. 2020 Jul 21;22(1):e13088. doi: 10.1111/obr.13088

TABLE 1.

Epidemiological evidence on the association between visceral obesity and incidence of specific types of cancer in adults and/or older adults

Author/year	Design Population	Outcome	Visceral obesity measurement	Visceral obesity results	Summary
Overall cancer
Britton (2013) ⁶	Cohort Framingham Heart Study (n = 3086, 49% women, mean age 50.2 years Followed 5.0 years	Incident of cancer Cancers were validated using medical records (pathology reports). Nonmelanoma skin cancers were not included.	Visceral adipose tissue (VAT) by computed tomography (CT)	After adjustment for clinical risk factors and general adiposity/BMI. VAT was associated with cancer HR = 1.43 (1.12–1.84). Women HR = 1.27 (0.88–1.82) Men HR = 1.43 (1.06–1.94)	VAT Overall—risk Women—NS Men—risk
Liu Y. (2016) ²⁴	Cohort 68 253 Chinese women	Overall cancer Major site‐specific cancers: postmenopausal breast cancer, endometrial, liver and ovarian	Waist‐hip ratio (WHR)	WHR was not associated with cancer risk after adjustment.	WHR Overall—NS
Lee (2018) ⁶¹	Cohort 22.9 million Korean adults 769 871 cancer cases Followed 7 years	23 of the most common cancers	WC—quintiles of the cohort	Positive association with 18 of 23 types of cancer varying by sex Adjust for BMI removed some association (premenopausal and postmenopausal uterus and ovary, postmenopausal breast and leukaemia)	WC Overall—risk Women—risk Men—risk 18 cancer—risk
Staunstrup (2019) ²³	Prospective Epidemiological Risk Factor (PERF) cohort 4679 Danish postmenopausal women	Cancer diagnoses were extracted from the Danish Cancer Registry. Overall cancer Site specific cancers	Central obesity defined—trunk‐to‐peripheral fat ratio, calculated by fat mass in the trunk area/fat mass in arms and legs evaluate by dual‐energy X‐ray absorptiometry scanners High central obese—quartile 4	Adjusted to BMI Overall cancer HR = 1.50 (1.20–1.88) Site‐specific cancers: Respiratory (Q1 vs. Q4) HR = 2.01 (1.17–3.47) Gastrointestinal (Q1 vs. Q4: HR = 1.55 (0.99–2.41) Female genital organs (Q1 vs. Q4) HR = 1.95 (1.00–3.78)	Trunk‐to‐peripheral fat ratio Overall—risk Overall—NS (gastrointestinal)
Kyrgiou (2017) ¹⁶	Umbrella review of systematic reviews and meta‐analyses of observational studies	Colon cancer Pancreatic Breast premenopausal Breast postmenopausal Endometrial Ovarian Lung Melanoma Non‐Hodgkin lymphoma Multiple myeloma Leukaemia Oesophageal adenocarcinoma Gastric Biliary tract Thyroid 36 cancer sites and subtypes were examined.	Waist circumference (WC) per 10 cm WHR per 0.1 units Continuous scale to measure adiposity	Colon WC HR = 1.25 (1.15–1.35) WC men 1.33 (1.18–1.50) WC women 1.16 (1.08–1.23) WHR HR = 1.29 (1.17–1.43) Men 1.43 (1.19–1.71) Women 1.20 (1.08–1.33) Pancreatic cancer WC 1.11 (1.05–1.18) WHR 1.20 (1.09–1.31) Endometrial WC 1.27 (1.17–1.39) WHR 1.21 (1.13–1.29) Ovarian WC 1.06 (1.00–1.12) WHR 1.00 (0.93–1.07) All other sites are not associated.	WC Overall—risk Women—risk Men—risk WHR Overall—risk Women—risk Men—risk Ovarian and all other sites—NS
Colorectal cancer
Chan (2007) ²⁸	Case–control Patients in Hong Kong, China, recruited after coronary angiography for suspected CAD. Age‐ and sex‐matched control was recruited from the general population (n = 207).	Colorectal neoplasm Assessed by colonoscopy. Advanced colonic lesion was defined as presence of cancer or adenomas.	WC Men ≥ 91.4 cm Women ≥ 81.3 cm	WC OR = 2.29 (1.29–3.72)	WC Overall—risk
Yamaji (2009) ²⁵	Case–control study 50–79 years old Screening in Tokyo, Japan 782 cases and 738 controls	Colorectal adenoma	Visceral fat area (VFA)—cm² by CT	OR = 1.58 (1.11–2.24) for men and women combined, independently of body mass index.	VFA Overall—risk
