The association between metabolic health, obesity phenotype and the risk of breast cancer

Yong Moon Mark Park, Alexandra J. White, Hazel B. Nichols, Katie M. O'Brien, Clarice R. Weinberg, Dale P. Sandler

Research output: Contribution to journalArticle

  • 3 Citations

Abstract

Beyond the current emphasis on body mass index (BMI), it is unknown whether breast cancer risk differs between metabolically healthy and unhealthy normal weight or overweight/obese women. The Sister Study is a nationwide prospective cohort study. Data came from 50,884 cohort participants aged 35 to 74 years enrolled from 2003 through 2009. Cox proportional hazards models were used to estimate multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for breast cancer risk. Metabolic abnormalities considered included: high waist circumference (≥88 cm); elevated blood pressure (≥130/85 mm Hg or antihypertensive medication); previously diagnosed diabetes or antidiabetic drug treatment; and cholesterol-lowering medication use. During follow-up (mean, 6.4 years), 1,388 invasive breast cancers were diagnosed at least 1 year after enrollment. Compared to women with BMI <25 kg/m2 with no metabolic abnormalities (metabolically healthy normal weight phenotype), women with a BMI <25 kg/m2 and ≥1 metabolic abnormality (metabolically unhealthy, normal weight phenotype) had increased risk of postmenopausal breast cancer (HR = 1.26, 95% CI: 1.01–1.56), as did women with a BMI ≥25 kg/m2 and no metabolic abnormalities (metabolically healthy overweight/obese phenotype) (HR = 1.24, 95% CI: 0.99–1.55). Furthermore, risk of postmenopausal breast cancer was consistently elevated in women with normal BMI and central obesity (normal weight central obesity phenotype) regardless of the criterion used to define central obesity, with HR for waist circumference ≥88 cm, waist circumference ≥80 cm, and waist-hip ratio ≥0.85 of 1.58, 95% CI: 1.02–2.46; 1.38, 95% CI: 1.09–1.75; and 1.38, 95% CI: 1.02–1.85, respectively. There was an inverse association between premenopausal breast cancer and metabolically healthy overweight/obese phenotype (HR = 0.71, 95% CI: 0.52–0.97). Our findings suggest that postmenopausal women who are metabolically unhealthy or have central adiposity may be at increased risk for breast cancer despite normal BMI.

LanguageEnglish (US)
Pages2657-2666
Number of pages10
JournalInternational Journal of Cancer
Volume140
Issue number12
DOIs
StatePublished - Jun 15 2017

Fingerprint

Obesity
Confidence Intervals
Breast Neoplasms
Body Mass Index
Phenotype
Health
Abdominal Obesity
Waist Circumference
Weights and Measures
Waist-Hip Ratio
Adiposity
Proportional Hazards Models
Hypoglycemic Agents
Antihypertensive Agents
Siblings
Cohort Studies
Cholesterol
Prospective Studies
Blood Pressure

Keywords

  • metabolic health
  • metabolically healthy obese
  • metabolically unhealthy normal weight
  • normal weight central obesity
  • obesity
  • postmenopausal breast cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Park, Y. M. M., White, A. J., Nichols, H. B., O'Brien, K. M., Weinberg, C. R., & Sandler, D. P. (2017). The association between metabolic health, obesity phenotype and the risk of breast cancer. International Journal of Cancer, 140(12), 2657-2666. DOI: 10.1002/ijc.30684

The association between metabolic health, obesity phenotype and the risk of breast cancer. / Park, Yong Moon Mark; White, Alexandra J.; Nichols, Hazel B.; O'Brien, Katie M.; Weinberg, Clarice R.; Sandler, Dale P.

In: International Journal of Cancer, Vol. 140, No. 12, 15.06.2017, p. 2657-2666.

Research output: Contribution to journalArticle

Park, YMM, White, AJ, Nichols, HB, O'Brien, KM, Weinberg, CR & Sandler, DP 2017, 'The association between metabolic health, obesity phenotype and the risk of breast cancer' International Journal of Cancer, vol. 140, no. 12, pp. 2657-2666. DOI: 10.1002/ijc.30684
Park YMM, White AJ, Nichols HB, O'Brien KM, Weinberg CR, Sandler DP. The association between metabolic health, obesity phenotype and the risk of breast cancer. International Journal of Cancer. 2017 Jun 15;140(12):2657-2666. Available from, DOI: 10.1002/ijc.30684
Park, Yong Moon Mark ; White, Alexandra J. ; Nichols, Hazel B. ; O'Brien, Katie M. ; Weinberg, Clarice R. ; Sandler, Dale P./ The association between metabolic health, obesity phenotype and the risk of breast cancer. In: International Journal of Cancer. 2017 ; Vol. 140, No. 12. pp. 2657-2666
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abstract = "Beyond the current emphasis on body mass index (BMI), it is unknown whether breast cancer risk differs between metabolically healthy and unhealthy normal weight or overweight/obese women. The Sister Study is a nationwide prospective cohort study. Data came from 50,884 cohort participants aged 35 to 74 years enrolled from 2003 through 2009. Cox proportional hazards models were used to estimate multivariable adjusted hazard ratios (HR) and 95{\%} confidence intervals (CIs) for breast cancer risk. Metabolic abnormalities considered included: high waist circumference (≥88 cm); elevated blood pressure (≥130/85 mm Hg or antihypertensive medication); previously diagnosed diabetes or antidiabetic drug treatment; and cholesterol-lowering medication use. During follow-up (mean, 6.4 years), 1,388 invasive breast cancers were diagnosed at least 1 year after enrollment. Compared to women with BMI <25 kg/m2 with no metabolic abnormalities (metabolically healthy normal weight phenotype), women with a BMI <25 kg/m2 and ≥1 metabolic abnormality (metabolically unhealthy, normal weight phenotype) had increased risk of postmenopausal breast cancer (HR = 1.26, 95{\%} CI: 1.01–1.56), as did women with a BMI ≥25 kg/m2 and no metabolic abnormalities (metabolically healthy overweight/obese phenotype) (HR = 1.24, 95{\%} CI: 0.99–1.55). Furthermore, risk of postmenopausal breast cancer was consistently elevated in women with normal BMI and central obesity (normal weight central obesity phenotype) regardless of the criterion used to define central obesity, with HR for waist circumference ≥88 cm, waist circumference ≥80 cm, and waist-hip ratio ≥0.85 of 1.58, 95{\%} CI: 1.02–2.46; 1.38, 95{\%} CI: 1.09–1.75; and 1.38, 95{\%} CI: 1.02–1.85, respectively. There was an inverse association between premenopausal breast cancer and metabolically healthy overweight/obese phenotype (HR = 0.71, 95{\%} CI: 0.52–0.97). Our findings suggest that postmenopausal women who are metabolically unhealthy or have central adiposity may be at increased risk for breast cancer despite normal BMI.",
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