in relation to lung cancer incidence in African American women. Cancer causes & control : CCC. 2013;24(9):1695–703.CrossRefPubMedPubMedCentral
26.
Everatt R, Virviciute D, Kuzmickiene I, Tamosiunas A. Body mass index, cholesterol level and risk of lung cancer in Lithuanian men. Lung cancer (Amsterdam, Netherlands). 2014;85(3):361–5.CrossRef
27.
Guo L, Li N, Wang G, Su K, Li F, Yang L, Ren J, Chang S, Chen S, Wu S et al: Body mass index and cancer incidence:a prospective cohort study in northern China. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 2014, 35(3):231–236.
28.
Knekt P, Heliovaara M, Rissanen A, Aromaa A, Seppanen R, Teppo L, Pukkala E. Leanness and lung-cancer risk. Int J Cancer. 1991;49(2):208–13.CrossRefPubMed
29.
Koh WP, Yuan JM, Wang R, Lee HP, Yu MC. Body mass index and smoking-related lung cancer risk in the Singapore Chinese health study. Br J Cancer. 2010;102(3):610–4.CrossRefPubMed
30.
Yang Y, Dong J, Sun K, Zhao L, Zhao F, Wang L, Jiao Y. Obesity and incidence of lung cancer: a meta-analysis. Int J Cancer. 2013;132(5):1162–9.CrossRefPubMed
31.
Duan P, Hu C, Quan C, Yi X, Zhou W, Yuan M, Yu T, Kourouma A, Yang K. Body mass index and risk of lung cancer: systematic review and dose-response meta-analysis. Sci Rep. 2015;5:16938.CrossRefPubMedPubMedCentral
32.
33.
Wannamethee SG, Shaper AG, Walker M. Weight change, body weight and mortality: the impact of smoking and ill health. Int J Epidemiol. 2001;30(4):777–86.CrossRefPubMed
34.
Henley SJ, Flanders WD, Manatunga A, Thun MJ. Leanness and lung cancer risk: fact or artifact? Epidemiology (Cambridge, Mass). 2002;13(3):268–76.CrossRef
35.
Lam TK, Moore SC, Brinton LA, Smith L, Hollenbeck AR, Gierach GL, Freedman ND. Anthropometric measures and physical activity and the risk of lung cancer in never-smokers: a prospective cohort study. PLoS One. 2013;8(8):e70672.CrossRefPubMedPubMedCentral
36.
Flegal KM, Graubard BI, Williamson DF, Cooper RS. Reverse causation and illness-related weight loss in observational studies of body weight and mortality. Am J Epidemiol. 2011;173(1):1–9.CrossRefPubMed
37.
Brennan P, McKay J, Moore L, Zaridze D, Mukeria A, Szeszenia-Dabrowska N, Lissowska J, Rudnai P, Fabianova E, Mates D, et al. Obesity and cancer: Mendelian randomization approach utilizing the FTO genotype. Int J Epidemiol. 2009;38(4):971–5.CrossRefPubMedPubMedCentral
38.
Gao C, Patel CJ, Michailidou K, Peters U, Gong J, Schildkraut J, Schumacher FR, Zheng W, Boffetta P, Stucker I, et al. Mendelian randomization study of adiposity-related traits and risk of breast, ovarian, prostate, lung and colorectal cancer. Int J Epidemiol. 2016;45(3):896–908.CrossRefPubMed
39.
Carreras-Torres R, Haycock PC, Relton CL, Martin RM, Smith GD, Kraft P, Gao C, Tworoger S, Le Marchand L, Wilkens LR, et al. The causal relevance of body mass index in different histological types of lung cancer: a Mendelian randomization study. Sci Rep. 2016;6:31121.CrossRefPubMedPubMedCentral
40.
Kanashiki M, Sairenchi T, Saito Y, Ishikawa H, Satoh H, Sekizawa K. Body mass index and lung cancer: a case-control study of subjects participating in a mass-screening program. Chest. 2005;128(3):1490–6.CrossRefPubMed
41.
Jee SH, Yun JE, Park EJ, Cho ER, Park IS, Sull JW, Ohrr H, Samet JM. Body mass index and cancer risk in Korean men and women. Int J Cancer. 2008;123(8):1892–6.CrossRefPubMed
42.
Olson JE, Yang P, Schmitz K, Vierkant RA, Cerhan JR, Sellers TA. Differential association of body mass index and fat distribution with three major histologic types of lung cancer: evidence from a cohort of older women. Am J Epidemiol. 2002;156(7):606–15.CrossRefPubMed
43.
Oh SW, Yoon YS, Shin S-A. Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J Clin Oncol. 2005;23(21):4742–54.CrossRefPubMed
44.
45.
Riboli E, Kaaks R. The EPIC project: rationale and study design. European prospective investigation into cancer and nutrition. Int J Epidemiol. 1997;26:Suppl 1:S6–14.
46.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, Charrondiere UR, Hemon B, Casagrande C, Vignat J, et al. European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr. 2002;5(6b):1113–24.CrossRefPubMed
47.
Thornquist MD, Omenn GS, Goodman GE, Grizzle JE, Rosenstock L, Barnhart S, Anderson GL, Hammar S, Balmes J, Cherniack M, et al. Statistical design and monitoring of the carotene and retinol efficacy trial (CARET). Control Clin Trials. 1993;14(4):308–24.CrossRefPubMed
48.
Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, Keogh JP, Meyskens FL, Valanis B, Williams JH, et al. Effects of a combination of beta carotene and vitamin a on lung cancer and cardiovascular disease. N Engl J Med. 1996;334(18):1150–5.CrossRefPubMed