Knag (2010) ³⁰	Case–control study 4276 subjects, Koreans that presented for health check‐ups	Colorectal adenoma	VAT by CT Highest quintile vs. lowest quintile WC male > 90 cm, female > 80 cm	VAT Adjusted (OR) = 3.09 (2.19–4.36) WC Adjusted OR = 1.66 (1.38–1.99)	VAT Overall—risk WC Overall—NS
Tae‐Hoon (2008) ²⁹	Prospectively enrolled 200 asymptomatic adults, Seoul, Korea, 133 males, 67 females. Mean age, 50.9 8.5 years follow‐up	Colorectal neoplasm	VAT by CT 136.61 cm² versus VAT under 67.23 cm² WC > 90 cm	After adjustment VAT OR = 4.07 (1.01–16.43) WC OR = 2.05 (0.63–6.70)	VAT Overall—risk WC Overall—NS
Keum (2015) ²⁶	Meta‐analysis of observational studies 12 studies included 2776 cases	Colorectal adenomas	VAT—each 25 cm² increase Range of VAT area = 30–228 cm²)	VAT OR = 1.13 (1.05–1.21)	VAT Overall—risk
Abar (2018) ²⁷	Systematic review of prospective studies 50 936 cases among 7 393 510 participants	Colorectal cancer (CRC)	WC per 10 cm WHR per 0.1 unit	WC HR = 1.02 (1.02–1.03) WHR HR = 1.03 (1.01–1.05)	WC and WHR Overall—risk
Prostate cancer
Blanc‐Lapierre (2015) ¹⁰	Population‐based case–control study 1937 men with incident prostate cancer, aged ≤75 years, diagnosed across hospitals, Montreal, Canada 1995 controls The Prostate Cancer & Environment Study (PROtEuS)	Prostate cancer Aggressiveness of PCa—defined by the Gleason score	WC cut‐off of 102 cm for abdominal obesity	Cases had similar WC (98.6 vs. 98.5 cm) OR = 0.70 (0.60, 0.82) after considering potential confounders negative association did not vary according to PCa aggressiveness	WC Overall—protective
Pischon (2008) ¹⁷	Cohort 29 502 men without cancer at baseline from eight countries of the European Prospective Investigation into Cancer and Nutrition (EPIC) Follow‐up of 8.5 years	Prostate cancer	WC per 5 cm WHR per 0.1 unit	WC RR advanced prostate cancer = 1.06 (1.01–1.1) WHR RR = 1.21 (1.04–1.39)	WC and WHR Overall—risk
De Nunzio (2016) ¹⁸	584 clinic patients Italy Patients with moderate/high cardiovascular risk evaluated for prostate cancer diagnosis.	Prostate cancer diagnosis at biopsy. Secondary end point High‐grade disease—Gleason score of ≥ 7	WC Men > 102 cm Women > 88 cm	WC was not associated with prostate cancer (p = 0.669). WC was associated with Gleason score (p = 0.028). Highest WC between Gleason score ≥ 7	WC Overall—NS
Breast cancer
Agnoli (2010) ³²	Case–control study postmenopausal women, ORDET cohort. Follow‐up 13.5 years Cases: 163 women Four matched controls per case	Breast cancer postmenopausal	WC > 86 cm	WC Adjusted RR = 1.23 (0.83–1.81)	WC Women—NS (post)
Agnoli (2015) ¹⁹	Case‐cohort study 22 494 women 593 breast cancer cases EPIC—Italian centres European Prospective Investigation into Cancer and Nutrition Followed up 15 years	Breast cancer (BC) Postmenopausal and premenopausal	WC > 80 cm	Whole cohort HR = 1.07(0.82–1.39) Premenopausal 0.77 (0.51–1.16) Postmenopausal 1.04 (0.69–1.57)	WC Women—NS (pre and post)
Bandera (2015) ³³	Case–control, AMBER Consortium, African American (AA) women Cases: 2104 ER+, 1070 ER− cases (including 491 TN cases) 12 060 controls	Breast cancer Premenopausal and postmenopausal Categorized according to hormone receptor status ER+, ER− and TN (ER−, PR− and HER2−)	WHR	Premenopausal ER+ tumours OR = 1.35 (1.01–1.80) Postmenopausal all tumour subtypes combined OR = 1.26 (1.02–1.56).	WHR Women risk (pre and post)
Park (2017) ³⁴	Cohort Sister Study, nationwide prospective cohort 50 884 participants aged 35 to 74 years old	Breast cancer Premenopausal and postmenopausal	WC (88 cm) WHR (0.85)	Premenopausal with normal BMI WC—NA WHR HR = 1.52 (0.89–2.61) Postmenopausal with normal BMI WC HR = 1.58 (1.02–2.46) WHR HR = 1.38 (1.02–1.85) Premenopausal with BMI ≥ 25 (overweight/obese) WC HR = 0.74 (0.54–1.01) WHR HR = 0.91 (0.62–1.33) Postmenopausal with BMI ≥ 25 WC HR = 1.43 (1.24–1.66) WHR HR = 1.49 (1.26–1.76)	Women Normal BMI WC and WHR—NS (pre) WC and WHR—risk (post) BMI ≥ 25 WC and WHR—NS (pre) WC and WHR—risk (post)
