Obesity, abdominal obesity and subsequent risk of kidney cancer: a cohort study of 23.3 million East Asians



Limited evidence exists regarding associations between obesity and kidney cancer among Asians. We examined the associations between obesity measures and risk of kidney cancer.


We included 23,313,046 adults who underwent health examinations provided by the Korean National Health Insurance Service 2009–2012 and performed multivariable Cox proportional hazards regression analyses.


During 5.4 years of follow-up, 18,036 cases of kidney cancer were recorded, and cumulative incidence was 0.12%. General and abdominal obesity were associated with 1.32-fold increased risk of kidney cancer compared with groups without either obesity status. Underweight individuals showed decreased adjusted hazard ratio (HR) for kidney cancer (0.76, 95% confidence interval: 0.68–0.85) compared to those with normal body mass index (BMI), while the HRs increased among individuals with BMI 23–24.9 kg/m2 (1.23, 1.18–1.28), 25–29.9 kg/m2 (1.41, 1.36–1.46) and ≥30 kg/m2 (1.77, 1.65–1.90) (P for trend < 0.001). HRs of kidney cancer increased with increasing waist circumference (WC) (P for trend < 0.001). Compared to non-obese condition, the coexistence of general and abdominal obesity increased the HR (1.45, 1.40–1.50).


This study demonstrated positive associations of BMI and WC with kidney cancer risk. General and abdominal obesity may be risk factors of kidney cancer.

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  1. 1.

    Chow, W. H., Dong, L. M. & Devesa, S. S. Epidemiology and risk factors for kidney cancer. Nat. Rev. Urol. 7, 245–257 (2010).

  2. 2.

    Song, W. & Jeon, H. G. Incidence of kidney, bladder, and prostate cancers in Korea: an update. Korean J. Urol. 56, 422–428 (2015).

  3. 3.

    Jung, K. W., Won, Y. J., Kong, H. J., Oh, C. M., Lee, D. H. & Lee, J. S. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res. Treat. 46, 109–123 (2014).

  4. 4.

    Sadowski, D. J., Geiger, S. W., Mueller, G. S., Zahnd, W. E., Alanee, S. R. & McVary, K. T. Kidney cancer in Rural Illinois: lower incidence yet higher mortality rates. Urology 94, 90–95 (2016).

  5. 5.

    Renehan, A. G., Tyson, M., Egger, M., Heller, R. F. & Zwahlen, M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371, 569–578 (2008).

  6. 6.

    Ildaphonse, G., George, P. S. & Mathew, A. Obesity and kidney cancer risk in men: a meta-analysis (1992–2008). Asian Pac. J. Cancer Prev. 10, 279–286 (2009).

  7. 7.

    Mathew, A., George, P. S. & Ildaphonse, G. Obesity and kidney cancer risk in women: a meta-analysis (1992–2008). Asian Pac. J. Cancer Prev. 10, 471–478 (2009).

  8. 8.

    Lipworth, L., Tarone, R. E. & McLaughlin, J. K. Renal cell cancer among African Americans: an epidemiologic review. BMC Cancer 11, 133 (2011).

  9. 9.

    Klinghoffer, Z., Yang, B., Kapoor, A. & Pinthus, J. H. Obesity and renal cell carcinoma: epidemiology, underlying mechanisms and management considerations. Expert Rev. Anticancer Ther. 9, 975–987 (2009).

  10. 10.

    Kabat, G. C., Xue, X., Kamensky, V., Lane, D., Bea, J. W., Chen, C. et al. Risk of breast, endometrial, colorectal, and renal cancers in postmenopausal women in association with a body shape index and other anthropometric measures. Cancer Causes Control 26, 219–229 (2015).

  11. 11.

    Kuk, J. L., Lee, S., Heymsfield, S. B. & Ross, R. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am. J. Clin. Nutr. 81, 1330–1334 (2005).

  12. 12.

    WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157–163 (2004).

  13. 13.

    Lee, S. Y., Park, H. S., Kim, D. J., Han, J. H., Kim, S. M., Cho, G. J. et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res. Clin. Pract. 75, 72–80 (2007).

  14. 14.

    Agarwal, D. P. Cardioprotective effects of light-moderate consumption of alcohol: a review of putative mechanisms. Alcohol Alcohol 37, 409–415 (2002).

  15. 15.

    Levey, A. S., Coresh, J., Greene, T., Stevens, L. A., Zhang, Y. L., Hendriksen, S. et al. Chronic kidney disease epidemiology collaboration. using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann. Intern. Med. 145, 247–254 (2006).

  16. 16.

    Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W. et al. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann. Intern. Med. 139, 137–147 (2003).

  17. 17.

    Sawada, N., Inoue, M., Sasazuki, S., Iwasaki, M., Yamaji, T., Shimazu, T. et al. Body mass index and subsequent risk of kidney cancer: a prospective cohort study in Japan. Ann. Epidemiol. 20, 466–472 (2010).

