Adiposity and cancer at major anatomical sites: umbrella review of the literature
Open accessAbstract
Objective To evaluate the strength and validity of the evidence for the association between adiposity and risk of developing or dying from cancer. Design Umbrella review of systematic reviews and meta-analyses. Data sources PubMed, Embase, Cochrane Database of Systematic Reviews, and manual screening of retrieved references. Eligibility criteria Systematic reviews or meta-analyses of observational studies that evaluated the association between indices of adiposity and risk of developing or dying from cancer. Data synthesis Primary analysis focused on cohort studies exploring associations for continuous measures of adiposity. The evidence was graded into strong, highly suggestive, suggestive, or weak after applying criteria that included the statistical significance of the random effects summary estimate and of the largest study in a meta-analysis, the number of cancer cases, heterogeneity between studies, 95% prediction intervals, small study effects, excess significance bias, and sensitivity analysis with credibility ceilings. Results 204 meta-analyses investigated associations between seven indices of adiposity and developing or dying from 36 primary cancers and their subtypes. Of the 95 meta-analyses that included cohort studies and used a continuous scale to measure adiposity, only 12 (13%) associations for nine cancers were supported by strong evidence. An increase in body mass index was associated with a higher risk of developing oesophageal adenocarcinoma; colon and rectal cancer in men; biliary tract system and pancreatic cancer; endometrial cancer in premenopausal women; kidney cancer; and multiple myeloma. Weight gain and waist to hip circumference ratio were associated with higher risks of postmenopausal breast cancer in women who have never used hormone replacement therapy and endometrial cancer, respectively. The increase in the risk of developing cancer for every 5 kg/m2 increase in body mass index ranged from 9% (relative risk 1.09, 95% confidence interval 1.06 to 1.13) for rectal cancer among men to 56% (1.56, 1.34 to 1.81) for biliary tract system cancer. The risk of postmenopausal breast cancer among women who have never used HRT increased by 11% for each 5 kg of weight gain in adulthood (1.11, 1.09 to 1.13), and the risk of endometrial cancer increased by 21% for each 0.1 increase in waist to hip ratio (1.21, 1.13 to 1.29). Five additional associations were supported by strong evidence when categorical measures of adiposity were included: weight gain with colorectal cancer; body mass index with gallbladder, gastric cardia, and ovarian cancer; and multiple myeloma mortality. Conclusions Although the association of adiposity with cancer risk has been extensively studied, associations for only 11 cancers (oesophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colon, rectum, biliary tract system, pancreas, breast, endometrium, ovary, and kidney) were supported by strong evidence. Other associations could be genuine, but substantial uncertainty remains. Obesity is becoming one of the biggest problems in public health; evidence on the strength of the associated risks may allow finer selection of those at higher risk of cancer, who could be targeted for personalised prevention strategies.
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Obesity may also increase the risk of breast cancer in postmenopausal women.
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From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [85]
An anomalous protective effect was found for lung cancer that was reported to be derived from a small sample of heterogeneous studies.
“an anomalous protective effect was found for lung cancer that was reported to be derived from a small sample of heterogeneous studies.85”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [85]
Obesity was associated with an increased risk of AD, DM, CHD, stroke and liver and bowel cancer by between 33% and 588%.