Chen (2016) ¹¹	Meta‐analysis of prospective studies	Breast cancer Premenopausal and postmenopausal	WC per 10 cm WHR per 0.1 unit	Premenopausal BC—adjusted RRs WC RR = 1.05 (0.99–1.10) WHR RR = 1.07 (0.95–1.21) Postmenopausal BC WC RR = 1.06 (1.04–1.09) WHR RR = 1.06 (0.99–1.13)	Women WC—risk (post) WC—NS (pre) WHR—NS (pre and post)
Endometrial cancer
Amankwah (2013) ³⁸	Population‐based case–control study 524 cases 1032 controls Alberta, Canada	Endometrial cancer	WC HP WHR	WC > 84.8–96.0 OR = 2.34 (1.59–3.43) WC > 96.0 OR = 4.21 (2.90–6.10) HP > 104.7–112.7 OR = 1.48 (1.03–2.11) HP > 112.7 OR = 2.87 (2.05–4.00) WHR > 0.81–0.86 OR = 1.86 (1.28–2.69) WHR > 0.86 OR = 2.57 (1.80–3.67)	Women WC—risk HP—risk WHR—risk
Reeves (2011) ³⁵	Cohort Women's Health Initiative 86 937 postmenopausal women 7.8 years of follow‐up	Endometrial cancer	WHR	WHR HR = 1.33 (1.04–1.70)	Women WHR—risk
Sponholtz (2016) ³⁷	Cohort 47 557 participants the Black Women's Health Study	Endometrial cancer	WC ≥ 88 cm HC highest quartile WHR ≥ 0.85	After adjustment WC RR = 1.09 (0.75–1.58) HC RR = 0.86 (0.55–1.36) WHR RR = 1.06 (0.79–1.42)	Women WC—NS HC—NS WHR—NS
Aune (2015) ¹²	Systematic review and meta‐analysis of prospective studies 22 320 cases among 6 445 402 participants	Endometrial cancer	WC per 10 cm HC 10‐cm increase WHR per 0.1 unit	WC 1.27 (1.17–1.39) HC 1.30 (1.19–1.41) WHR 1.21 (1.13–1.29)	Women WC—risk HC—risk WHR—risk
Raglan (2019) ³⁶	Umbrella review analysed systematic reviews or meta‐analyses of observational studies	Endometrial cancer	WHR 0.1 unit	Premenopausal women RR = 1.21 (1.13–1.29)	Women WHR—risk
Pancreatic cancer
Luo (2008) ⁴⁰	Cohort 138 503 women followed for 7.7 years Women's Health Initiative in the United States	Pancreatic cancer	WC per 10 cm WHR per 0.1 unit	WC 1.08 (0.98–1.18) WHR 1.32 (1.12–1.56)	Women WC—NS WHR—risk
Genkinger (2011) ³⁹	Analysis of 14 cohort studies on 846 340 individuals 2135 individuals were diagnosed with pancreatic cancer	Pancreatic cancer	WHR Highest versus lowest quartile	RR = 1.35 (1.03–1.78)	Overall WHR—risk
Aune (2012) ¹³	Systematic review and meta‐analysis of prospective studies	Pancreatic cancer	WC 10‐cm increase WHR 0.1‐unit increment	WC RR = 1.11 (1.05–1.18) WHR RR = 1.19 (1.09–1.31).	Overall WC—Risk WHR—risk
Gastro‐oesophageal cancer
Du (2017) ¹⁴	Systematic review and meta‐analysis of prospective studies Total of 2130 gastro‐oesophageal cancer cases diagnosed among 913 182 participants	Gastro‐oesophageal cancer: total gastro‐oesophageal cancer, gastric cancer and oesophageal cancer.	WC WHR	Gastro‐oesophageal cancer WC RR = 1.68 (1.38–2.04) WHR RR = 1.49 (1.19–1.88) Gastric cancer WC RR = 1.48 (1.24–1.78) WHR RR = 1.33 (1.04–1.70) Oesophageal cancer WC RR 2.06 (1.30–3.24) WHR RR = 1.99 (1.05–3.75).	Overall WC—risk WHR—risk
Steffen (2015) ⁴²	European Prospective Investigation into Cancer and Nutrition (EPIC) study 11 years of follow‐up 391 456 individuals	Oesophageal adenocarcinoma (EAC) Gastric cardia adenocarcinoma (GCC) Gastric noncardia adenocarcinoma (GNCC)	WC—highest versus lowest quintile HC—highest versus lowest quintile WHR—highest versus lowest quintile	EAC Adjusted for BMI WC HR = 3.76 (1.72–8.22) HC HR = 0.35 (0.18–0.68) WHR HR = 4.05 (1.85–8.87) GCC WC (HR = 1.91 (1.09–3.37) HC (HR = 0.38 (0.42–1.13) WHR HR = 1.95 (1.12–3.38) GNCC WC HR = 1.25 (0.75–2.08) HC HR = 0.69 (0.41–1.15) WHR HR = 2.05 (1.19–3.52)	Overall WC—risk HC—protection WHR—risk
O'Doherty (2012) ⁴¹	Prospective NIH–AARP cohort 218 854 participants	Oesophageal adenocarcinoma (EAC) Gastric cardia adenocarcinoma (GCC)	WC WHR	WC EAC HR = 2.01, CI 1.35–3.00 GCC HR = 2.22, 1.43–3.47) WHR EAC HR = 1.81, CI 1.24–2.64) GCC not associated	Overall WC—risk WHR—risk (EAC) WHR—NS (GC)
