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Cited by 7,696Cancer Risks and FactorsObesity, Physical Activity, DietGlobal Cancer Incidence and Screening

Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. Adults

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Calle, Eugenia E., Rodriguez, Carmen, Walker-Thurmond, Kimberly, Thun, Michael J.·2003·New England Journal of Medicine
DOI 10.1056/nejmoa021423
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Abstract

BACKGROUND: The influence of excess body weight on the risk of death from cancer has not been fully characterized. METHODS: In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population. RESULTS: The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin's lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. CONCLUSIONS: Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.

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  • The main limitation of probiotic studies is wide variation in methods, including differences in type, formulation, concentration, and duration of exposure.

    “The main limitation of these studies is the wide variation in methodologies including differences in the type, formulation, concentration, and duration of exposure to probiotics.”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1709]

    The Study Population section describes a prospective study of body-mass index and cancer mortality, while the passages on covariates and study limitations concern that analysis. Searches for probiotics and for variation in probiotic study methods found no passage addressing the claimed limitation; page numbers were not supplied for the indexed passages. (LLM, conf=0.78)

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  • Several randomized controlled trials and systematic reviews or meta-analyses have noted a positive effect of probiotics on glucose, A1C, lipids, and blood pressure.

    “Several RCTs and systematic reviews/meta-analyses have noted a positive effect of probiotics on glucose, A1C, lipids, and BP.1705–1714”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1709]

    The paper’s population attributable fraction discussion concerns body-mass index and cancer risk, not probiotic interventions. Searches for probiotics, glycemic control, A1C, lipids, and blood pressure found no passage reporting the claimed effects of probiotics in trials or reviews; the matching References passage mentions glucose only in relation to pancreatic cancer mortality. No page numbers were supplied for these passages. (LLM, conf=0.78)

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  • A large prospective analysis of more than 900,000 Americans found greater than a 50% increase in cancer mortality among patients with the highest body mass index.

    “Many epidemiological studies report associations between obesity and cancer, and a large prospective analysis of more than 900,000 Americans found greater than a 50% increase in cancer mortality in patients with the highest body mass index (15, 16).”

    From Metabolic reprogramming and cancer progression (2020) · cites this paper as [15]

  • A recent study of approximately 900,000 individuals suggests that obesity may account for 14% of cancers in men and 20% of cancers in women, and in this cohort, the heaviest men and women were 52% and 62%, respectively, more likely to die of cancer.

    “A recent study of approximately 900 000 individuals suggests that obesity may account for 14% of cancers in men and 20% of cancers in women, and in this cohort, the heaviest men and women were 52% and 62%, respectively, more likely to die of cancer.”

    From Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association (2004) · cites this paper as [75]

  • Overweight or obese individuals have a higher risk for many types of cancer compared with normal-weight individuals.

    “Overweight (BMI ≥25 and <30 kg/m2) or obese (BMI ≥30 kg/m2) individuals have a higher risk for many types of cancer compared with individuals whose BMI is considered within the normal range (18.5 to <25 kg/m2) (16,17).”

    From Diabetes and Cancer (2010) · cites this paper as [16]

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Research works printed but not linked: 9

  1. [18]18. Petrelli JM, Calle EE, Rodriguez C, Thun The New England Journal of Medicine Downloaded from nejm.org on August 29, 2023. For personal use only. No other uses without permission. Copyright © 2003 Massachusetts Medical Society. All rights reserved. n engl j med 348;17
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Authors
Calle, E. E., Rodriguez, C., Walker-Thurmond, K., & Thun, M. J.
Affiliations
American Cancer Society (US)
ORCID
Calle, Eugenia E.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2003-04-24
Volume
348
Issue
17
Pages
1625-1638
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa021423
OpenAlex
W2141662760
Cited by
7,696
References
59
Citations by year
2026: 82 · 2025: 197 · 2024: 209 · 2023: 298 · 2022: 330 · 2021: 380 · 2020: 370 · 2019: 317 · 2018: 342 · 2017: 366 · 2016: 384 · 2015: 464 · 2014: 482 · 2013: 479 · 2012: 453
FWCI
122.06
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
obesity, overweight, body mass index, cancer mortality, attributable risk, esophageal cancer, colon and rectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, kidney cancer, non-Hodgkin lymphoma, multiple myeloma, gastric cancer, prostate cancer, breast cancer, gynecologic cancer, sex differences, United States adults, NHANES
MeSH terms
Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasms, Obesity, Prospective Studies, Surveys and Questionnaires, Risk, Risk Factors, United States, Cohort Studies, Confounding Factors, Epidemiologic, Body Mass Index, Prevalence, Proportional Hazards Models

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