“Obesity was associated with an increased risk of AD, DM, CHD, stroke and liver and bowel cancer by between 33% and 588%.11,77,81,85”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [85]
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Self-citationAune, D., Navarro Rosenblatt, D. A., Chan, D. S. M., Abar, L., Vingeliene, S., Vieira, A. R., Greenwood, D. C., & Norat, T. (2015) · International Journal of Cancer · doi:10.1002/ijc.29207 · Cited by 100 · see citing works
The association between BMI and cervical cancer risk
Poorolajal, J., & Jenabi, E. (2015) · European Journal of Cancer Prevention · doi:10.1097/cej.0000000000000164 · Cited by 99 · see citing works
Mendelian Randomization Study of Body Mass Index and Colorectal Cancer Risk
Thrift, A. P., Gong, J., Peters, U., Chang-Claude, J. C., Rudolph, A., Slattery, M. L., Chan, A. T., Locke, A. E., Kahali, B., Justice, A. E., et al. (2015) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-14-1309 · Cited by 93 · see citing works
Tsilidis, K. K., Papatheodorou, S., Εvangelou, Ε., & Ioannidis, J. P. A. (2012) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djs437 · Cited by 93 · see citing works
Self-citationImpact of obesity upon prostate cancer-associated mortality: A meta-analysis of 17 cohort studies
ZHANG, X., ZHOU, G., SUN, B., ZHAO, G., LIU, D., SUN, J., LIU, C., & GUO, H. (2015) · Oncology Letters · doi:10.3892/ol.2014.2841 · Cited by 91 · see citing works
Keum, N., Greenwood, D. C., Lee, D. H., Kim, R., Aune, D., Ju, W., Hu, F. B., & Giovannucci, E. L. (2015) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/dju428 · Cited by 87 · see citing works
Incidence of Cancer Following Bariatric Surgery: Systematic Review and Meta-analysis
Casagrande, D. S., Rosa, D. D., Umpierre, D., Sarmento, R. A., Rodrigues, C. G., & Schaan, B. D. (2014) · Obesity Surgery · doi:10.1007/s11695-014-1276-0 · Cited by 86 · see citing works
Body size and breast cancer risk: The multiethnic cohort
White, K. K. L., Park, S., Kolonel, L. N., Henderson, B. E., & Wilkens, L. R. (2011) · International Journal of Cancer · doi:10.1002/ijc.27373 · Cited by 81 · see citing works
Upala, S., & Sanguankeo, A. (2014) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2014.09.024 · Cited by 78 · see citing works
Schlesinger, S., Lieb, W., Koch, M., Fedirko, V., Dahm, C. C., Pischon, T., Nöthlings, U., Boeing, H., & Aleksandrova, K. (2015) · Obesity Reviews · doi:10.1111/obr.12286 · Cited by 70 · see citing works
Body Mass Index and Risk of Primary Liver Cancer: A Meta-Analysis of Prospective Studies
Wang, Y., Wang, B., Shen, F., Fan, J., & Cao, H. (2012) · The Oncologist · doi:10.1634/theoncologist.2012-0066 · Cited by 67 · see citing works
Castillo, J. J., Ingham, R. R., Reagan, J. L., Furman, M. S., Dalia, S. M., & Mitri, J. (2013) · Clinical Lymphoma Myeloma & Leukemia · doi:10.1016/j.clml.2013.10.005 · Cited by 54 · see citing works
Park, M., Song, D. Y., Je, Y., & Lee, J. E. (2014) · Preventive Medicine · doi:10.1016/j.ypmed.2014.03.027 · Cited by 53 · see citing works
Overweight, Obesity and Meningioma Risk: A Meta-Analysis
Shao, C., Bai, L.-P., Qi, Z., Hui, G., & Wang, Z. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090167 · Cited by 52 · see citing works
Obesity and the risk of cholangiocarcinoma: a meta-analysis
Li, J.-S., Han, T., Jing, N., Li, L., Zhang, X., Ma, F.-Z., & Liu, J. (2014) · Tumor Biology · doi:10.1007/s13277-014-1939-4 · Cited by 50 · see citing works
Papatheodorou, S., Tsilidis, K. K., Εvangelou, Ε., & Ioannidis, J. P. A. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.09.004 · Cited by 42 · see citing works
Self-citationBody Mass Index Effects on Risk of Ovarian Cancer: A Meta-Analysis
Poorolajal, J., Jenabi, E., & Masoumi, S. Z. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.18.7665 · Cited by 39 · see citing works
Carreras‐Torres, R., Haycock, P., Relton, C. L., Martin, R. M., Smith, G. D., Kraft, P., Gao, C., Tworoger, S. S., Marchand, L. L., Wilkens, L. R., et al. (2016) · Scientific Reports · doi:10.1038/srep31121 · Cited by 32 · see citing works
Sandholt, C. H., Allin, K. H., Toft, U., Borglykke, A., Ribel‐Madsen, R., Sparsø, T., Justesen, J. M., Harder, M. N., Jørgensen, T., Hansen, T. F., et al. (2013) · Obesity · doi:10.1002/oby.20540 · Cited by 31 · see citing works
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Obesity and cancer risk: Emerging biological mechanisms and perspectives
Avgerinos, K. I., Spyrou, N., Mantzoros, C. S., & Dalamaga, M. (2019) · Metabolism · doi:10.1016/j.metabol.2018.11.001 · Cited by 1,567 · see citing works
PATEL, A. V., FRIEDENREICH, C. M., MOORE, S. C., HAYES, S. C., SILVER, J. K., CAMPBELL, K. L., WINTERS-STONE, K., GERBER, L. H., GEORGE, S. M., FULTON, J. E., et al. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002117 · Cited by 861 · see citing works
The Intestinal Microbiota in Colorectal Cancer.
