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Body Size and Risk of Prostate Cancer in the European Prospective Investigation into Cancer and Nutrition

¹ Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; ² Department of Urology, Charité -University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany; ³ Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom; ⁴ Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark; Departments of ⁵ Clinical Epidemiology and ⁶ Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; ⁷ Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany; ⁸ Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece; ⁹ Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; ¹⁰ Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy; ¹¹ Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy; ¹² Cancer Registry Azienda Ospedaliera "Civile M.P.Arezzo", Ragusa, Italy; ¹³ Unit of Cancer Epidemiology, University of Turin, Turin, Italy; ¹⁴ National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; ¹⁵ Department of Surgery, Malmö University Hospital and ¹⁶ Department of Clinical Sciences, Lund University, Malmö, Sweden; Departments of ¹⁷ Surgical and Perioperative Sciences, Urology and Andrology and ¹⁸ Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden; ¹⁹ Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Program, Catalan Institute of Oncology, Barcelona, Spain; ²⁰ Public Health Department of Gipuzkoa, Basque Government and CIBERESP, San Sebastian, Spain; ²¹ Epidemiology Department, Murcia Health Council, CIBER en Epidemiología y Salud Pública, Barcelona, Spain; ²² Andalusian School of Public Health and CIBER Epidemiología y Salud Pública, Granada, Spain; ²³ Public Health and Health Planning Directorate, Asturias, Spain; ²⁴ Public Health Institute of Navarra, Pamplona, Spain, and CIBER Epidemiología y Salud Pública, Spain; ²⁵ Centre for Nutrition and Cancer and ²⁶ Clinical Gerontology, University of Cambridge, Cambridge, United Kingdom; ²⁷ IARC-WHO, Lyon, France; and the ²⁸ Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom

Requests for reprints: Tobias Pischon, Department of Epidemiology, German Institute of Human Nutrition (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. Phone: 49-33200/88711; Fax: 49-33200/88721. E-mail: pischon{at}dife.de

Background: Body size has been hypothesized to influence the risk of prostate cancer; however, most epidemiologic studies have relied on body mass index (BMI) to assess adiposity, whereas only a few studies have examined whether body fat distribution predicts prostate cancer.

Methods: We examined the association of height, BMI, waist and hip circumference, and waist-hip ratio with prostate cancer risk among 129,502 men without cancer at baseline from 8 countries of the European Prospective Investigation into Cancer and Nutrition (EPIC), using Cox regression, with age as time metric, stratifying by study center and age at recruitment, and adjusting for education, smoking status, alcohol consumption, and physical activity.

Results: During a mean follow-up of 8.5 years, 2,446 men developed prostate cancer. Waist circumference and waist-hip ratio were positively associated with risk of advanced disease. The relative risk of advanced prostate cancer was 1.06 (95% confidence interval, 1.01-1.1) per 5-cm-higher waist circumference and 1.21 (95% confidence interval, 1.04-1.39) per 0.1-unit-higher waist-hip ratio. When stratified by BMI, waist circumference and waist-hip ratio were positively related to risk of total, advanced, and high-grade prostate cancer among men with lower but not among those with higher BMI (P_interaction for waist with BMI, 0.25, 0.02, and 0.05, respectively; P_interaction for waist-hip ratio with BMI, 0.27, 0.22, and 0.14; respectively).

Conclusions: These data suggest that abdominal adiposity may be associated with an increased risk of advanced prostate cancer. This association may be stronger among individuals with lower BMI; however, this finding needs confirmation in future studies. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3252–61)

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