Renal cancer
Luo (2007) ¹⁵	Cohort Women's Health Initiative 7.7 years of follow‐up 140 057 postmenopausal women aged 50–79 years	Renal cell carcinoma	WHR—highest vs. lowest quartile	RR = 1.8 (1.2–2.5)	Women WHR—risk
Pischon (2006) ⁴³	European Prospective Investigation into Cancer and Nutrition (EPIC)—eight countries 348 550 men and women 6.0 years of follow‐up	Renal cell carcinoma	WC (≥102 cm in men; ≥88 in women) HC quintile WHR quintile	Multivariable adjustment Women WC RR = 1.80 (1.18–2.75) HC RR = 1.65 (0.64–4.23) WHR RR = 1.01 (0.54–1.89) Men WC RR = 1.19 (0.98–1.97) HC RR = 0.44 (0.20–0.98) WHR RR = 1.86 (0.97–3.56)	Women WC—risk HC—NS WHR—NS Men WC—NS HC—protective WHR—NS
Nam (2019) ⁴⁴	23 313 046 Korean adults 5.4 years of follow‐up, 18 036 cases	Kidney cancer	WC per 5 cm WC male ≥ 100.0, female ≥ 95.0	HR increased with increasing waist circumference (WC) (p for trend < 0.001) WC per 5 cm Adjusted HR = 1.09 (1.08–1.11) WC male ≥ 100.0, female ≥ 95.0 Adjusted HR = 1.18 (1.09–1.28)	Overall WC—risk
Several types of cancer
Montella (2015) ²⁰	Case–control study Italy—hospital‐based 690 incident UCB 665 controls	Bladder cancer Urothelial carcinoma of the bladder (UCB)	WC ≥94 cm for men ≥80 cm for women	Bladder cancer OR = 1.63 (1.22–2.19) UCB OR = 1.63 (1.22–2.19)	Overall WC—risk
Britton (2008) ⁴⁷	European Prospective Investigation into Cancer and Nutrition (EPIC), 371 983 cancer‐free individuals. 8.5 years of follow‐up, 1219 histologically confirmed incident cases	Hodgkin's lymphoma (NHL) and multiple myeloma (MM)	WC ≥ 102 cm men, ≥88 cm women WHR ≥ 0.95 men, ≥0.80 women Sex‐specific analyses	Visceral obesity was not associated with NHL and MM in men and women. Men—multivariate WC RR = 1.19 (0.91–1.56) WHR RR = 1.12 (0.91–1.36) Women—multivariate WC RR = 0.98 (0.74–1.29) WHR RR = 0.93 (0.77–1.13)	Men WC—NS Women≥NS
Schlesinger (2013) ⁴⁶	European Prospective Investigation into Cancer and Nutrition study 359 525 men and women in the follow‐up of 8.6 years	Hepatocellular carcinoma (HCC), intrahepatic (IBDC) extrahepatic bile duct system cancer (EBDSC including gallbladder cancer [GBC]) 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC	WC and WHR—extreme tertiles Waist‐to‐height ratio (WHtR)—extreme tertiles	All anthropometric measures were positively associated with risk of HCC and GBC. WHtR HCC RR = 3.51 (2.09–5.87) GBC RR = 1.56 (1.12–2.16) No association was observed between abdominal obesity and risk of IBDC and EBDSC.	Overall WC—risk WHtR—risk WC and WHR—NS (IBDC and EBDSC)
Gaudet (2015) ⁴⁹	20 cohort studies Pooled data from 1 941 300 participants, including 3760 cases	Head and neck cancer	WC per 5 cm: WHR per 0.1 unit HC	After adjustment for BMI WC HR = 1.04 (1.03–1.05) WHR HR = 1.07 (1.05–1.09) Larger HC was not associated.	Overall WC—risk WHR—risk HC—NS
Kitahara (2016) ⁵⁰	Pooled analysis of 22 prospective studies	Thyroid cancer	WC (per 5 cm)	HR = 1.03 (1.01–1.05)	Overall WC—risk
Aune (2015) ⁴⁵	Systematic review and meta‐analysis of prospective studies	Ovarian cancer	WC per 10 cm HC WHR	WC RR = 1.06 (1.00–1.12) HC and WHR—not association	Overall WC—NS HC—NS WHR—NS
Hidayat (2016) ⁴⁸	Meta‐analyses of observational studies	Lung cancer	WC—10‐cm increase WHR—0.1‐unit increase	WC RR = 1.10 (1.04–1.17) WHR RR = 1.05 (1.00–1.11) Highest versus lowest categories: WC RR = 1.32 (1.13–1.54) WHR RR = 1.10 (1.00–1.23) WC Never smokers RR = 1.11 (1.00–1.23) Former smokers RR = 1.12 (1.03–1.22) Current smokers RR = 1.16 (1.08–1.25)	Overall WC—Risk
Abar (2019) ⁶²	Meta‐analysis of prospective studies	Lymphohaematopoietic cancers	WC WHR	Higher WC—no associated with multiple myeloma WHR associated with diffuse large β‐cell lymphoma	WC—NS WHR—risk

