Akindele Olupelumi Adebiyi1, Ann W Hsing2,3,4,5, Ilir Agalliu6, Wei-Kaung Jerry Lin7, Janice S Zhang8,7, Judith S Jacobson9, Thomas E Rohan8, Ben Adusei10, Nana Yaa F Snyper10, Caroline Andrews11, Elkhansa Sidahmed11,12, James E Mensah13, Richard Biritwum13, Andrew A Adjei14, Victoria Okyne13, Joana Ainuson-Quampah15, Pedro Fernandez16, Hayley Irusen16, Emeka Odiaka17, Oluyemisi Folake Folasire17, Makinde Gabriel Ifeoluwa17, Oseremen I Aisuodionoe-Shadrach18, Maxwell Madueke Nwegbu18, Audrey Pentz19, Wenlong Carl Chen19,20,21, Maureen Joffe19,22, Alfred I Neugut23, Thierno Amadou Diallo24, Mohamed Jalloh24, Timothy R Rebbeck11,12. 1. College of Medicine and University College Hospital, University of Ibadan, Ibadan, Nigeria. adebiyi20012002@yahoo.com. 2. Stanford School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. annhsing@stanford.edu. 3. Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA, USA. annhsing@stanford.edu. 4. Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA. annhsing@stanford.edu. 5. Stanford Cancer Institute, 780 Welch Road, Room 250D, Stanford, CA, 94305, USA. annhsing@stanford.edu. 6. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA. ilir.agalliu@einsteinmed.org. 7. Stanford School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. 8. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA. 9. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. 10. 37 Military Hospital, Accra, Ghana. 11. Dana Farber Cancer Institute, Boston, MA, USA. 12. Harvard T.H. Chan School of Public Health, Boston, MA, USA. 13. Korle-Bu Teaching Hospital and University of Ghana, Accra, Ghana. 14. College of Health Sciences, University of Ghana Medical School, Accra, Ghana. 15. College of Health Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana. 16. Stellenbosch University, Cape Town, South Africa. 17. College of Medicine and University College Hospital, University of Ibadan, Ibadan, Nigeria. 18. College of Health Sciences, University of Abuja, and University of Abuja Teaching Hospital and Cancer Science Centre, Abuja, Nigeria. 19. Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa. 20. National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa. 21. Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 22. SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 23. Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA. 24. Institut de Formation et de la Recherche en Urologie et de la Santé Familiale, Hôpital Général de Grand Yoff, Dakar, Senegal.
Abstract
PURPOSE: African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men. METHODS: Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multi-center, hospital-based case-control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively. RESULTS: Among controls 16.4% were obese (BMI ≥ 30 kg/m2), 26% and 90% had WC > 97 cm and WHR > 0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive PCa, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR = 1.38, 95% CI 0.99-1.93), and central obesity (WC > 97 cm: OR = 1.60, 95% CI 1.10-2.33; and WHtR > 0.59: OR = 1.68, 95% CI 1.24-2.29) were positively associated with D'Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant. DISCUSSION: The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.
PURPOSE: African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men. METHODS: Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multi-center, hospital-based case-control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively. RESULTS: Among controls 16.4% were obese (BMI ≥ 30 kg/m2), 26% and 90% had WC > 97 cm and WHR > 0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive PCa, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR = 1.38, 95% CI 0.99-1.93), and central obesity (WC > 97 cm: OR = 1.60, 95% CI 1.10-2.33; and WHtR > 0.59: OR = 1.68, 95% CI 1.24-2.29) were positively associated with D'Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant. DISCUSSION: The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.
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