Article open access publication

Measured Adiposity in Relation to Head and Neck Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

Cancer Epidemiology Biomarkers & Prevention, American Association for Cancer Research (AACR), ISSN 1055-9965

Volume 26, 6, 2017

DOI:10.1158/1055-9965.epi-16-0886, Dimensions: pub.1083738090, PMC: PMC5540168, PMID: 28183827,



  1. (1) Imperial College London, grid.7445.2
  2. (2) German Institute of Human Nutrition, grid.418213.d
  3. (3) Umeå University, grid.12650.30
  4. (4) International Agency For Research On Cancer, grid.17703.32
  5. (5) Aalborg Hospital, grid.27530.33, North Denmark Region
  6. (6) Aarhus University, grid.7048.b, AU
  7. (7) Danish Cancer Society, grid.417390.8
  8. (8) Centre for research in epidemiology and population health, grid.463845.8
  9. (9) Institut Gustave Roussy, grid.14925.3b
  10. (10) German Cancer Research Center, grid.7497.d
  11. (11) Hellenic Health Foundation, grid.424637.0
  12. (12) Academy of Athens, grid.417593.d
  13. (13) Harvard University, grid.38142.3c
  14. (14) National and Kapodistrian University of Athens, grid.5216.0
  15. (15) University of Naples Federico II, grid.4691.a
  16. (16) Fondazione IRCCS Istituto Nazionale dei Tumori, grid.417893.0
  17. (17) Cancer Registry and Histopathology Unit, Civic-M.P.Arezzo Hospital, Contrada Rito, ASP Ragusa, Italy.
  18. (18) HuGeF Foundation, Torino, Italy.
  19. (19) Istituto per lo Studio e la Prevenzione Oncologica, grid.417623.5
  20. (20) University Medical Center Utrecht, grid.7692.a
  21. (21) National Institute for Public Health and the Environment, grid.31147.30
  22. (22) Cancer Registry of Norway, grid.418941.1
  23. (23) Folkhälsans Forskningscentrum, grid.428673.c
  24. (24) Karolinska Institute, grid.4714.6
  25. (25) The Arctic University of Norway, grid.10919.30
  26. (26) Catalan Institute of Oncology, grid.418701.b
  27. (27) Public Health Directorate, Asturias, Spain.
  28. (28) Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, Donostia, Spain.
  29. (29) CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
  30. (30) Instituto de Salud Pública de Navarra, grid.419126.9
  31. (31) Instituto Murciano de Investigación Biosanitaria, grid.452553.0
  32. (32) University of Granada, grid.4489.1
  33. (33) Department of Surgical Sciences, Uppsala University, University Hospital, Uppsala, Sweden.
  34. (34) Ear Nose and Throat Department, Lund University, Department of Otorhinolaryngology, University Hospital, Malmö, Sweden.
  35. (35) Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
  36. (36) University of Oxford, grid.4991.5
  37. (37) Institute of Metabolic Science, grid.470900.a
  38. (38) University of Cambridge, grid.5335.0
  39. (39) Cancer Research UK/Public Health England, London, United Kingdom.


Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer. However, most studies have used self-reported anthropometry which is prone to error.Methods: Among 363,094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of head and neck cancer. Head and neck cancer risk was examined in relation to body mass index (BMI) [lean: <22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: ≥30 kg/m2], waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) using Cox proportional hazards models.Results: Among men, a BMI < 22.5 kg/m2 was associated with higher head and neck cancer risk [HR 1.62; 95% confidence interval (CI), 1.23-2.12)]; BMI was not associated with head and neck cancer among women. WC and WHR were associated with greater risk of head and neck cancer among women (WC per 5 cm: HR, 1.08; 95% CI, 1.02-1.15; WHR per 0.1 unit: HR, 1.64; 95% CI, 1.38-1.93). After stratification by smoking status, the association for WHR was present only among smokers (Pinteraction = 0.004). Among men, WC and WHR were associated with head and neck cancer only upon additional adjustment for BMI (WC per 5 cm: HR 1.16; 95% CI, 1.07-1.26; WHR per 0.1 unit: HR, 1.42; 95% CI, 1.21-1.65).Conclusions: Central adiposity, particularly among women, may have a stronger association with head and neck cancer risk than previously estimated.Impact: Strategies to reduce obesity may beneficially impact head and neck cancer incidence. Cancer Epidemiol Biomarkers Prev; 26(6); 895-904. ©2017 AACR.


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