| Title: | Explaining the link between adiposity and colorectal cancer risk in men and postmenopausal women in the UK Biobank: A sequential causal mediation analysis |
| Journal: | International Journal of Cancer |
| Published: | 13 Apr 2020 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/32181888/ |
| DOI: | https://doi.org/10.1002/ijc.32980 |
| Citations: | 14 (3 in last 2 years) as of 8 Aug 2024 |
Publication 4828
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Abstract
Mechanisms underlying adiposity-colorectal cancer (CRC) association are incompletely understood. Using UK Biobank data, we investigated the role of C-reactive protein (CRP), hemoglobin-A1c (HbA1c) and (jointly) sex hormone-binding globulin (SHBG) and testosterone, in explaining this association. Total effect of obesity versus normal-weight (based on waist circumference, body mass index, waist-hip ratio) on CRC risk was decomposed into natural direct (NDE) and indirect (NIE) effects using sequential mediation analysis. After a median follow-up of 7.1 years, 2070 incident CRC cases (men = 1,280; postmenopausal women = 790) were recorded. For men, the adjusted risk ratio (RR) for waist circumference (≥102 vs. ≤94 cm) was 1.37 (95% confidence interval [CI], 1.19-1.58). The RRsNIE were 1.08 (95% CI: 1.01-1.16) through all biomarkers, 1.06 (95% CI: 1.01-1.11) through pathways influenced by CRP, 0.99 (95% CI: 0.97-1.01) through HbA1c beyond (the potential influence of) CRP and 1.03 (95% CI: 0.99-1.08) through SHBG and testosterone combined beyond CRP and HbA1c. The RRNDE was 1.26 (95% CI: 1.09-1.47). For women, the RR for waist circumference (≥88 vs. ≤80 cm) was 1.27 (95% CI: 1.07-1.50). The RRsNIE were 1.08 (95% CI: 0.94-1.22) through all biomarkers, 1.08 (95% CI: 0.99-1.17) through CRP, 1.00 (95% CI: 0.98-1.02) through HbA1c beyond CRP and 1.00 (95% CI: 0.92-1.09) through SHBG and testosterone combined beyond CRP and HbA1c. The RRNDE was 1.18 (95% CI: 0.96-1.45). For men and women, pathways influenced by CRP explained a small proportion of the adiposity-CRC association. Testosterone and SHBG also explained a small proportion of this association in men. These results suggest that pathways marked by these obesity-related factors may not explain a large proportion of the adiposity-CRC association.</p>
17 Keywords
- Adiposity
- Adult
- Aged
- C-Reactive Protein
- Colorectal Neoplasms
- Female
- Glycated Hemoglobin
- Humans
- Male
- Mediation Analysis
- Middle Aged
- Postmenopause
- Prospective Studies
- Sex Hormone-Binding Globulin
- Testosterone
- United Kingdom
- Waist Circumference
8 Authors
- S. Ghazaleh Dashti
- Vivian Viallon
- Julie A. Simpson
- Amalia Karahalios
- Margarita Moreno-Betancur
- Dallas R. English
- Marc J. Gunter
- Neil Murphy
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