Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women
Open accessAbstract
Importance: Colorectal cancer (CRC) incidence and mortality among individuals younger than 50 years (early-onset CRC) are increasing. The reasons for such increases are largely unknown, although the increasing prevalence of obesity may be partially responsible. Objective: To investigate prospectively the association between obesity and weight gain since early adulthood with the risk of early-onset CRC. Design, Setting, and Participants: The Nurses' Health Study II is a prospective, ongoing cohort study of US female nurses aged 25 to 42 years at study enrollment (1989). A total of 85 256 women free of cancer and inflammatory bowel disease at enrollment were included in this analysis, with follow-up through December 31, 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially. Statistical analysis was performed from June 12, 2017, to June 28, 2018. Exposures: Current body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), BMI at 18 years of age, and weight gain since 18 years of age. Main Outcomes and Measures: Relative risk (RR) for incident early-onset CRC. Results: Among the 85 256 women studied, 114 cases of early-onset CRC were documented (median age at diagnosis, 45 years; interquartile range, 41-47 years) during 1 196 452 person-years of follow-up. Compared with women with a BMI of 18.5 to 22.9, the multivariable RR was 1.37 (95% CI, 0.81-2.30) for overweight women (BMI, 25.0-29.9) and 1.93 (95% CI, 1.15-3.25) for obese women (BMI, ≥30.0). The RR for each 5-unit increment in BMI was 1.20 (95% CI, 1.05-1.38; P = .01 for trend). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at 18 years of age and weight gain since 18 years of age contributed to this observation. Compared with women with a BMI of 18.5 to 20.9 at 18 years of age, the RR of early-onset CRC was 1.32 (95% CI, 0.80-2.16) for women with a BMI of 21.0 to 22.9 and 1.63 (95% CI, 1.01-2.61) for women with a BMI of 23.0 or greater at 18 years of age (P = .66 for trend). Compared with women who had gained less than 5.0 kg or had lost weight, the RR of early-onset CRC was 1.65 (95% CI, 0.96-2.81) for women gaining 20.0 to 39.9 kg and 2.15 (95% CI, 1.01-4.55) for women gaining 40.0 kg or more (P = .007 for trend). Conclusions and Relevance: Obesity was associated with an increased risk of early-onset CRC among women. Further investigations among men and to elucidate the underlying biological mechanisms are warranted.
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The development of colorectal cancer is associated with the action of non-modifiable and modifiable risk factors.
“The development of CRC is associated with the action of non-modifiable and modifiable risk factors.”
From Risk factors, prevention and screening of colorectal cancer: A rising problem (2025) · cites this paper as [5]
Modifiable factors for colorectal cancer are associated with characteristics of a person's lifestyle, including obesity, tobacco smoking, alcohol consumption, and unhealthy diet.
“Modifiable factors are associated with the characteristics of a person's lifestyle (obesity, tobacco smoking, alcohol consumption, unhealthy diet)[5-10].”
From Risk factors, prevention and screening of colorectal cancer: A rising problem (2025) · cites this paper as [5]
Obesity might contribute to the increasing incidence of young-onset colorectal cancer.
“Obesity might also be contributing to the increasing incidence of young-onset CRC.79”
From Influence of the Gut Microbiome, Diet, and Environment on Risk of Colorectal Cancer (2020) · cites this paper as [79]
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- Authors
- Liu, P.-H., Wu, K., Ng, K., Zauber, A. G., Nguyen, L. H., Song, M., He, X., Fuchs, C. S., Ogino, S., Willett, W. C., Chan, A. T., Giovannucci, E. L., & Cao, Y.
- Affiliations
- Harvard University (US)
- Memorial Sloan Kettering Cancer Center (US)
- Yale Cancer Center (US)
- Broad Institute (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Cao, Yin
- ORCID
- Venue
- JAMA Oncology
- Publisher
- American Medical Association (AMA)
- Published
- 2019-01-01
- Volume
- 5
- Issue
- 1
- Pages
- 37
- ISSN
- 2374-2437 (ISSN-L)
- PMC
- PMC6382547
- OpenAlex
- W2896926952
- Cited by
- 514
- References
- 91
- Citations by year
- 2026: 45 · 2025: 65 · 2024: 77 · 2023: 79 · 2022: 90 · 2021: 70 · 2020: 56 · 2019: 30 · 2018: 1
- FWCI
- 14.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Crohn's and Colitis Foundation (563526)
- National Cancer Institute (R01CA118553, R01CA137178, R35CA197735, UM1CA176726, K07CA218377, P30CA008748, R01CA205406)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK098311)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- early-onset colorectal cancer, obesity, body mass index, young women, colorectal cancer risk factors, Nurses' Health Study II, overweight, family history of colorectal cancer, colorectal cancer screening
- MeSH terms
- Adult, Female, Humans, Middle Aged, Nurses, Obesity, Prospective Studies, Risk Factors, Time Factors, United States, Colorectal Neoplasms, Weight Gain, Body Mass Index, Incidence, Age of Onset, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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