Anthropometry and the risk of lung cancer in EPIC

Nikmah Utami Dewi, Hendriek C. Boshuizen*, Mattias Johansson, Paolo Vineis, Ellen Kampman, Annika Steffen, Anne Tjønneland, Jytte Halkjær, Kim Overvad, Gianluca Severi, Guy Fagherazzi, Marie Christine Boutron-Ruault, Rudolf Kaaks, Kuanrong Li, Heiner Boeing, Antonia Trichopoulou, Christina Bamia, Eleni Klinaki, Rosario Tumino, Domenico PalliAmalia Mattiello, Giovanna Tagliabue, Petra H. Peeters, Roel Vermeulen, Elisabete Weiderpass, Inger Torhild Gram, José María Huerta, Antonio Agudo, María José Sánchez, Eva Ardanaz, Miren Dorronsoro, José Ramón Quirós, Emily Sonestedt, Mikael Johansson, Kjell Grankvist, Tim Key, Kay Tee Khaw, Nick Wareham, Amanda J. Cross, Teresa Norat, Elio Riboli, Anouar Fanidi, David Muller, H. Bas Bueno-De-Mesquita

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

22 Citations (Scopus)


The associations of body mass index (BMI) and other anthropometric measurements with lung cancer were examined in 348,108 participants in the European Investigation Into Cancer and Nutrition (EPIC) between 1992 and 2010. The study population included 2,400 case patients with incident lung cancer, and the average length of follow-up was 11 years. Hazard ratios were calculated using Cox proportional hazard models in which we modeled smoking variables with cubic splines. Overall, there was a significant inverse association between BMI (weight (kg)/height (m)2) and the risk of lung cancer after adjustment for smoking and other confounders (for BMI of 30.0-34.9 versus 18.5-25.0, hazard ratio = 0.72, 95% confidence interval: 0.62, 0.84). The strength of the association declined with increasing follow-up time. Conversely, after adjustment for BMI, waist circumference and waist-to-height ratio were significantly positively associated with lung cancer risk (for the highest category of waist circumference vs. the lowest, hazard ratio = 1.25, 95% confidence interval: 1.05, 1.50). Given the decline of the inverse association between BMI and lung cancer over time, the association is likely at least partly due to weight loss resulting from preclinical lung cancer that was present at baseline. Residual confounding by smoking could also have influenced our findings.

Original languageEnglish
Pages (from-to)129-139
Number of pages11
JournalAmerican Journal of Epidemiology
Issue number2
Publication statusPublished - 15 Jul 2016
Externally publishedYes


  • body mass index
  • lung cancer
  • obesity
  • smoking
  • waist circumference
  • waist to hip ratio
  • waist-to-height ratio


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