Sangjun Lee1,2,3, Jieun Jang1,2,3, Sarah Krull Abe4, Shafiur Rahman4,5, Eiko Saito6, Rashedul Islam4,7, Prakash C Gupta8, Norie Sawada9, Akiko Tamakoshi10, Xiao-Ou Shu11, Woon-Puay Koh12,13, Atsuko Sadakane14, Ichiro Tsuji15, Jeongseon Kim16, Isao Oze17, Chisato Nagata18, San-Lin You19, Myung-Hee Shin20, Mangesh S Pednekar8, Shoichiro Tsugane9, Hui Cai11, Jian-Min Yuan21,22, Wanqing Wen11, Kotaro Ozasa14, Sanae Matsuyama15, Seiki Kanemura15, Aesun Shin1,2,23, Hidemi Ito24,25, Keiko Wada18, Yumi Sugawara15, Chien-Jen Chen26, Yoon-Ok Ahn1, Yu Chen27, Habibul Ahsan28, Paolo Boffetta29,30, Kee Seng Chia13, Keitaro Matsuo17,31, You-Lin Qiao32, Nathaniel Rothman33, Wei Zheng11, Manami Inoue4, Daehee Kang1,2,23, Sue K Park1,2,23. 1. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. 2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. 4. Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. 5. Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 6. Division of Cancer Statistics Integration, Center for Cancer Control & Information Services, National Cancer Center, Tokyo, Japan. 7. Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 8. Healis-Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India. 9. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. 10. Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 11. Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, USA. 12. Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, Singapore, Singapore. 13. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. 14. Radiation Effects Research Foundation, Hiroshima, Japan. 15. Tohoku University Graduate School of Medicine, Miyagi Prefecture, Miyagi, Japan. 16. Graduate School of Science and Policy, National Cancer Center, Goyang, Korea. 17. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Naogya, Japan. 18. Graduate School of Medicine, Gifu University, Gifu, Japan. 19. School of Medicine & Big Data Research Center, Fu Jen Catholic University, Taipei, Taiwan. 20. Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. 21. Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA. 22. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 23. Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea. 24. Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan. 25. Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 26. Genomics Research Center, Academia Sinica, Taipei, Taiwan. 27. Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, USA. 28. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA. 29. Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA. 30. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 31. Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 32. Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 33. Division of Cancer Epidemiology & Genetics, Occupational and Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA.
Abstract
BACKGROUND: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. METHODS: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. CONCLUSION: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.
BACKGROUND: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. METHODS: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. CONCLUSION: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.
Authors: Matthew D Venesky; Travis E Wilcoxen; Michelle A Rensel; Louise Rollins-Smith; Jacob L Kerby; Matthew J Parris Journal: Oecologia Date: 2011-10-30 Impact factor: 3.225
Authors: Sun Ha Jee; Jae Woong Sull; Jungyong Park; Sang-Yi Lee; Heechoul Ohrr; Eliseo Guallar; Jonathan M Samet Journal: N Engl J Med Date: 2006-08-22 Impact factor: 91.245
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