Author/year

Design Population

Outcome

Visceral obesity measurement

Visceral obesity results

Summary

Overall cancer

Britton (2013) ⁶

Cohort

Framingham Heart Study (n = 3086, 49% women, mean age 50.2 years

Followed 5.0 years

Incident of cancer

Cancers were validated using medical records (pathology reports).

Nonmelanoma skin cancers were not included.

Visceral adipose tissue (VAT) by computed tomography (CT)

After adjustment for clinical risk factors and general adiposity/BMI.

VAT was associated with cancer

HR = 1.43 (1.12–1.84).

Women HR = 1.27 (0.88–1.82)

Men HR = 1.43 (1.06–1.94)

VAT

Overall—risk

Women—NS

Men—risk

Liu Y. (2016) ²⁴

Cohort

68 253

Chinese women

Overall cancer

Major site‐specific cancers: postmenopausal breast cancer, endometrial, liver and ovarian

Waist‐hip ratio (WHR)

WHR was not associated with cancer risk after adjustment.

WHR

Overall—NS

Lee (2018) ⁶¹

Cohort

22.9 million Korean adults

769 871 cancer cases

Followed 7 years

23 of the most common cancers

WC—quintiles of the cohort

Positive association with 18 of 23 types of cancer varying by sex

Adjust for BMI removed some association (premenopausal and postmenopausal uterus and ovary, postmenopausal breast and leukaemia)

Overall—risk

Women—risk

Men—risk

18 cancer—risk

Staunstrup (2019) ²³

Prospective Epidemiological Risk Factor (PERF) cohort

4679 Danish postmenopausal women

Cancer diagnoses were extracted from the Danish Cancer Registry.

Overall cancer

Site specific cancers

Central obesity defined—trunk‐to‐peripheral fat ratio, calculated by fat mass in the trunk area/fat mass in arms and legs evaluate by dual‐energy X‐ray absorptiometry scanners

High central obese—quartile 4

Adjusted to BMI

Overall cancer HR = 1.50 (1.20–1.88)

Site‐specific cancers:

Respiratory (Q1 vs. Q4) HR = 2.01 (1.17–3.47)

Gastrointestinal (Q1 vs. Q4: HR = 1.55 (0.99–2.41)

Female genital organs (Q1 vs. Q4) HR = 1.95 (1.00–3.78)

Trunk‐to‐peripheral fat ratio

Overall—risk

Overall—NS (gastrointestinal)

Kyrgiou (2017) ¹⁶

Umbrella review of systematic reviews and meta‐analyses of observational studies

Colon cancer

Pancreatic

Breast premenopausal

Breast postmenopausal

Endometrial

Ovarian

Lung

Melanoma

Non‐Hodgkin lymphoma

Multiple myeloma

Leukaemia

Oesophageal adenocarcinoma

Gastric

Biliary tract

Thyroid

36 cancer sites and subtypes were examined.

Waist circumference (WC) per 10 cm

WHR per 0.1 units

Continuous scale to measure adiposity

Colon

WC HR = 1.25 (1.15–1.35)

WC men 1.33 (1.18–1.50)

WC women 1.16 (1.08–1.23)

WHR HR = 1.29 (1.17–1.43)

Men 1.43 (1.19–1.71)

Women 1.20 (1.08–1.33)

Pancreatic cancer

WC 1.11 (1.05–1.18)

WHR 1.20 (1.09–1.31)

Endometrial

WC 1.27 (1.17–1.39)

WHR 1.21 (1.13–1.29)

Ovarian

WC 1.06 (1.00–1.12)

WHR 1.00 (0.93–1.07)

All other sites are not associated.

Overall—risk

Women—risk

Men—risk

WHR

Overall—risk

Women—risk

Men—risk

Ovarian and all other sites—NS

Colorectal cancer

Chan (2007) ²⁸

Case–control

Patients in Hong Kong, China, recruited after coronary angiography for suspected CAD.

Age‐ and sex‐matched control was recruited from the general population (n = 207).

Colorectal neoplasm

Assessed by colonoscopy.

Advanced colonic lesion was defined as presence of cancer or adenomas.

Men ≥ 91.4 cm

Women ≥ 81.3 cm

OR = 2.29 (1.29–3.72)

Overall—risk

Yamaji (2009) ²⁵

Case–control study

50–79 years old

Screening in Tokyo, Japan

782 cases and 738 controls

Colorectal adenoma

Visceral fat area (VFA)—cm² by CT

OR = 1.58 (1.11–2.24) for men and women combined, independently of body mass index.

VFA

Overall—risk

Knag (2010) ³⁰

Case–control study

4276 subjects, Koreans that presented for health check‐ups

Colorectal adenoma

VAT by CT

Highest quintile vs. lowest quintile

WC male > 90 cm, female > 80 cm

VAT

Adjusted (OR) = 3.09 (2.19–4.36)

Adjusted OR = 1.66 (1.38–1.99)

VAT

Overall—risk

Overall—NS

Tae‐Hoon (2008) ²⁹

Prospectively enrolled 200 asymptomatic adults, Seoul, Korea, 133 males, 67 females.

