Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Outcome and Exposures
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BMI | Body Mass Index |
CRC | Colorectal Cancer |
GBTM | Group-Based Trajectory Modeling |
HR | Hazard Ratio |
IQR | Interquartile Range |
MEC | Multiethnic Cohort Study |
NCI | National Cancer Institute |
NCDB | National Cancer Database |
PH | Proportional Hazard |
SEER | Surveillance, Epidemiology, and End Results |
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Variable | All-Cause Mortality N = 394 | No Mortality N = 530 | p-Value |
---|---|---|---|
Age (years), Median (Q1, Q3) | 64.0 (58.0, 69.0) | 57.0 (51.0, 63.0) | <0.001 |
Age of CRC Diagnosis (years) | 81.5 (75.0, 86.0) | 75.0 (69.0, 82.0) | <0.001 |
Body Mass Index (kg/m2) at cohort entry | 25.8 (23.1, 28.8) | 25.8 (23.1, 28.6) | 0.992 |
BMI Class at cohort entry | |||
Underweight | 7 (1.8%) | 8 (1.5%) | 0.637 |
Normal weight | 149 (37.8%) | 206 (38.9%) | |
Overweight | 162 (41.1%) | 220 (41.5%) | |
Class 1 Obesity | 46 (11.7%) | 70 (13.2%) | |
Class 2 Obesity | 20 (5.1%) | 18 (3.4%) | |
Class 3 Obesity | 10 (2.5%) | 8 (1.5%) | |
Change in BMI (kg/m2) | −0.7 (−2.3, 0.9) | 0.0 (−1.5, 1.6) | <0.001 |
Change in BMI (%) | −2.7 (−8.6, 3.6) | 0.0 (−5.8, 6.2) | <0.001 |
Variance of BMI | 1.5 (0.5, 3.6) | 1.2 (0.4, 3.0) | 0.127 |
Female | 202 (51.3%) | 294 (55.5%) | 0.206 |
Ethnicity * | |||
African American | 54 (13.7%) | 49 (9.2%) | 0.017 |
Hawaiian | 29 (7.4%) | 29 (5.5%) | |
Hispanic or Latino | 74 (18.8%) | 94 (17.7%) | |
Japanese | 161 (40.9%) | 212 (40.0%) | |
White | 76 (19.3%) | 146 (27.5%) | |
Diabetes | 45 (11.4%) | 38 (7.2%) | 0.027 |
Smoking at Cohort Entry | |||
Current | 62 (15.7%) | 78 (14.7%) | 0.308 |
Past | 153 (38.8%) | 184 (34.7%) | |
Never | 174 (44.2%) | 260 (49.1%) | |
Missing | 5 (1.3%) | 8 (1.5%) | |
Family History of CRC | 50 (12.7%) | 54 (10.2%) | 0.248 |
CRC Type | |||
Colon | 304 (77.2%) | 410 (77.4%) | 0.126 |
Rectal | 82 (20.8%) | 117 (22.1%) | |
Overlapping | 8 (2.0%) | 3 (0.6%) | |
CRC Stage | |||
Localized | 97 (24.6%) | 286 (54.0%) | <0.001 |
Regional | 136 (34.5%) | 209 (39.4%) | |
Distant | 108 (27.4%) | 23 (4.3%) | |
Unknown | 53 (13.5%) | 12 (2.3%) | |
BMI Follow-Up Duration (years) | 16.0 (11.0, 17.0) | 17.0 (16.0, 17.8) | <0.001 |
Follow-Up after CRC diagnosis (years) | 1.0 (0.0, 3.0) | 5.0 (2.0, 8.0) | <0.001 |
Variable | Subset | All-Cause Mortality HR (95% CI, p-Value) | CA Mortality HR (95% CI, p-Value) |
---|---|---|---|
BMI Trajectory | Group 2 | - | - |
Group 1 | 1.09 (0.82–1.44, p = 0.539) | 0.91 (0.64–1.27, p = 0.566) | |
Group 3 | 0.81 (0.61–1.08, p = 0.147) | 0.80 (0.56–1.13, p = 0.200) | |
Group 4 | 1.24 (0.90–1.71, p = 0.185) | 1.06 (0.71–1.58, p = 0.760) | |
Sex | Female | - | - |
Male | 1.09 (0.87–1.37, p = 0.466) | 0.79 (0.60–1.06, p = 0.112) | |
Ethnicity | White | - | - |
African American | 1.58 (1.09–2.29, p = 0.016) | 1.08 (0.69–1.68, p = 0.749) | |
