Anthropometry And The Risk Of Digestive System Tumors: A Prospective Cohort Study

Background:Digestive system tumors are malignant tumors with severe disease burden that seriously threaten human health.Previous epidemiological studies suggested that underweight may increase the risk of esophagus squamous cell carcinoma,while obesity may increase the risk of esophageal adenocarcinoma,colorectal cancer and pancreatic cancer.The current prospective and large-scale cohort studies based on Chinese population are limited.Additionally,previous epidemiological studies focused on the association between baseline high anthropometry and digestive system tumors,and paid less attention to the association between the low anthropometry or anthropometric changes and the incidence of digestive tumors.Objective:To investigate the association of the baseline value and the change of anthropometry with the risk of digestive system tumors among 132 153 participants from the Kailuan cohort.Methods:1.Based on the biennial questionnaire survey and health check-up conducted in the Kailuan cohort(2006-2015),the anthropometries including height,weight,waist circumference(WC),hip circumference(HC),other epidemiology information and the outcome of digestive system tulors(esophageal cancer,gastric cancer,colorectal cancer,hepatocellular carcinoma,pancreatic carcinoma)were collected.In addition,passive follow-up was eonducted for supplementary information of missing lung eancer eases.2.Multivariate Cox proportional regression was conducted to estimate the hazard ratio(HR)and 95%confidence interval(95%CI)of baseline BMI,WC,HC,waist-to-hip ratio(WHR),Waist-to-height ratio(WHtR),and a body shape index(ABSI)for digestive system tumors.The restrictive cubic spline(RCS)curves were used to explore non-linear correlations between baseline anthropometries and digestive system tumors.3.Furthermore,the check-up data of first time and 4-year later was used to explore the associations between the changes of BMI,WC,WHR,WHtR and the risk of digestive system tumors.Participants with 3 complete health eheck-up data were selected as a subset,and grolp-based trajectory models were applied to evaluate the associations between BMI and WC ehange trajectory and digestive system tumor.Results:1.A total of 132 153 participants were included in this analysis,with 106 339 males(80.47%)and 25 814 females(19.53%).The cohort was followed up for a total of 1 049 376.48 person years,and the median follow-up time was 8.8 years.A total of 1387 digestive system tumor cases were newly diagnosed,including 143 esophageal cancer cases,292 gastric cancer cases,469 colorectal cancer cases,377 liver cancer cases,and 106 pancreatic cancer cases.2.Baseline anthropometry and digestive tumors(1)The BMI(P-non-linear:0.005)and WC(P-non-linear:0.008)showed a U-shaped association with overall digestive system tumor,while the HC,WHR,WHtR,and ABSI didn’t show a non-linear association with overall digestive system tumor.(2)Low BMI(BMI<18.5 kg/m2)increased the risk of gastric cancer by 110%(95%CI:1.17-3.74).Low WC(male WC<82cm,female WC<75cm)increased the risk of overall digestive system tumor(HR=1.27,95%Cl:1.06-1.52),especially for liver cancer(HR=1.42,95%CI:1.00-2.02)and gastric caner(HR=1.49,95%CI:1.02-2.18).Similarly,low HC(male HC<92.0cm,female HC<89.5cm)also increased the risk of overall digestive system tumor(HR=1.24,95%CI:1.03-1.48),especially for liver cancer(HR=1.47,95%CI:1.04-2.08).Low WHR(male WHR<0.86,female WHR<0.81)and low WHtR(WHtR<0.48)didn’t show a positive association with digestive system tumors.However,low ABSI(male ABSI<0.076,female ABSI<0.074)reduced the risk of colorectal cancer(HR=0.71,95%CI:0.50-0.99)(3)High BMI(BMI>28.0 kg/m2)increased the risk of liver cancer by 56%(95%CI:1.12-2.18),while reduced the risk of esophageal cancer by 60%(95%CI:0.17-0.92).High WC(male WC>94cm,female WC>89cm)increased the risk of overall digestive system tumor(HR=1.27,95%CI:1.07-1.50),also the positive association was detected for liver cancer(HR=1.80,95%CI:1.30-2.51).Similarly,high HC(male HC>103.0 cm,fenale HC>89.5cm)increased the risk of liver cancer(HR=1.56,95%CI:1.12-2.19).High WHR(male WHR>0.94,female WHR>0.91)had an increased risk of overall digestive system tumor(HR=1.21,95%CI:1.02-1.43).And high WHtR(WHtR>0.55)increased the risk of liver cancer(HR=1.39,95%CI:1.03-1.87).High ABSI(male ABSI>0.085,female ABSI>0.083)increased the risk of esophageal cancer(HR=1.90,95%CI:1.08-3.32).(4)Participants with both high BMI and high WC showed a higher risk of colorectal cancer(HR=1.27,95%CI:1.00-1.61)and liver cancer(HR=1.37,95%CI:1.05-1.78)but a lower risk of esophageal cancer(HR=0.57,95%CI:0.36-0.91).Similarly,high BMI combined with high WHR leaded to an increased risk of liver cancer(HR=1.69,95%CI:1.04-2.76).In the subjects with high BMI combined with high WHtR,a higher risk of esophageal cancer was detected(HR=0.52,95%CI:0.32-0.84)in this study.3.The change of anthropometry and digestive system tumorsParticipants with persist high BMI(BMI≥24.0 kg/m2)had a lower risk of esophageal cancer(HR=0.45,95%CI:0.23-0.87),while participants with persist liigh WHR(male WHR≥1.0,female WHR≥0.85)had higer risk gastric cancer(HR=3.96,95%CI:1.11-14.18).Subjects with WC and WHtR increased by 5%had 69%(95%CI:0.14-0.71)and 63%(95%CI:0.16-0.86)lower risk of esophageal cancer,respectively.All the participants were grouped by the group trajectory model according to the changes of 3 times BMI and WC data,and possitive assoeiation between change trajectory of BMI and WC and the risk of digestive system tumors wasn’t detected in this study.Conclusion:Participants with lower antlropometry had an increased risk of overall digestive system tumor,especially for gastric eancer and liver cancer.And higher anthropometry also increased the risk of overall digestive system tumor,especially for colorectal cancer and liver cancer,while reduced the risk of esophageal cancer.Persistent obesity increasesed the risk of gastric cancer,while reduced the risk of esophageal cancer.More prospective studies with large sample size are needed to provide scientific basis for exploring risk factors and effective prevention strategies for digestive system tumor.