Association of obesity status and metabolic syndrome with site-specific cancers: a population-based cohort study



Obesity and metabolic syndrome (MetS) appear in clusters and are both associated with an increased risk of cancer. However, it remains unknown whether obesity status with or without MetS increases the risk of site-specific cancers.


We used data derived from 390,575 individuals (37–73 years old) from the UK Biobank who were enrolled from 2006–2016 with a median of 7.8 years of follow-up. Obesity was defined by BMI ≥ 30 kg/m2 and MetS was defined by the criteria of the Adult Treatment Panel-III (ATP-III). Cox proportional hazards models were used to investigate the associations of BMI and MetS with 22 cancers.


Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) phenotypes represented 6.7% and 17.9% of the total analytic samples and 27.1% and 72.9% of the included subpopulation with obesity, respectively. Obesity was independently associated with higher risks of 10 of 22 cancers. Stratified by metabolic status, the MUO phenotype was consistently associated with 10 obesity-related cancers. In contrast, the MHO phenotype was only associated with increased risks of five cancers: endometrium, oesophagus, kidney, pancreas and postmenopausal breast cancers.


Even in metabolically healthy individuals, obesity was associated with increased risks of five cancers, whereas we did not find that these individuals were associated with increased risks of several other obesity-related cancers.

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Fig. 1: Distribution of MetS criteria by metabolic health and obesity status.
Fig. 2: Incidence rate per 1000 person-year and multivariable HRs of cancers according to BMI categories.


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We thank the participants of the UK Biobank. This research has been conducted using the UK Biobank Resource under the project number of 45676.

Author information




Z.C.: Conceptualisation, formal analysis, data curation, methodology, acquisition, software, writing—original draft. X.Z.: Conceptualisation, formal analysis, methodology, project software, writing—original draft. H.Y.: Formal analysis, data curation, methodology, acquisition, software and writing—review and editing. S.L.: Data curation, methodology, acquisition, software. F.X.: Data curation, methodology, software. X.Y.: Methodology, writing—review and editing. Y.W.: Conceptualisation, funding, project administration, acquisition and writing—review and editing.

Corresponding author

Correspondence to Yaogang Wang.

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Ethics approval and consent to participate

UK Biobank has approval from the North West Multi-Centre Research Ethics Committee, the National Information Governance Board for Health & Social Care in England and Wales and the Community Health Index Advisory Group in Scotland. Written informed consent was provided by all participants. The study was performed in accordance with the Declaration of Helsinki.

Data availability

Information about data access is available online (http://www.ukbiobank.ac.uk/wp-content/uploads/2011/11/UK-Biobank-Protocol.pdf)

Competing interests

The authors declare no competing interests.

Funding information

This study was supported by the National Natural Science Foundation of China (grant No. 91746205, grants No. 71910107004 and grant No. 71673199).

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Cao, Z., Zheng, X., Yang, H. et al. Association of obesity status and metabolic syndrome with site-specific cancers: a population-based cohort study. Br J Cancer (2020). https://doi.org/10.1038/s41416-020-1012-6

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