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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention

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Research Articles

Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study)

Bette J. Caan, Jeffrey A. Meyerhardt, Candyce H. Kroenke, Stacey Alexeeff, Jingjie Xiao, Erin Weltzien, Elizabeth Cespedes Feliciano, Adrienne L. Castillo, Charles P. Quesenberry, Marilyn L. Kwan and Carla M. Prado
Bette J. Caan
Division of Research, Kaiser Permanente, Oakland, California.
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  • For correspondence: Bette.caan@kp.org
Jeffrey A. Meyerhardt
Dana Farber Cancer Institute, Boston, Massachusetts.
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Candyce H. Kroenke
Division of Research, Kaiser Permanente, Oakland, California.
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Stacey Alexeeff
Division of Research, Kaiser Permanente, Oakland, California.
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Jingjie Xiao
Department of Agricultural, Food and Nutritional Sciences, Agriculture/Forestry Centre University of Alberta, Edmonton, Alberta, Canada.
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Erin Weltzien
Division of Research, Kaiser Permanente, Oakland, California.
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Elizabeth Cespedes Feliciano
Division of Research, Kaiser Permanente, Oakland, California.
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Adrienne L. Castillo
Division of Research, Kaiser Permanente, Oakland, California.
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Charles P. Quesenberry
Division of Research, Kaiser Permanente, Oakland, California.
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Marilyn L. Kwan
Division of Research, Kaiser Permanente, Oakland, California.
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Carla M. Prado
Department of Agricultural, Food and Nutritional Sciences, Agriculture/Forestry Centre University of Alberta, Edmonton, Alberta, Canada.
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DOI: 10.1158/1055-9965.EPI-17-0200 Published July 2017
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Abstract

Background: Body composition may partially explain the U-shaped association between body mass index (BMI) and colorectal cancer survival.

Methods: Muscle and adiposity at colorectal cancer diagnosis and survival were examined in a retrospective cohort using Kaplan–Meier curves, multivariable Cox regression, and restricted cubic splines in 3,262 early-stage (I–III) male (50%) and female (50%) patients. Sarcopenia was defined using optimal stratification and sex- and BMI-specific cut points. High adiposity was defined as the highest tertile of sex-specific total adipose tissue (TAT). Primary outcomes were overall mortality and colorectal cancer–specific mortality (CRCsM).

Results: Slightly over 42% patients were sarcopenic. During 5.8 years of follow-up, 788 deaths occurred, including 433 from colorectal cancer. Sarcopenic patients had a 27% [HR, 1.27; 95% confidence interval (CI), 1.09–1.48] higher risk of overall mortality than those who were not sarcopenic. Females with both low muscle and high adiposity had a 64% higher risk of overall mortality (HR, 1.64; 95% CI, 1.05–2.57) than females with adequate muscle and lower adiposity. The lowest risk of overall mortality was seen in patients with a BMI between 25 and <30 kg/m2, a range associated with the greatest number of patients (58.6%) who were not at increased risk of overall mortality due to either low muscle or high adiposity.

Conclusions: Sarcopenia is prevalent among patients with non-metastatic colorectal cancer, and should, along with adiposity be a standard oncological marker.

Impact: Our findings suggest a biologic explanation for the obesity paradox in colorectal cancer and refute the notion that the association between overweight and lower mortality is due solely to methodologic biases. Cancer Epidemiol Biomarkers Prev; 26(7); 1008–15. ©2017 AACR.

This article is featured in Highlights of This Issue, p. 983

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Received March 3, 2017.
  • Revision received March 3, 2017.
  • Accepted March 10, 2017.
  • ©2017 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 26 (7)
July 2017
Volume 26, Issue 7
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Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study)
Bette J. Caan, Jeffrey A. Meyerhardt, Candyce H. Kroenke, Stacey Alexeeff, Jingjie Xiao, Erin Weltzien, Elizabeth Cespedes Feliciano, Adrienne L. Castillo, Charles P. Quesenberry, Marilyn L. Kwan and Carla M. Prado
Cancer Epidemiol Biomarkers Prev July 1 2017 (26) (7) 1008-1015; DOI: 10.1158/1055-9965.EPI-17-0200

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Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study)
Bette J. Caan, Jeffrey A. Meyerhardt, Candyce H. Kroenke, Stacey Alexeeff, Jingjie Xiao, Erin Weltzien, Elizabeth Cespedes Feliciano, Adrienne L. Castillo, Charles P. Quesenberry, Marilyn L. Kwan and Carla M. Prado
Cancer Epidemiol Biomarkers Prev July 1 2017 (26) (7) 1008-1015; DOI: 10.1158/1055-9965.EPI-17-0200
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