  18. 18.

    Washio, M., Mori, M., Mikami, K., Miki, T., Watanabe, Y., Nakao, M. et al. Cigarette smoking and other risk factors for kidney cancer death in a Japanese population: Japan Collaborative Cohort Study for evaluation of cancer risk (JACC study). Asian Pac. J. Cancer Prev. 14, 6523–6528 (2014).

  19. 19.

    Shen, T., Shu, X. O., Xiang, Y. B., Li, H. L., Cai, H., Gao, Y. T. et al. Association of hypertension and obesity with renal cell carcinoma risk: a report from the Shanghai Men’s and Women’s Health Studies. Cancer Causes Control 26, 1173–1180 (2015).

  20. 20.

    Jee, S. H., Yun, J. E., Park, E. J., Cho, E. R., Park, I. S., Sull, J. W. et al. Body mass index and cancer risk in Korean men and women. Int. J. Cancer 123, 1892–1896 (2008).

  21. 21.

    van Kruijsdijk, R. C., van der Wall, E. & Visseren, F. L. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol. Biomarkers Prev. 18, 2569–2578 (2009).

  22. 22.

    Washio, M., Mori, M., Mikami, K., Miki, T., Watanabe, Y., Nakao, M. et al. Risk factors for renal cell carcinoma in a Japanese population. Asian Pac. J. Cancer Prev. 15, 9065–9070 (2014).

  23. 23.

    Handa, K. & Kreiger, N. Diet patterns and the risk of renal cell carcinoma. Public Health Nutr. 5, 757–767 (2002).

  24. 24.

    Mahabir, S., Leitzmann, M. F., Pietinen, P., Albanes, D., Virtamo, J. & Taylor, P. R. Physical activity and renal cell cancer risk in a cohort of male smokers. Int. J. Cancer 108, 600–605 (2004).

  25. 25.

    Menezes, R. J., Tomlinson, G. & Kreiger, N. Physical activity and risk of renal cell carcinoma. Int. J. Cancer 107, 642–646 (2003).

  26. 26.

    Pischon, T., Lahmann, P. H., Boeing, H., Tjønneland, A., Halkjaer, J., Overvad, K. et al. Body size and risk of renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC). Int. J. Cancer 118, 728–738 (2006).

  27. 27.

    Prineas, R. J., Folsom, A. R., Zhang, Z. M., Sellers, T. A. & Potter, J. Nutrition and other risk factors for renal cell carcinoma in postmenopausal women. Epidemiology 8, 31–36 (1997).

  28. 28.

    Nicodemus, K. K., Sweeney, C. & Folsom, A. R. Evaluation of dietary, medical and lifestyle risk factors for incident kidney cancer in postmenopausal women. Int. J. Cancer 108, 115–121 (2004).

  29. 29.

    Bosy-Westphal, A., Geisler, C., Onur, S., Korth, O., Selberg, O., Schrezenmeir, J. et al. Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors. Int. J. Obes. 30, 475–483 (2006).

  30. 30.

    Kaaks, R., Lukanova, A. & Kurzer, M. S. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol. Biomarkers Prev. 11, 1531–1543 (2002).

  31. 31.

    Khandekar, M. J., Cohen, P. & Spiegelman, B. M. Molecular mechanisms of cancer development in obesity. Nat. Rev. Cancer 11, 886–895 (2011).

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G.E.N., K.H.C. and Y.G.P. were the principal investigators. They contributed substantially to the study design, literature search, collection and assembly of data, data analyses and data interpretation. G.E.N., K.H.C. and Y.G.P wrote all drafts and the final version of the report. K.H. and Y.G.P. analysed data and created all the tables. G.E.N., K.H.C., K.H., C.M.K., B.H., S.J.C., S.J.J., Y.K., Y.H.K., D.H.K., S.M.K., Y.S.C., Y.K.R. and Y.G.P. contributed to the conception and design of the study, the collection and assembly of data, data analyses and data interpretation. All authors contributed to preparation of the report and approved the final version. K.H.C. and Y.G.P. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis and all authors had final responsibility for the decision to submit for publication.

Corresponding authors

Correspondence to Kyung Hwan Cho or Yong Gyu Park.

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The authors declare no competing interests.

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The study protocol was evaluated and approved by the Institutional Review Board of the Catholic University of Korea, St. Mary’s Hospital (IRB number: KC16EISI0939). This study was performed in accordance with the Declaration of Helsinki.



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Data are available through the Korean National Health Insurance Sharing Service (NHISS). Researchers who wish to access the data can apply at (https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do).

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Nam, G., Cho, K., Han, K. et al. Obesity, abdominal obesity and subsequent risk of kidney cancer: a cohort study of 23.3 million East Asians. Br J Cancer 121, 271–277 (2019). https://doi.org/10.1038/s41416-019-0500-z

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