Hawaiian | 1.18 (0.75–1.88, p = 0.472) | 0.48 (0.27–0.87, p = 0.015) | |
Hispanic or Latino | 1.10 (0.78–1.55, p = 0.577) | 0.91 (0.60–1.37, p = 0.650) | |
Japanese | 1.04 (0.78–1.39, p = 0.781) | 0.68 (0.48–0.96, p = 0.029) | |
Diabetes | No | - | - |
Yes | 1.29 (0.92–1.83, p = 0.144) | 0.79 (0.50–1.24, p = 0.300) | |
Smoking at Cohort Entry | Never | - | - |
Past | 1.28 (1.01–1.63, p = 0.044) | 1.00 (0.74–1.36, p = 0.979) | |
Current | 1.66 (1.21–2.29, p = 0.002) | 1.33 (0.90–1.97, p = 0.147) | |
Age of CRC Dx | Mean (SD) | - | - |
(Cubic Spline) | 1 | 0.32 (0.03–3.28, p = 0.337) | 0.31 (0.03–3.59, p = 0.345) |
2 | 7.86 (2.77–22.32, p < 0.001) | 0.41 (0.12–1.43, p = 0.161) | |
3 | 6.45 (1.25–33.41, p = 0.027) | 3.62 (0.62–21.16, p = 0.151) |
Variable | Subset | CA Mortality HR (95% CI, p-Value) | Competing Risk All-Cause Mortality HR (95% CI, p-Value) |
---|---|---|---|
BMI Trajectory | Group 2 | - | - |
Group 1 | 1.09 (0.79–1.51, p = 0.598) | 0.99 (0.60–1.63, p = 0.968) | |
Group 3 | 0.72 (0.50–1.02, p = 0.066) | 0.96 (0.61–1.53, p = 0.878) | |
Group 4 | 1.15 (0.77–1.73, p = 0.492) | 1.45 (0.80–2.63, p = 0.223) | |
Sex | Female | - | - |
Male | 0.92 (0.70–1.23, p = 0.583) | 1.52 (0.99–2.33, p = 0.053) | |
Ethnicity | White | - | - |
African American | 1.56 (1.00–2.43, p = 0.048) | 1.53 (0.75–3.15, p = 0.244) | |
Hawaiian | 0.78 (0.45–1.36, p = 0.384) | 2.85 (1.31–6.21, p = 0.009) | |
Hispanic or Latino | 1.06 (0.70–1.61, p = 0.791) | 1.29 (0.69–2.42, p = 0.422) | |
Japanese | 0.90 (0.64–1.26, p = 0.535) | 1.41 (0.84–2.36, p = 0.189) | |
Diabetes | No | - | - |
Yes | 0.96 (0.58–1.57, p = 0.861) | 1.83 (1.08–3.10, p = 0.026) | |
Smoking at Cohort Entry | Never | - | - |
Past | 1.21 (0.90–1.63, p = 0.199) | 1.34 (0.88–2.04, p = 0.170) | |
Current | 1.59 (1.10–2.32, p = 0.015) | 1.56 (0.87–2.81, p = 0.138) | |
Age of CRC Dx | Mean (SD) | - | - |
(Cubic Spline) | 1 | 0.16 (0.01–2.25, p = 0.172) | 11.50 (0.06–2106.96, p = 0.357) |
2 | 2.95 (0.87–10.01, p = 0.082) | 98.04 (12.08–795.78, p < 0.001) | |
3 | 2.92 (0.44–19.40, p = 0.265) | 109.61 (3.47–3463.77, p = 0.008) |
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Kumar, S.; Blandon, C.; Sikorskii, A.; Kaplan, D.E.; Mehta, S.J.; Su, G.L.; Goldberg, D.S.; Crane, T.E. Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort. Cancers 2024, 16, 2950. https://doi.org/10.3390/cancers16172950
Kumar S, Blandon C, Sikorskii A, Kaplan DE, Mehta SJ, Su GL, Goldberg DS, Crane TE. Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort. Cancers. 2024; 16(17):2950. https://doi.org/10.3390/cancers16172950
Chicago/Turabian StyleKumar, Shria, Catherine Blandon, Alla Sikorskii, David E. Kaplan, Shivan J. Mehta, Grace L. Su, David S. Goldberg, and Tracy E. Crane. 2024. "Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort" Cancers 16, no. 17: 2950. https://doi.org/10.3390/cancers16172950