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Epidemiology and Population Health

Obesity and “obesity-related” cancers: are there body mass index cut-points?

International Journal of Obesity volume 46, pages 1770–1777 (2022)Cite this article

Subjects

Abstract

Background

Despite compelling links between excess body weight and cancer, body mass index (BMI) cut-points, or thresholds above which cancer incidence increased, have not been identified. The objective of this study was to determine if BMI cut-points exist for 14 obesity-related cancers.

Subjects/methods

In this retrospective cohort study, patients 18–75 years old were included if they had ≥2 clinical encounters with BMI measurements in the electronic health record (EHR) at a single academic medical center from 2008 to 2018. Patients who were pregnant, had a history of cancer, or had undergone bariatric surgery were excluded. Adjusted logistic regression was performed to identify cancers that were associated with increasing BMI. For those cancers, BMI cut-points were calculated using adjusted quantile regression for cancer incidence at 80% sensitivity. Logistic and quantile regression models were adjusted for age, sex, race/ethnicity, and smoking status.

Results

A total of 7079 cancer patients (mean age 58.5 years, mean BMI 30.5 kg/m2) and 270,441 non-cancer patients (mean age 43.8 years, mean BMI 28.8 kg/m2) were included in the study. In adjusted logistic regression analyses, statistically significant associations were identified between increasing BMI and the incidence of kidney, thyroid, and uterine cancer. BMI cut-points were identified for kidney (26.3 kg/m2) and uterine (26.9 kg/m2) cancer.

Conclusions

BMI cut-points that accurately predicted development kidney and uterine cancer occurred in the overweight category. Analysis of multi-institutional EHR data may help determine if these relationships are generalizable to other health care settings. If they are, incorporation of BMI into the screening algorithms for these cancers may be warranted.

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Fig. 1: STROBE diagram—study cohort creation.
Fig. 2: Multivariable logistic regression with cancer incidence as the outcome.
Fig. 3: Relationship of cancer risk and BMI.
Fig. 4: Adjusted cut-point analysis for kidney and uterine cancers.

Data availability

Aggregated and de-identified data is available upon request. Those interested in acquiring the data will require a Data Transfer and Use Agreement (DTUA) for de-identified data between University of Wisconsin and the recipient. The form is available at https://rsp.wisc.edu/contracts/dtua.cfm under “DTUA forms.”

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Funding

Effort on this study and manuscript was made possible by an American College of Surgeons George H.A. Clowes Career Development Award and a VA Career Development Award to LMF (CDA 015–060). The views in this study represent those of the authors and not those of the Department of Veterans Affairs or the U.S. Government. The project was also supported by the Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) (grant UL1TR002373). Further funding was through the NIH T32 Surgical Oncology Research Training Program (grant CA090217–17) and the NIH Metabolism and Nutrition Training Program T32 (grant DK 007665).

Author information

Author notes

  1. These authors contributed equally: Jacqueline A. Murtha, Natalie Liu.

Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Jacqueline A. Murtha, Natalie Liu, Bret M. Hanlon, Manasa Venkatesh & Luke M. Funk

  2. Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA

    Jen Birstler & Bret M. Hanlon

  3. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Lawrence P. Hanrahan

  4. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Tudor Borza

  5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    David M. Kushner

  6. Department of Surgery, William S. Middleton Memorial VA, Madison, WI, USA

    Luke M. Funk

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Contributions

NL, JB, BMH, MV, LPH, and LMF contributed to study design. JAM, NL, JB, BMH, MV, and LMF contributed to data collection and analysis. JAM, NL, JB, and LMF contributed to manuscript composition. All co-authors participated in the data interpretation and manuscript revisions. All co-authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

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Correspondence to Luke M. Funk.

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Murtha, J.A., Liu, N., Birstler, J. et al. Obesity and “obesity-related” cancers: are there body mass index cut-points?. Int J Obes 46, 1770–1777 (2022). https://doi.org/10.1038/s41366-022-01178-0

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