Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium

Sangjun Lee; Jieun Jang; Sarah Krull Abe; Shafiur Rahman; Eiko Saito; Rashedul Islam; Prakash C. Gupta; Norie Sawada; Akiko Tamakoshi; Xiao Ou Shu; Woon Puay Koh; Atsuko Sadakane; Ichiro Tsuji; Jeongseon Kim; Isao Oze; Chisato Nagata; San Lin You; Myung Hee Shin; Mangesh S. Pednekar; Shoichiro Tsugane; Hui Cai; Jian Min Yuan; Wanqing Wen; Kotaro Ozasa; Sanae Matsuyama; Seiki Kanemura; Aesun Shin; Hidemi Ito; Keiko Wada; Yumi Sugawara; Chien Jen Chen; Yoon Ok Ahn; Yu Chen; Habibul Ahsan; Paolo Boffetta; Kee Seng Chia; Keitaro Matsuo; You Lin Qiao; Nathaniel Rothman; Wei Zheng; Manami Inoue; Daehee Kang; Sue K. Park

doi:10.1093/ije/dyac023

Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium

Sangjun Lee, Jieun Jang, Sarah Krull Abe, Shafiur Rahman, Eiko Saito, Rashedul Islam, Prakash C. Gupta, Norie Sawada, Akiko Tamakoshi, Xiao Ou Shu, Woon Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, San Lin You, Myung Hee Shin, Mangesh S. Pednekar, Shoichiro TsuganeHui Cai, Jian Min Yuan, Wanqing Wen, Kotaro Ozasa, Sanae Matsuyama, Seiki Kanemura, Aesun Shin, Hidemi Ito, Keiko Wada, Yumi Sugawara, Chien Jen Chen, Yoon Ok Ahn, Yu Chen, Habibul Ahsan, Paolo Boffetta, Kee Seng Chia, Keitaro Matsuo, You Lin Qiao, Nathaniel Rothman, Wei Zheng, Manami Inoue, Daehee Kang, Sue K. Park

Urban Initiative

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Abstract

Background: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. Methods: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. Results: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Conclusion: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.

Original language	English (US)
Pages (from-to)	1190-1203
Number of pages	14
Journal	International Journal of Epidemiology
Volume	51
Issue number	4
DOIs	https://doi.org/10.1093/ije/dyac023
State	Published - Aug 1 2022

Keywords

Asia Cohort Consortium
Oesophageal neoplasms
body mass index

ASJC Scopus subject areas

Epidemiology

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10.1093/ije/dyac023

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Lee, S., Jang, J., Abe, S. K., Rahman, S., Saito, E., Islam, R., Gupta, P. C., Sawada, N., Tamakoshi, A., Shu, X. O., Koh, W. P., Sadakane, A., Tsuji, I., Kim, J., Oze, I., Nagata, C., You, S. L., Shin, M. H., Pednekar, M. S., ... Park, S. K. (2022). Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium. International Journal of Epidemiology, 51(4), 1190-1203. https://doi.org/10.1093/ije/dyac023

Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium. / Lee, Sangjun; Jang, Jieun; Abe, Sarah Krull et al.
In: International Journal of Epidemiology, Vol. 51, No. 4, 01.08.2022, p. 1190-1203.

Research output: Contribution to journal › Article › peer-review

Lee, S, Jang, J, Abe, SK, Rahman, S, Saito, E, Islam, R, Gupta, PC, Sawada, N, Tamakoshi, A, Shu, XO, Koh, WP, Sadakane, A, Tsuji, I, Kim, J, Oze, I, Nagata, C, You, SL, Shin, MH, Pednekar, MS, Tsugane, S, Cai, H, Yuan, JM, Wen, W, Ozasa, K, Matsuyama, S, Kanemura, S, Shin, A, Ito, H, Wada, K, Sugawara, Y, Chen, CJ, Ahn, YO, Chen, Y, Ahsan, H, Boffetta, P, Chia, KS, Matsuo, K, Qiao, YL, Rothman, N, Zheng, W, Inoue, M, Kang, D & Park, SK 2022, 'Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium', International Journal of Epidemiology, vol. 51, no. 4, pp. 1190-1203. https://doi.org/10.1093/ije/dyac023