Mean age, 50.9

8.5 years follow‐up

Colorectal neoplasm

VAT by CT

136.61 cm² versus VAT under 67.23 cm²

WC > 90 cm

After adjustment

VAT

OR = 4.07 (1.01–16.43)

OR = 2.05 (0.63–6.70)

VAT

Overall—risk

Overall—NS

Keum (2015) ²⁶

Meta‐analysis of observational studies

12 studies included

2776 cases

Colorectal adenomas

VAT—each 25 cm² increase

Range of VAT area = 30–228 cm²)

VAT

OR = 1.13 (1.05–1.21)

VAT

Overall—risk

Abar (2018) ²⁷

Systematic review of prospective studies

50 936 cases among 7 393 510 participants

Colorectal cancer (CRC)

WC per 10 cm

WHR per 0.1 unit

HR = 1.02 (1.02–1.03)

WHR

HR = 1.03 (1.01–1.05)

WC and WHR

Overall—risk

Prostate cancer

Blanc‐Lapierre (2015) ¹⁰

Population‐based case–control study

1937 men with incident prostate cancer, aged ≤75 years, diagnosed across hospitals, Montreal, Canada

1995 controls

The Prostate Cancer & Environment Study (PROtEuS)

Prostate cancer

Aggressiveness of PCa—defined by the Gleason score

WC cut‐off of 102 cm for abdominal obesity

Cases had similar WC (98.6 vs. 98.5 cm)

OR = 0.70 (0.60, 0.82) after considering potential confounders negative association did not vary according to PCa aggressiveness

Overall—protective

Pischon (2008) ¹⁷

Cohort

29 502 men without cancer at baseline from eight countries of the European Prospective Investigation into Cancer and Nutrition (EPIC)

Follow‐up of 8.5 years

Prostate cancer

WC per 5 cm

WHR per 0.1 unit

RR advanced prostate cancer = 1.06 (1.01–1.1)

WHR

RR = 1.21 (1.04–1.39)

WC and WHR

Overall—risk

De Nunzio (2016) ¹⁸

584 clinic patients Italy

Patients with moderate/high cardiovascular risk evaluated for prostate cancer diagnosis.

Prostate cancer diagnosis at biopsy.

Secondary end point

High‐grade disease—Gleason score of ≥ 7

Men > 102 cm

Women > 88 cm

WC was not associated with prostate cancer (p = 0.669).

WC was associated with Gleason score (p = 0.028).

Highest WC between Gleason score ≥ 7

Overall—NS

Breast cancer

Agnoli (2010) ³²

Case–control study postmenopausal women, ORDET cohort.

Follow‐up 13.5 years

Cases: 163 women

Four matched controls per case

Breast cancer postmenopausal

WC > 86 cm

Adjusted RR = 1.23 (0.83–1.81)

Women—NS (post)

Agnoli (2015) ¹⁹

Case‐cohort study

22 494 women

593 breast cancer cases

EPIC—Italian centres European Prospective Investigation into Cancer and Nutrition

Followed up 15 years

Breast cancer (BC)

Postmenopausal and premenopausal

WC > 80 cm

Whole cohort HR = 1.07(0.82–1.39)

Premenopausal 0.77 (0.51–1.16)

Postmenopausal 1.04 (0.69–1.57)

Women—NS (pre and post)

Bandera (2015) ³³

Case–control, AMBER Consortium, African American (AA) women

Cases:

2104 ER+,

1070 ER− cases (including 491 TN cases)

12 060 controls

Breast cancer

Premenopausal and postmenopausal

Categorized according to hormone receptor status ER+, ER− and TN (ER−, PR− and HER2−)

WHR

Premenopausal ER+ tumours

OR = 1.35 (1.01–1.80)

Postmenopausal all tumour subtypes combined

OR = 1.26 (1.02–1.56).

WHR

Women risk (pre and post)

Park (2017) ³⁴

Cohort

Sister Study, nationwide prospective cohort

50 884 participants aged 35 to 74 years old

Breast cancer

Premenopausal and postmenopausal

WC (88 cm)

WHR (0.85)

Premenopausal with normal BMI

WC—NA

WHR

HR = 1.52 (0.89–2.61)

Postmenopausal with normal BMI

HR = 1.58 (1.02–2.46)

WHR

HR = 1.38 (1.02–1.85)

Premenopausal with BMI ≥ 25 (overweight/obese)

HR = 0.74 (0.54–1.01)

WHR

HR = 0.91 (0.62–1.33)

Postmenopausal with BMI ≥ 25

HR = 1.43 (1.24–1.66)

WHR

HR = 1.49 (1.26–1.76)

Women

Normal BMI

WC and WHR—NS (pre)

WC and WHR—risk (post)

BMI ≥ 25

WC and WHR—NS (pre)

WC and WHR—risk (post)

Chen (2016) ¹¹

Meta‐analysis of prospective studies

Breast cancer

Premenopausal and postmenopausal

WC per 10 cm

WHR per 0.1 unit

Premenopausal BC—adjusted RRs

RR = 1.05 (0.99–1.10)

WHR

RR = 1.07 (0.95–1.21)

Postmenopausal BC

RR = 1.06 (1.04–1.09)

WHR

RR = 1.06 (0.99–1.13)

Women

WC—risk (post)

WC—NS (pre)

WHR—NS (pre and post)

