Elsevier

Public Health

Volume 129, Issue 7, July 2015, Pages 872-880
Public Health

Review Paper
The effect of body mass index on endometrial cancer: a meta-analysis

https://doi.org/10.1016/j.puhe.2015.04.017Get rights and content

Highlights

  • We developed a wide search strategy to include as many studies as possible.

  • We included 40 eligible studies in the meta-analysis involving 32,281,242 participants.

  • We indicated that BMI is strongly associated with an increased risk of endometrial cancer.

Abstract

Background

Several epidemiological studies have investigated the association between body mass index (BMI) and endometrial cancer in recent years. This up-to-date meta-analysis was conducted to obtain an overall effect estimate based on current evidence.

Study design

A meta-analysis was conducted until March 2015.

Methods

Major electronic databases including PubMed, Web of Science, and Scopus were searched. The reference lists and related scientific conference databases were searched for additional data. Cohort and case-control studies addressing the association between BMI and endometrial cancer were included. The exposure of interest was overweight and obesity. The outcome of interest was endometrial cancer of any type confirmed pathologically. The effect measure of choice was rate ratio (RR) for cohort studies and odds ratio (OR) for case-control studies. The random effect model was reported.

Results

Of 6241 retrieved references, 40 studies were included in the meta-analysis including 20 prospective cohort studies and 20 case-control studies involving 32,281,242 participants. The results of both cohort and case-control studies showed a significant association. Based on random effect model, compared to normal weight people, the estimated RR and OR of endometrial cancer was 1.34 (95% CI: 1.20, 1.48) and 1.43 (95% CI: 1.30, 1.56) for the overweight and 2.54 (95% CI: 2.27, 2.81) and 3.33 (95% CI: 2.87, 3.79) for the obese, respectively.

Conclusions

The results of this meta-analysis indicated that BMI is strongly associated with an increased risk of endometrial cancer. Further investigations are required to expect the pathophysiology of the endometrial cancer caused by overweight and obesity.

Introduction

Endometrial cancer is the seventh most common cancer in women worldwide and the most common gynecological malignancy in developed countries.1, 2 Its incidence has been increasing over the last decades.3 The main etiology of uterine cancer is not well known. Some risk factors reported for uterine cancer are age, reproductive history, diabetes, early menarche, late menopause, and the use of estrogen hormone without progesterone.2, 4, 5

The prevalence of overweight and obesity is dramatically increasing in most parts of the world and is generally higher in women than in men.6 The association between body mass index (BMI) and breast, ovarian, and cervical cancers has already been addressed.7, 8, 9 Some studies reported a significant association between BMI and endometrial cancer10, 11, 12, 13 while others have not confirmed the association.14, 15, 16, 17, 18 The findings from a current meta-analysis which included the published papers by 2011 confirmed the association between BMI and endometrial cancer.19 The present up-to-date meta-analysis was conducted to assess the results of both cohort and case-control studies addressing the correlation between BMI and endometrial cancer separately based on the current evidence.

Section snippets

Definitions

Endometrial cancer is the cancer of the uterine corpus. Two major types of endometrial cancer have been described. Type I tumors are mostly endometrioid adenocarcinomas (about 80% of endometrial cancers) and Type II tumors are mainly serous and clear cell adenocarcinomas.20, 21

BMI is weight in kilograms divided by the square of the height in meters. Based on the World Health Organization classification, BMI is divided into underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight

Description of studies

As shown in Fig. 1, we retrieved 6241 references up to March 2015, including 5952 references through searching electronic databases, 289 references through checking other sources such as reference lists, related conference databases, or through personal contact with authors of the included studies. Of 158 references considered potentially eligible after screening, 118 studies were excluded and 40 studies were eventually included for meta-analysis including 20 prospective cohort studies1, 2, 10,

Discussion

The results of this meta-analysis revealed that increase in BMI is significantly associated with an increased risk of endometrial cancer, so that, compared to normal weight individuals, the risk of endometrial cancer increase about 1.5 fold in overweight people and more than 2.5 fold in obese people. In other words, as BMI increases, the risk of endometrial cancer also increases. This evidence shows a dose-response relationship for BMI and endometrial cancer. When a dose-response relationship

Acknowledgments

We would like to thank the Vice-chancellor of Research and Technology of Islamic Azad University, Branch Toyserkan for approval of this study.

Ethical approval

Ethical approval was not sought, as it was not required for conducting a meta-analysis.

Funding

This study was supported by the Vice-chancellor of Research and Technology of Islamic Azad University, Branch Toyserkan.

Conflict of interest statement

The authors have declared that no competing interests exist.

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