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title = "Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium",

abstract = "Background: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. Methods: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. Results: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Conclusion: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.",

keywords = "Asia Cohort Consortium, Oesophageal neoplasms, body mass index",

author = "Sangjun Lee and Jieun Jang and Abe, {Sarah Krull} and Shafiur Rahman and Eiko Saito and Rashedul Islam and Gupta, {Prakash C.} and Norie Sawada and Akiko Tamakoshi and Shu, {Xiao Ou} and Koh, {Woon Puay} and Atsuko Sadakane and Ichiro Tsuji and Jeongseon Kim and Isao Oze and Chisato Nagata and You, {San Lin} and Shin, {Myung Hee} and Pednekar, {Mangesh S.} and Shoichiro Tsugane and Hui Cai and Yuan, {Jian Min} and Wanqing Wen and Kotaro Ozasa and Sanae Matsuyama and Seiki Kanemura and Aesun Shin and Hidemi Ito and Keiko Wada and Yumi Sugawara and Chen, {Chien Jen} and Ahn, {Yoon Ok} and Yu Chen and Habibul Ahsan and Paolo Boffetta and Chia, {Kee Seng} and Keitaro Matsuo and Qiao, {You Lin} and Nathaniel Rothman and Wei Zheng and Manami Inoue and Daehee Kang and Park, {Sue K.}",

year = "2022",

month = aug,

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doi = "10.1093/ije/dyac023",

language = "English (US)",

volume = "51",

pages = "1190--1203",

journal = "International Journal of Epidemiology",

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T1 - Association between body mass index and oesophageal cancer mortality

T2 - A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium

AU - Lee, Sangjun

AU - Jang, Jieun

AU - Abe, Sarah Krull

AU - Rahman, Shafiur

AU - Saito, Eiko

AU - Islam, Rashedul

AU - Gupta, Prakash C.

AU - Sawada, Norie

AU - Tamakoshi, Akiko

AU - Shu, Xiao Ou

AU - Koh, Woon Puay

AU - Sadakane, Atsuko

AU - Tsuji, Ichiro

AU - Kim, Jeongseon

AU - Oze, Isao

AU - Nagata, Chisato

AU - You, San Lin

AU - Shin, Myung Hee

AU - Pednekar, Mangesh S.

AU - Tsugane, Shoichiro

AU - Cai, Hui

AU - Yuan, Jian Min

AU - Wen, Wanqing

AU - Ozasa, Kotaro

AU - Matsuyama, Sanae

AU - Kanemura, Seiki

AU - Shin, Aesun

AU - Ito, Hidemi

AU - Wada, Keiko

AU - Sugawara, Yumi

AU - Chen, Chien Jen

AU - Ahn, Yoon Ok

AU - Chen, Yu

AU - Ahsan, Habibul

AU - Boffetta, Paolo

AU - Chia, Kee Seng

AU - Matsuo, Keitaro

AU - Qiao, You Lin

AU - Rothman, Nathaniel

AU - Zheng, Wei

AU - Inoue, Manami

AU - Kang, Daehee

AU - Park, Sue K.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Background: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. Methods: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. Results: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Conclusion: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.

AB - Background: The association between body mass index (BMI) and oesophageal cancer (OC) has been consistently negative among Asians, whereas different associations based on histological OC subtypes have been observed in Europeans and North Americans. We examined the association between BMI and OC mortality in the Asia Cohort Consortium. Methods: We performed a pooled analysis to evaluate the association between BMI and OC mortality among 842 630 Asians from 18 cohort studies. Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. Results: A wide J-shaped association between BMI and overall OC mortality was observed. The OC mortality risk was increased for underweight (BMI <18.5 kg/m2: HR = 2.20, 95% CI 1.80-2.70) and extreme obesity (BMI ≥35 kg/m2: HR = 4.38, 95% CI 2.25-8.52) relative to the reference BMI (23-25 kg/m2). This association pattern was confirmed by several alternative analyses based on OC incidence and meta-analysis. A similar wide J-shaped association was observed in oesophageal squamous cell carcinoma (OSCC). Smoking and alcohol synergistically increased the OC mortality risk in underweight participants (HR = 6.96, 95% CI 4.54-10.67) relative to that in reference BMI participants not exposed to smoking and alcohol. Conclusion: Extreme obesity and being underweight were associated with an OC mortality risk among Asians. OC mortality and BMI formed a wide J-shaped association mirrored by OSCC mortality. Although the effect of BMI on OSCC and oesophageal adenocarcinoma mortality can be different in Asians, further research based on a large case-control study is recommended.

KW - Asia Cohort Consortium

KW - Oesophageal neoplasms

KW - body mass index

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M3 - Article

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SN - 0300-5771

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SP - 1190

EP - 1203

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

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ER -

Association between body mass index and oesophageal cancer mortality: A pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium

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