Endometrial cancer

Amankwah (2013) ³⁸

Population‐based case–control study

524 cases

1032 controls

Alberta, Canada

Endometrial cancer

WHR

WC > 84.8–96.0

OR = 2.34 (1.59–3.43)

WC > 96.0

OR = 4.21 (2.90–6.10)

HP > 104.7–112.7

OR = 1.48 (1.03–2.11)

HP > 112.7

OR = 2.87 (2.05–4.00)

WHR > 0.81–0.86

OR = 1.86 (1.28–2.69)

WHR > 0.86

OR = 2.57 (1.80–3.67)

Women

WC—risk

HP—risk

WHR—risk

Reeves (2011) ³⁵

Cohort

Women's Health Initiative

86 937 postmenopausal women

7.8 years of follow‐up

Endometrial cancer

WHR

HR = 1.33 (1.04–1.70)

Women

WHR—risk

Sponholtz (2016) ³⁷

Cohort

47 557 participants the Black Women's Health Study

Endometrial cancer

WC ≥ 88 cm

HC highest quartile

WHR ≥ 0.85

After adjustment

RR = 1.09 (0.75–1.58)

RR = 0.86 (0.55–1.36)

WHR

RR = 1.06 (0.79–1.42)

Women

WC—NS

HC—NS

WHR—NS

Aune (2015) ¹²

Systematic review and meta‐analysis of prospective studies

22 320 cases among

6 445 402 participants

Endometrial cancer

WC per 10 cm

HC 10‐cm increase

WHR per 0.1 unit

WC 1.27 (1.17–1.39)

HC 1.30 (1.19–1.41)

WHR 1.21 (1.13–1.29)

Women

WC—risk

HC—risk

WHR—risk

Raglan (2019) ³⁶

Umbrella review analysed systematic reviews or meta‐analyses of observational studies

Endometrial cancer

WHR 0.1 unit

Premenopausal women

RR = 1.21 (1.13–1.29)

Women

WHR—risk

Pancreatic cancer

Luo (2008) ⁴⁰

Cohort

138 503 women followed for 7.7 years

Women's Health Initiative in the United States

Pancreatic cancer

WC per 10 cm

WHR per 0.1 unit

WC 1.08 (0.98–1.18)

WHR 1.32 (1.12–1.56)

Women

WC—NS

WHR—risk

Genkinger (2011) ³⁹

Analysis of 14 cohort studies on 846 340 individuals

2135 individuals were diagnosed with pancreatic cancer

Pancreatic cancer

WHR

Highest versus lowest quartile

RR = 1.35 (1.03–1.78)

Overall

WHR—risk

Aune (2012) ¹³

Systematic review and meta‐analysis of prospective studies

Pancreatic cancer

WC 10‐cm increase

WHR 0.1‐unit increment

RR = 1.11 (1.05–1.18)

WHR

RR = 1.19 (1.09–1.31).

Overall

WC—Risk

WHR—risk

Gastro‐oesophageal cancer

Du (2017) ¹⁴

Systematic review and meta‐analysis of prospective studies

Total of 2130 gastro‐oesophageal cancer cases diagnosed among 913 182 participants

Gastro‐oesophageal cancer: total gastro‐oesophageal cancer, gastric cancer and oesophageal cancer.

WHR

Gastro‐oesophageal cancer

RR = 1.68 (1.38–2.04)

WHR

RR = 1.49 (1.19–1.88)

Gastric cancer

RR = 1.48 (1.24–1.78)

WHR

RR = 1.33 (1.04–1.70)

Oesophageal cancer

RR 2.06 (1.30–3.24)

WHR

RR = 1.99 (1.05–3.75).

Overall

WC—risk

WHR—risk

Steffen (2015) ⁴²

European Prospective Investigation into Cancer and Nutrition (EPIC) study

11 years of follow‐up

391 456 individuals

Oesophageal adenocarcinoma (EAC)

Gastric cardia adenocarcinoma (GCC)

Gastric noncardia adenocarcinoma (GNCC)

WC—highest versus lowest quintile

HC—highest versus lowest quintile

WHR—highest versus lowest quintile

EAC

Adjusted for BMI

HR = 3.76 (1.72–8.22)

HR = 0.35 (0.18–0.68)

WHR

HR = 4.05 (1.85–8.87)

GCC

WC (HR = 1.91 (1.09–3.37)

HC (HR = 0.38 (0.42–1.13)

WHR

HR = 1.95 (1.12–3.38)

GNCC

HR = 1.25 (0.75–2.08)

HR = 0.69 (0.41–1.15)

WHR

HR = 2.05 (1.19–3.52)

Overall

WC—risk

HC—protection

WHR—risk

O'Doherty (2012) ⁴¹

Prospective NIH–AARP cohort

218 854 participants

Oesophageal adenocarcinoma (EAC)

Gastric cardia adenocarcinoma (GCC)

WHR

EAC

HR = 2.01, CI 1.35–3.00

GCC

HR = 2.22, 1.43–3.47)

WHR

EAC

HR = 1.81, CI 1.24–2.64)

GCC not associated

Overall

WC—risk

WHR—risk (EAC)

WHR—NS (GC)