49.
Ross RK, Yuan JM, Yu MC, Wogan GN, Qian GS, Tu JT, Groopman JD, Gao YT, Henderson BE. Urinary aflatoxin biomarkers and risk of hepatocellular carcinoma. Lancet (London, England). 1992;339(8799):943–6.CrossRef
50.
Yuan JM, Ross RK, Wang XL, Gao YT, Henderson BE. Yu MC: morbidity and mortality in relation to cigarette smoking in shanghai, China. A prospective male cohort study. JAMA. 1996;275(21):1646–50.CrossRefPubMed
51.
Hankin JH, Stram DO, Arakawa K, Park S, Low SH, Lee HP, Yu MC. Singapore Chinese health study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer. 2001;39(2):187–95.CrossRefPubMed
52.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clin Res ed). 2003;327(7414):557–60.CrossRef
53.
Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010;29(9):1037–57.PubMed
54.
Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet (London, England). 2014;384(9945):755–65.CrossRef
55.
Kim KH, Jahan SA, Kabir E, Brown RJ. A review of airborne polycyclic aromatic hydrocarbons (PAHs) and their human health effects. Environ Int. 2013;60:71–80.CrossRefPubMed
56.
57.
Godschalk RW, Feldker DE, Borm PJ, Wouters EF, van Schooten FJ. Body mass index modulates aromatic DNA adduct levels and their persistence in smokers. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2002;11(8):790–3.
58.
Rundle A, Madsen A, Orjuela M, Mooney L, Tang D, Kim M, Perera F. The association between benzo[a]pyrene-DNA adducts and body mass index, calorie intake and physical activity. Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals. 2007;12(2):123–32.CrossRef
59.
Mizoue T, Tokunaga S, Kasai H, Kawai K, Sato M, Kubo T. Body mass index and oxidative DNA damage: a longitudinal study. Cancer Sci. 2007;98(8):1254–8.CrossRefPubMed
60.
Li X, Bai Y, Wang S, Nyamathira SM, Zhang X, Zhang W, Wang T, Deng Q, He M, Zhang X, et al. Association of body mass index with chromosome damage levels and lung cancer risk among males. Sci Rep. 2015;5:9458.CrossRefPubMedPubMedCentral
61.
Dick KJ, Nelson CP, Tsaprouni L, Sandling JK, Aissi D, Wahl S, Meduri E, Morange PE, Gagnon F, Grallert H, et al. DNA methylation and body-mass index: a genome-wide analysis. Lancet (London, England). 2014;383(9933):1990–8.CrossRef
62.
63.
Pasanen A, Heikkila M, Rautavuoma K, Hirsila M, Kivirikko KI, Myllyharju J. Hypoxia-inducible factor (HIF)-3alpha is subject to extensive alternative splicing in human tissues and cancer cells and is regulated by HIF-1 but not HIF-2. Int J Biochem Cell Biol. 2010;42(7):1189–200.CrossRefPubMed
64.
Heikkila M, Pasanen A, Kivirikko KI, Myllyharju J. Roles of the human hypoxia-inducible factor (HIF)-3alpha variants in the hypoxia response. Cellular and molecular life sciences : CMLS. 2011;68(23):3885–901.CrossRefPubMed
65.
Stommel M, Schoenborn CA. Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006. BMC Public Health. 2009;9:421.CrossRefPubMedPubMedCentral
66.
Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002;5(4):561–5.CrossRefPubMed
67.
Palta M, Prineas RJ, Berman R, Hannan P. Comparison of self-reported and measured height and weight. Am J Epidemiol. 1982;115(2):223–30.CrossRefPubMed
Metadata
Title
Body mass index and lung cancer risk: a pooled analysis based on nested case-control studies from four cohort studies
Authors
Harinakshi Sanikini
Jian-Min Yuan
Lesley M. Butler
Woon-Puay Koh
Yu-Tang Gao
Annika Steffen
Mattias Johansson
Paolo Vineis
Gary E. Goodman
Matt J. Barnett
Rayjean J. Hung
Chu Chen
Isabelle Stücker
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4124-0

Other articles of this Issue 1/2018

BMC Cancer 1/2018 Go to the issue

Research article

ADSCs and adipocytes are the main producers in the autotaxin–lysophosphatidic acid axis of breast cancer and healthy mammary tissue in vitro

Research article

Intra-arterial ethanol embolization augments response to TACE for treatment of HCC with portal venous tumor thrombus

Research article

Metformin, Asian ethnicity and risk of prostate cancer in type 2 diabetes: a systematic review and meta-analysis

Research article

The alterations of cytokeratin and vimentin protein expressions in primary esophageal spindle cell carcinoma

Research article

Retrospective analysis of the impact of anthracycline dose reduction and chemotherapy delays on the outcomes of early breast cancer molecular subtypes

Research article

Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: emphasis on partial nephrectomy
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits