Obesity and colorectal cancer risk: a meta-analysis of cohort studies.

Aim: To evaluate the association between obesity and colorectal cancer risk.

Methods: We searched PubMed, EMBASE, and the Cochrane Library up to January 1, 2007. Cohort studies permitting the assessment of causal association between obesity and colorectal cancer, with clear definition of obesity and well-defined outcome of colorectal cancer were eligible. Study design, sample size at baseline, mean follow-up time, co-activators and study results were extracted. Pooled standardized effect sizes were calculated.

Results: The pooled relative risk (RR) of colorectal cancer was 1.37 (95% CI: 1.21-1.56) for overweight and obese men, 1.07 (95% CI: 0.97-1.18) for women measured by body mass index (BMI). The pooled RR for the highest vs the lowest quantiles of BMI was 1.59 (95% CI: 1.35-1.86) for men and 1.22 (95% CI: 1.08-1.39) for women at risk of colon cancer, 1.16 (95% CI: 0.93-1.46) for men and 1.23 (95% CI: 0.98-1.54) for women at risk of rectal cancer. The pooled RR for the highest vs the lowest quantiles of waist circumference was 1.68 (95% CI: 1.36-2.08) for men and 1.48 (95% CI: 1.19-1.84) for women at risk of colon cancer, 1.26 (95% CI: 0.90-1.77) for men and 1.23 (95% CI: 0.81-1.86) for women at risk of rectal cancer. The pooled RR for the highest quantiles vs the lowest quantiles of waist-to-hip ratio was 1.91 (95% CI: 1.46-2.49) for men and 1.49 (95% CI 1.23-1.81) for women at risk of colon cancer, 1.93 (95% CI: 1.19-3.13) for men and 1.20 (95% CI: 0.81-1.78) for women at risk of rectal cancer. Compared with 'normal range', the pooled RR for proximal colon cancer was 1.14 (95% CI: 0.88-1.47) for the overweight and 1.41 (95% CI: 0.66-3.01) for the obese. The pooled RR for the highest quantiles vs the lowest quantiles was 2.05 (95% CI: 1.23-3.41) with waist circumference, 1.66 (95% CI: 0.69-3.99) with waist-to-hip ratio. Compared with 'normal range', the pooled RR for distal colon cancer was 1.38 (95% CI: 1.02-1.87) for the overweight and 1.23 (95% CI: 0.80-1.90) for the obese. The pooled RR for the highest quantiles vs the lowest quantiles was 1.86 (95% CI: 1.05-3.30) with waist circumference, and 1.79 (95% CI: 0.82-3.90) with waist-to-hip ratio.

Conclusion: Obesity is a statistically significant risk factor for colorectal cancer and the relationship is more significant in men than in women among different cancer subsites. Indexes of abdominal obesity are more sensitive than those of overall obesity.