Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort

Yunxia Lu*, Amanda J. Cross, Neil Murphy, Heinz Freisling, Ruth C. Travis, Pietro Ferrari, Verena A. Katzke, Rudolf Kaaks, Åsa Olsson, Ingegerd Johansson, Frida Renström, Salvatore Panico, Valeria Pala, Domenico Palli, Rosario Tumino, Petra H. Peeters, Peter D. Siersema, H. B. Bueno-de-Mesquita, Antonia Trichopoulou, Eleni KlinakiChristos Tsironis, Antonio Agudo, Carmen Navarro, María José Sánchez, Aurelio Barricarte, Marie Christine Boutron-Ruault, Guy Fagherazzi, Antoine Racine, Elisabete Weiderpass, Marc J. Gunter, Elio Riboli

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)


Background: The etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC. Methods: We investigated overall obesity and abdominal adiposity in relation to SIC in the European Prospective Investigation into Cancer and Nutrition (EPIC), a large prospective cohort of approximately half a million men and women from ten European countries. Overall obesity and abdominal obesity were assessed by body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression modeling was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Stratified analyses were conducted by sex, BMI, and smoking status. Results: During an average of 13.9 years of follow-up, 131 incident cases of SIC (including 41 adenocarcinomas, 44 malignant carcinoid tumors, 15 sarcomas and 10 lymphomas, and 21 unknown histology) were identified. WC was positively associated with SIC in a crude model that also included BMI (HR per 5-cm increase = 1.20, 95 % CI 1.04, 1.39), but this association attenuated in the multivariable model (HR 1.18, 95 % CI 0.98, 1.42). However, the association between WC and SIC was strengthened when the analysis was restricted to adenocarcinoma of the small intestine (multivariable HR adjusted for BMI = 1.56, 95 % CI 1.11, 2.17). There were no other significant associations. Conclusion: WC, rather than BMI, may be positively associated with adenocarcinomas but not carcinoid tumors of the small intestine. Impact: Abdominal obesity is a potential risk factor for adenocarcinoma in the small intestine.

Original languageEnglish
Pages (from-to)919-927
Number of pages9
JournalCancer Causes and Control
Issue number7
Publication statusPublished - 1 Jul 2016
Externally publishedYes


  • Abdominal obesity
  • Cancer
  • Obesity
  • Small intestine


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