Tilg, H., Adolph, T. E., Gerner, R. R., & Moschen, A. R. (2018) · Cancer Cell · doi:10.1016/j.ccell.2018.03.004 · Cited by 777 · see citing works
Cupp, M. A., Cariolou, M., Tzoulaki, I., Aune, D., Evangelou, E., & Berlanga-Taylor, A. J. (2020) · BMC Medicine · doi:10.1186/s12916-020-01817-1 · Cited by 697 · see citing works
US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., et al. (2018) · JAMA · doi:10.1001/jama.2018.13022 · Cited by 563 · see citing works
What causes psychosis? An umbrella review of risk and protective factors
Radua, J., Ramella‐Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., Yenn Thoo, H., Oliver, D., Davies, C., Morgan, C., et al. (2018) · World Psychiatry · doi:10.1002/wps.20490 · Cited by 553 · see citing works
Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses
Veronese, N., Solmi, M., Caruso, M. G., Giannelli, G., Osella, A. R., Evangelou, E., Maggi, S., Fontana, L., Stubbs, B., & Tzoulaki, I. (2018) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqx082 · Cited by 536 · see citing works
Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women
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., et al. (2019) · JAMA Oncology · doi:10.1001/jamaoncol.2018.4280 · Cited by 514 · see citing works
Executive Function Performance in Obesity and Overweight Individuals: A Meta-Analysis and Review
Yang, Y., Shields, G. S., Guo, C., & Liu, Y. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.11.020 · Cited by 498 · see citing works
LeBlanc, E. S., Patnode, C. D., Webber, E. M., Redmond, N., Rushkin, M., & O’Connor, E. A. (2018) · JAMA · doi:10.1001/jama.2018.7777 · Cited by 463 · see citing works
Direct medical costs of obesity in the United States and the most populous states
Cawley, J., Biener, A., Meyerhoefer, C., Ding, Y., Zvenyach, T., Smolarz, B. G., & Ramasamy, A. (2021) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2021.20410 · Cited by 400 · see citing works
Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity
Aminian, A., Wilson, R., Al-Kurd, A., Tu, C., Milinovich, A., Kroh, M., Rosenthal, R. J., Brethauer, S. A., Schauer, P. R., Kattan, M. W., et al. (2022) · JAMA · doi:10.1001/jama.2022.9009 · Cited by 357 · see citing works
Hunt, H., Pollock, A., Campbell, P., Estcourt, L., & Brunton, G. (2018) · Systematic Reviews · doi:10.1186/s13643-018-0695-8 · Cited by 314 · see citing works
Köhler, C. A., Evangelou, E., Stubbs, B., Solmi, M., Veronese, N., Belbasis, L., Bortolato, B., Melo, M. C. A., Coelho, C. A., Fernandes, B. S., et al. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.05.020 · Cited by 302 · see citing works
Rezende, L. F. M. D., Sá, T. H. D., Markozannes, G., Rey-López, J. P., Lee, I.-M., Tsilidis, K. K., Ioannidis, J. P. A., & Eluf-Neto, J. (2018) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-098391 · Cited by 276 · see citing works
Self-citationKim, J. Y., Son, M. J., Son, C. Y., Radua, J., Eisenhut, M., Gressier, F., Koyanagi, A., Carvalho, A. F., Stubbs, B., Solmi, M., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30181-6 · Cited by 271 · see citing works
Peters, R., Ee, N., Peters, J., Beckett, N., Booth, A., Rockwood, K., & Anstey, K. J. (2019) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622319880392 · Cited by 213 · see citing works
Contribution of adipose tissue to development of cancer
Cozzo, A. J., Fuller, A. M., & Makowski, L. (2017) · Comprehensive Physiology · doi:10.1002/cphy.c170008 · Cited by 188 · see citing works
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Nauck, M. A., Jensen, T. J., Rosenkilde, C., Calanna, S., Buse, J. B., & the LEADER Publication Committee on behalf of the LEADER Trial Investigators (2018) · Diabetes Care · doi:10.2337/dc17-1825 · Cited by 94 · see citing works
