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Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis.

Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Department of Nutrition, Bjørknes University College, Oslo, Norway. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway. Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK. Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA. Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France. Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, UK. National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, UK. Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands. World Cancer Research Fund International, London, UK. American Institute for Cancer Research, Arlington, Virginia, USA. Division of Medical Oncology, The Department of Internal Medicine, College of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

International journal of cancer. 2023;(4):572-599
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Abstract

Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2  = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.

Methodological quality

Publication Type : Meta-Analysis

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