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Renal cell carcinoma survival and body mass index: a dose–response meta-analysis reveals another potential paradox within a paradox

International Journal of Obesity volume 40, pages 18171822 (2016) | Download Citation

Abstract

Background:

In healthy subjects increasing body mass index (BMI) leads to greater mortality from a range of causes. Following onset of specific diseases, however, the reverse is often found: called the ‘obesity paradox’. But we recently observed the phenomenon called the ‘paradox within the paradox’ for stroke patients.

Objective:

The objective of our study was to examine the effect of each unit increase in BMI on renal cancer-specific survival (CSS), cancer-specific mortality, overall survival (OS) and overall mortality.

Design:

Random-effects generalized least squares models for trend estimation were used to analyze the data. Eight studies, comprising of 8699 survivals of 10 512 renal cell carcinoma (RCC) patients met the inclusion criteria, including 5 on CSS and 3 on OS.

Results:

The association of BMI with CSS and OS was non-linear (P<0.0001, P=0.004, respectively). We observed that CSS increased in relation to BMI, indicating that there was the obesity paradox in RCC. However, each unit increase in BMI over 25 was associated with decreased OS, indicating that RCC may also exhibit a paradox within the paradox.

Conclusions:

Inconsistent effects of increases in BMI on CSS and OS, as previously observed for stroke, creates a paradox (different directions of mortality for different causes) within the obesity paradox.

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Acknowledgements

The study was supported by Tehran University of Medical Sciences. We gratefully thank Dr Peter Lee for providing us with technical assistance.

Author contributions

MB designed research, analyzed data, wrote paper and had primary responsibility for final content. JRS has developed overall research plan, wrote paper and had responsibility for critical revision. FS had hands-on data collection. KD was responsible for interpretation of data, drafting of manuscript and critical revision.

Author information

Affiliations

  1. Department of Community Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran

    • M Bagheri
    •  & F Shemirani
  2. Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    • M Bagheri
  3. Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK

    • J R Speakman
  4. State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China

    • J R Speakman
  5. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran

    • K Djafarian

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to K Djafarian.

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DOI

https://doi.org/10.1038/ijo.2016.171

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