Reevaluating the fraction of cancer attributable to excess weight: overcoming the hidden impact of prediagnostic weight loss,European Journal of Epidemiology

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Reevaluating the fraction of cancer attributable to excess weight: overcoming the hidden impact of prediagnostic weight loss
European Journal of Epidemiology ( IF 7.7 ) Pub Date : 2024-09-18 , DOI: 10.1007/s10654-024-01146-0
Fatemeh Safizadeh _{1,

2} , Marko Mandic _{1,

2} , Michael Hoffmeister ₁ , Hermann Brenner _{1,

3,

4}

Affiliation

Objective

To evaluate the magnitude of the potential underestimation of the proportion of cancer cases attributable to excess weight, known as population attributable fraction (PAF), due to potential bias from prediagnostic weight loss already present at baseline of cohort studies and to overcome it as much as possible.

Methods

Data from the UK Biobank cohort participants aged 40–69 without prior cancer diagnosis were analyzed. We assessed the magnitude of associations of excess weight with the incidence of obesity-related cancers combined, and separately for gastrointestinal (GI) and other cancers. Using multivariable Cox proportional hazards models, hazard ratios (HR) and their 95% confidence intervals (CI), and PAFs for excess weight at baseline were estimated for various periods of time after weight measurements.

Findings

Of 458,660 participants, 20,218 individuals developed obesity-related cancers during a median 11.0-year follow-up, comprising 8,460 GI, and 11,765 non-GI cancers. PAFs were much higher for cancers occurring more than four years after recruitment than for cancers occurring within the initial four years: 17.7% versus 7.2%, 21.4% versus 11.7% for GI, non-GI and all obesity-related cancers combined, respectively. With respect to total cancer (including cancers with no established relationship with excess weight), PAFs were estimated as 5.1% and 8.8% for the 0–4 and 4-14-year periods of follow-up.

Conclusion

The proportion of cancers attributable to excess weight is likely substantially larger than previously estimated based on cohort studies with short follow-up time or no or only limited exclusion of the early years of follow-up from the analyses.

中文翻译：

重新评估超重导致的癌症比例：克服诊断前体重减轻的隐藏影响

目的

评估由于队列研究基线时已经存在的诊断前体重减轻的潜在偏倚而可能低估的癌症病例比例的程度，称为人群归因分数（PAF），并尽可能地克服它。

方法

分析了来自 40-69 岁且既往未诊断出癌症的英国生物样本库队列参与者的数据。我们评估了超重与肥胖相关癌症发病率的关联程度，并分别评估了胃肠道（GI）和其他癌症的关联程度。使用多变量 Cox 比例风险模型，在体重测量后的不同时间段内估计风险比（HR）及其 95% 置信区间（CI）和基线超重的 PAF。

发现

在 458,660 名参与者中，有 20,218 人在中位 11.0 年的随访期间患上了肥胖相关癌症，其中包括 8,460 名胃肠道癌症和 11,765 名非胃肠道癌症。招募后四年以上发生的癌症的 PAF 远高于最初四年内发生的癌症：胃肠道、非胃肠道和所有肥胖相关癌症的总和分别为 17.7% 对 7.2%、21.4% 对 11.7%。关于总癌症（包括与超重没有确定关系的癌症），在 0-4 年和 4-14 年随访期间，PAF 估计为 5.1% 和 8.8%。