Renal cancer

Luo (2007) ¹⁵

Cohort Women's Health Initiative

7.7 years of follow‐up

140 057 postmenopausal women aged 50–79 years

Renal cell carcinoma

WHR—highest vs. lowest quartile

RR = 1.8 (1.2–2.5)

Women

WHR—risk

Pischon (2006) ⁴³

European Prospective Investigation into Cancer and Nutrition (EPIC)—eight countries

348 550 men and women

6.0 years of follow‐up

Renal cell carcinoma

(≥102 cm in men; ≥88 in women)

HC quintile

WHR quintile

Multivariable adjustment

Women

WC RR = 1.80 (1.18–2.75)

HC RR = 1.65 (0.64–4.23)

WHR RR = 1.01 (0.54–1.89)

Men

WC RR = 1.19 (0.98–1.97)

HC RR = 0.44 (0.20–0.98)

WHR RR = 1.86 (0.97–3.56)

Women

WC—risk

HC—NS

WHR—NS

Men

WC—NS

HC—protective

WHR—NS

Nam (2019) ⁴⁴

23 313 046 Korean adults

5.4 years of follow‐up, 18 036 cases

Kidney cancer

WC per 5 cm

WC male ≥ 100.0, female ≥ 95.0

HR increased with increasing waist circumference (WC) (p for trend < 0.001)

WC per 5 cm

Adjusted HR = 1.09 (1.08–1.11)

WC male ≥ 100.0, female ≥ 95.0

Adjusted HR = 1.18 (1.09–1.28)

Overall

WC—risk

Several types of cancer

Montella (2015) ²⁰

Case–control study

Italy—hospital‐based

690 incident UCB

665 controls

Bladder cancer Urothelial carcinoma of the bladder (UCB)

≥94 cm for men

≥80 cm for women

Bladder cancer

OR = 1.63 (1.22–2.19)

UCB

OR = 1.63 (1.22–2.19)

Overall

WC—risk

Britton (2008) ⁴⁷

European Prospective Investigation into Cancer and Nutrition (EPIC), 371 983 cancer‐free individuals.

8.5 years of follow‐up, 1219 histologically confirmed incident cases

Hodgkin's lymphoma (NHL) and multiple myeloma (MM)

WC ≥ 102 cm men, ≥88 cm women

WHR ≥ 0.95 men, ≥0.80 women

Sex‐specific analyses

Visceral obesity was not associated with NHL and MM in men and women.

Men—multivariate

RR = 1.19 (0.91–1.56)

WHR

RR = 1.12 (0.91–1.36)

Women—multivariate

RR = 0.98 (0.74–1.29)

WHR

RR = 0.93 (0.77–1.13)

Men

WC—NS

Women≥NS

Schlesinger (2013) ⁴⁶

European Prospective

Investigation into Cancer and Nutrition study 359 525 men and women in the follow‐up of 8.6 years

Hepatocellular carcinoma (HCC), intrahepatic (IBDC) extrahepatic bile duct system cancer (EBDSC including gallbladder cancer [GBC])

177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC

WC and WHR—extreme tertiles

Waist‐to‐height ratio (WHtR)—extreme tertiles

All anthropometric measures were positively associated with risk of HCC and GBC.

WHtR

HCC

RR = 3.51 (2.09–5.87)

GBC

RR = 1.56 (1.12–2.16)

No association was observed between abdominal obesity and risk of IBDC and EBDSC.

Overall

WC—risk

WHtR—risk

WC and WHR—NS (IBDC and EBDSC)

Gaudet (2015) ⁴⁹

20 cohort studies

Pooled data from 1 941 300 participants, including 3760 cases

Head and neck cancer

WC per 5 cm:

WHR per 0.1 unit

After adjustment for BMI

HR = 1.04 (1.03–1.05)

WHR

HR = 1.07 (1.05–1.09)

Larger HC was not associated.

Overall

WC—risk

WHR—risk

HC—NS

Kitahara (2016) ⁵⁰

Pooled analysis of 22 prospective studies

Thyroid cancer

WC (per 5 cm)

HR = 1.03 (1.01–1.05)

Overall

WC—risk

Aune (2015) ⁴⁵

Systematic review and meta‐analysis of prospective studies

Ovarian cancer

WC per 10 cm

WHR

RR = 1.06 (1.00–1.12)

HC and WHR—not association

Overall

WC—NS

HC—NS

WHR—NS

Hidayat (2016) ⁴⁸

Meta‐analyses of observational studies

Lung cancer

WC—10‐cm increase

WHR—0.1‐unit increase

RR = 1.10 (1.04–1.17)

WHR

RR = 1.05 (1.00–1.11)

Highest versus lowest categories:

RR = 1.32 (1.13–1.54)

WHR

RR = 1.10 (1.00–1.23)

Never smokers RR = 1.11 (1.00–1.23)

Former smokers RR = 1.12 (1.03–1.22)

Current smokers RR = 1.16 (1.08–1.25)

Overall

WC—Risk

Abar (2019) ⁶²

Meta‐analysis of prospective studies

Lymphohaematopoietic cancers

WHR

Higher WC—no associated with multiple myeloma

WHR associated with diffuse large β‐cell lymphoma

WC—NS

WHR—risk