Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 184, Issue 2, Pages 129-139Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwv298
Keywords
body mass index; lung cancer; obesity; smoking; waist circumference; waist to hip ratio; waist-to-height ratio
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Funding
- Europe Against Cancer Programme of the European Commission
- Ligue contre le Cancer (France)
- Institut Gustave Roussy (France)
- Mutuelle Generale de l'Education Nationale
- Institut National de la Sante et de la Recherche Medicale (INSERM)
- German Cancer Aid
- German Cancer Research Center
- German Federal Ministry of Education and Research
- Danish Cancer Society
- Health Research Fund of the Spanish Ministry of Health
- Red Tematica de Investigacion Cooperativa en Cancer of the Spanish Ministry of Health (Institute de Salud Carlos III Red Tematica de Investigacion Cooperativa en Cancer) [R06/0020/0091, RD12/0036/0018]
- Regional Government of Asturias
- Cancer Research UK
- Medical Research Council, United Kingdom
- Stroke Association, United Kingdom
- British Heart Foundation
- Department of Health, United Kingdom
- Food Standards Agency, United Kingdom
- Wellcome Trust, United Kingdom
- Hellenic Health Foundation
- Associazione Italiana per la Ricerca sul CancroAIRC-Italy Italian National Research Council
- Dutch Ministry of Public Health, Welfare and Sports
- Dutch Prevention Fund
- LK Research Fund
- Zorg Onderzoek Nederland
- World Cancer Research Fund
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane, Sweden
- Norwegian Cancer Society
- County Council of Vasterbotten, Sweden
- IARC Australia Fellowship from the International Agency for Research on Cancer
- Cancer Council Australia
- Cancer Research UK [16491, 14136] Funding Source: researchfish
- Medical Research Council [MC_UU_12015/1, MC_U106179471, MR/N003284/1, G1000143, MC_PC_13048, G0401527] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10114, NF-SI-0512-10135] Funding Source: researchfish
- MRC [MC_UU_12015/1, MR/N003284/1] Funding Source: UKRI
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The associations of body mass index (BMI) and other anthropometric measurements with lung cancer were examined in 348,108 participants in the European Investigation Into Cancer and Nutrition (EPIC) between 1992 and 2010. The study population included 2,400 case patients with incident lung cancer, and the average length of follow-up was 11 years. Hazard ratios were calculated using Cox proportional hazard models in which we modeled smoking variables with cubic splines. Overall, there was a significant inverse association between BMI (weight (kg)/height (m)(2)) and the risk of lung cancer after adjustment for smoking and other confounders (for BMI of 30.0-34.9 versus 18.5-25.0, hazard ratio = 0.72, 95% confidence interval: 0.62, 0.84). The strength of the association declined with increasing follow-up time. Conversely, after adjustment for BMI, waist circumference and waist-to-height ratio were significantly positively associated with lung cancer risk (for the highest category of waist circumference vs. the lowest, hazard ratio = 1.25, 95% confidence interval: 1.05, 1.50). Given the decline of the inverse association between BMI and lung cancer over time, the association is likely at least partly due to weight loss resulting from preclinical lung cancer that was present at baseline. Residual confounding by smoking could also have influenced our findings.
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