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Central Obesity Metrics Outperform BMI in Colorectal Cancer Risk Assessment

A UK Biobank cohort study published in JAMA Network Open has revealed that central obesity metrics, such as waist circumference (WC) and waist-to-hip ratio (WHR), are stronger predictors of colorectal cancer (CRC) risk than body mass index (BMI). The findings highlight the importance of focusing on central adiposity in CRC prevention efforts.

The study included 458,543 participants aged 40–69 years who were followed for a median of 11.8 years. During this time, 5,944 participants were diagnosed with CRC. Hazard ratios (HRs) showed a stronger association between CRC incidence and high WC (HR: 1.37, 95% CI: 1.27–1.49) and high WHR (HR: 1.40, 95% CI: 1.29–1.51) compared to high BMI (HR: 1.23, 95% CI: 1.14–1.33). These associations remained significant after excluding cases diagnosed during the initial follow-up years to account for reverse causality.

The study also calculated the population attributable fraction (PAF) of CRC cases linked to excess weight. The PAF for high BMI was 9.9% (95% CI: 5.5%–14.4%), significantly lower than the PAFs for high WC (17.3%, 95% CI: 12.3%–22.1%) and high WHR (17.6%, 95% CI: 12.9%–22.2%). After adjusting for reverse causality by excluding the first seven years of follow-up, the PAF estimates were comparable across all measures: BMI (15.7%, 95% CI: 8.9%–22.4%), WC (16.9%, 95% CI: 9.8%–23.8%), and WHR (18.0%, 95% CI: 11.5%–24.6%).

"These results suggest that the PAF of CRC attributable to excess weight is considerably underestimated when using BMI alone," the authors reported. "WC and WHR provide more consistent and higher estimates, underscoring the need to prioritize central obesity in CRC prevention strategies."

 

Reference

Safizadeh F, Mandic M, Hoffmeister M, Brenner H. Colorectal cancer and central obesity. JAMA Network Open. 2025;8(1):e2454753. doi:https://doi.org/10.1001/jamanetworkopen.2024.54753

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