Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study

Mirjam Kohls, Heinz Freisling*, Hadrien Charvat, Isabelle Soerjomataram, Vivian Viallon, Veronica Davila-Batista, Rudolf Kaaks, Renée Turzanski-Fortner, Krasimira Aleksandrova, Matthias B Schulze, Christina C Dahm, Helene Tilma Vistisen, Agnetha Linn Rostgaard-Hansen, Anne Tjønneland, Catalina Bonet, Maria-Jose Sánchez, Sandra Colorado-Yohar, Giovanna Masala, Domenico Palli, Vittorio KroghFulvio Ricceri, Olov Rolandsson, Sai San Moon Lu, Konstantinos K Tsilidis, Elisabete Weiderpass, Marc J Gunter, Pietro Ferrari, Ursula Berger, Melina Arnold*

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


BACKGROUND: Body mass index (BMI) and cardiometabolic comorbidities such as cardiovascular disease and type 2 diabetes have been studied as negative prognostic factors in cancer survival, but possible dependencies in the mechanisms underlying these associations remain largely unexplored. We analysed these associations in colorectal and breast cancer patients.

METHODS: Based on repeated BMI assessments of cancer-free participants from four European countries in the European Prospective Investigation into Cancer and nutrition (EPIC) study, individual BMI-trajectories reflecting predicted mean BMI between ages 20 to 50 years were estimated using a growth curve model. Participants with incident colorectal or breast cancer after the age of 50 years were included in the survival analysis to study the prognostic effect of mean BMI and cardiometabolic diseases (CMD) prior to cancer. CMD were defined as one or more chronic conditions among stroke, myocardial infarction, and type 2 diabetes. Hazard ratios (HRs) and confidence intervals (CIs) of mean BMI and CMD were derived using multivariable-adjusted Cox proportional hazard regression for mean BMI and CMD separately and both exposures combined, in subgroups of localised and advanced disease.

RESULTS: In the total cohort of 159,045 participants, there were 1,045 and 1,620 eligible patients of colorectal and breast cancer. In colorectal cancer patients, a higher BMI (by 1 kg/m2) was associated with a 6% increase in risk of death (95% CI of HR: 1.02-1.10). The HR for CMD was 1.25 (95% CI: 0.97-1.61). The associations for both exposures were stronger in patients with localised colorectal cancer. In breast cancer patients, a higher BMI was associated with a 4% increase in risk of death (95% CI: 1.00-1.08). CMDs were associated with a 46% increase in risk of death (95% CI: 1.01-2.09). The estimates and CIs for BMI remained similar after adjustment for CMD and vice versa.

CONCLUSIONS: Our results suggest that cumulative exposure to higher BMI during early to mid-adulthood was associated with poorer survival in patients with breast and colorectal cancer, independent of CMD prior to cancer diagnosis. The association between a CMD diagnosis prior to cancer and survival in patients with breast and colorectal cancer was independent of BMI.

Original languageEnglish
Article number546
JournalBMC Cancer
Number of pages11
Publication statusPublished - May 2022


  • Adult
  • Body Mass Index
  • Breast Neoplasms/complications
  • Cardiovascular Diseases/epidemiology
  • Cohort Studies
  • Colorectal Neoplasms
  • Diabetes Mellitus, Type 2/complications
  • Female
  • Humans
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Young Adult


Dive into the research topics of 'Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study'. Together they form a unique fingerprint.

Cite this