Validation of obesity‐related diagnosis codes in claims data
Suissa, K., Schneeweiss, S., Lin, K. J., Brill, G., Kim, S. C., & Patorno, E. (2021) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14512 · Cited by 89 · see citing works
Special Report: The Biology of Inequalities in Health: The Lifepath Consortium
Vineis, P., Avendano-Pabon, M., Barros, H., Bartley, M., Carmeli, C., Carra, L., Chadeau-Hyam, M., Costa, G., Delpierre, C., D'Errico, A., et al. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00118 · Cited by 80 · see citing works
Efficacy and safety of once-weekly semaglutide in adults with overweight or obesity: a meta-analysis
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Sarcopenic obesity and health outcomes: An umbrella review of systematic reviews with meta‐analysis
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Psaltopoulou, T., Sergentanis, T. N., Ntanasis‐Stathopoulos, I., Tzanninis, I., Riza, E., & Dimopoulos, M. A. (2019) · International Journal of Cancer · doi:10.1002/ijc.32109 · Cited by 47 · see citing works
Zinc supplementation reduces diet-induced obesity and improves insulin sensitivity in rats
Thoen, R. U., Barther, N. N., Schemitt, E., Bona, S., Fernandes, S., Coral, G., Marroni, N. P., Tovo, C., Guedes, R. P., & Porawski, M. (2019) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2018-0519 · Cited by 43 · see citing works
Outdoor air quality and human health: An overview of reviews of observational studies
Markozannes, G., Pantavou, K., Rizos, E. C., Sindosi, O. Α., Tagkas, C., Seyfried, M., Saldanha, I. J., Hatzianastassiou, N., Nikolopoulos, G. K., & Ntzani, E. (2022) · Environmental Pollution · doi:10.1016/j.envpol.2022.119309 · Cited by 40 · see citing works
Self-citationComprehensive cancer control: promoting survivor health and wellness
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Maternal adiposity and perinatal and offspring outcomes: an umbrella review
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- Authors
- Kyrgiou, M., Kalliala, I., Markozannes, G., Gunter, M. J., Paraskevaidis, E., Gabra, H., Martin-Hirsch, P., & Tsilidis, K. K.
- Affiliations
- Hammersmith Hospital (GB)
- Imperial College London (GB)
- University of Ioannina (GR)
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Kyrgiou, Maria
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-02-28
- Volume
- 356
- Pages
- j477
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC5421437
- OpenAlex
- W2592578600
- Cited by
- 803
- References
- 109
- Citations by year
- 2026: 36 · 2025: 65 · 2024: 109 · 2023: 94 · 2022: 111 · 2021: 106 · 2020: 82 · 2019: 80 · 2018: 85 · 2017: 34
- FWCI
- 8.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CLOK (University of Central Lancashire) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- World Health Organization
- Genesis Research Trust (P63522)
- World Cancer Research Fund International (2014/1180)
- Cancer Research UK
- National Institute for Health and Care Research (P45272)
- Ovarian Cancer Action (PS5827)
- Imperial Experimental Cancer Medicine Centre
- World Cancer Research Fund (2014/1180)
- 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 › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- adiposity, cancer risk, body mass index, weight gain, waist-to-hip ratio, esophageal adenocarcinoma, colon and rectal cancer, biliary tract cancer, pancreatic cancer, endometrial cancer, postmenopausal breast cancer, kidney cancer, multiple myeloma, hormone replacement therapy, level of evidence, cancer mortality
- MeSH terms
- Humans, Neoplasms, Meta-Analysis as Topic, Adiposity, Observational Studies as Topic
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.
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