Table 3.
Pooled Multivariable1 Hazard Ratios (HR) and 95% Confidence Intervals (CI) of Prostate Cancer According to Body Mass Index at Baseline and in Early Adulthood
| Anthropometric Factor | HR (95% CI) by Categories of Anthropometric Factor | p-value, test for trend2 | p-value, test for between-studies heterogeneity3 | I2 4 | p-value, test for common effects5 | Continuous HR (95% CI) for 5kg/m2 increment | p-value, test for between-studies heterogeneity | I2 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BMI in Early Adulthood (kg/m2) | <18.5 | 18.5-20.9 | 21.0-22.9 | 23.0-24.9 | >25.0 | |||||||||
| All case N | 3266 | 11423 | 11049 | 7594 | 5159 | |||||||||
| Prostate Cancer mortality case N | 176 | 720 | 616 | 441 | 287 | |||||||||
| All | 0.97 (0.93-1.01) | 1.00 (0.97-1.03) | 1.00 (REF) | 0.98 (0.95-1.01) | 0.94 (0.90-0.98) | 0.33 | 0.18 | 30% | **11 | |||||
| By stage | ||||||||||||||
| Localized6 | 0.97 (0.92-1.01) | 1.01 (0.97-1.05) | 1.00 (REF) | 0.98 (0.95-1.01) | 0.91 (0.88-0.95) | <0.01 | 0.42 | 2% | **11 | |||||
| Advanced7 | 0.86 (0.69-1.09) | 0.95 (0.87-1.04) | 1.00 (REF) | 0.92 (0.77-1.11) | 0.97 (0.85-1.10) | 0.58 | 0.30 | 16% | 0.42 | 1.01 (0.89-1.15) | <0.01 | 72% | ||
| Restricted8 | 0.98 (0.76-1.26) | 0.95 (0.85-1.07) | 1.00 (REF) | 0.89 (0.70-1.13) | 0.93 (0.79-1.08) | 0.82 | 0.50 | 0% | 0.89 | 0.97 (0.85-1.12) | 0.01 | 62% | ||
| Prostate Cancer Mortality9 | 0.90 (0.66-1.24) | 0.93 (0.83-1.03) | 1.00 (REF) | 0.95 (0.80-1.13) | 0.99 (0.86-1.14) | 0.43 | 0.52 | 0% | 0.28 | 1.03 (0.89-1.20) | <0.01 | 69% | ||
| By grade | ||||||||||||||
| Low9 | 0.95 (0.91-1.00) | 1.01 (0.97-1.04) | 1.00 (REF) | 0.97 (0.93-1.01) | 0.93 (0.87-0.99) | 0.15 | 0.05 | 48% | **11 | |||||
| High10 | 0.98 (0.89-1.07) | 0.94 (0.87-1.01) | 1.00 (REF) | 0.98 (0.89-1.09) | 0.95 (0.88-1.03) | >0.99 | 0.56 | 0% | 0.61 | 1.00 (0.96-1.05) | 0.89 | 0% | ||
| BMI at baseline (kg/m2) | <21.0 | 21.0-22.9 | 23.0-24.9 | 25.0-29.9 | 30.0-34.9 | ≥35.0 | ||||||||
| All case N | 1817 | 5546 | 11518 | 25407 | 6176 | 1270 | ||||||||
| Prostate Cancer mortality case N | 133 | 369 | 687 | 1426 | 338 | 74 | ||||||||
| All | 0.96 (0.90-1.02) | 1.00 (REF) | 1.02 (0.99-1.06) | 1.00 (0.96-1.05) | 0.94 (0.89-1.00) | 0.90 (0.81-1.00) | 0.07 | 0.10 | 39% | **11 | ||||
| By stage | ||||||||||||||
| Localized6 | 0.97 (0.91-1.03) | 1.00 (REF) | 1.02 (0.97-1.07) | 0.99 (0.95-1.04) | 0.92 (0.88-0.96) | 0.84 (0.76-0.93) | <0.01 | 0.25 | 23% | **12 | ||||
| Advanced7 | 0.88 (0.74-1.04) | 1.00 (REF) | 0.97 (0.87-1.08) | 1.01 (0.92-1.12) | 1.05 (0.90-1.23) | 1.30 (0.95-1.78) | 0.01 | 0.11 | 37% | 0.01 | 1.07 (1.02-1.12) | 0.32 | 13% | |
| Restricted8 | 0.74 (0.59-0.92) | 1.00 (REF) | 0.92 (0.81-1.04) | 0.95 (0.83-1.09) | 0.89 (0.75-1.05) | 0.92 (0.68-1.25) | 0.86 | 0.567 | 0% | 0.60 | 1.01 (0.96-1.08) | 0.34 | 11% | |
| Prostate Cancer Mortality9 | 0.97 (0.79-1.19) | 1.00 (REF) | 0.96 (0.83-1.12) | 1.02 (0.88-1.18) | 1.13 (0.93-1.39) | 1.52 (1.12-2.07) | <0.01 | 0.34 | 12% | <0.001 | 1.10 (1.05-1.16) | 0.45 | 0% | |
| By grade | ||||||||||||||
| Low10 | 0.98 (0.92-1.05) | 1.00 (REF) | 1.01 (0.98-1.05) | 0.99 (0.94-1.04) | 0.91 (0.85-0.96) | 0.81 (0.72-0.91) | <0.01 | 0.12 | 39% | **12 | ||||
| High11 | 0.98 (0.86-1.11) | 1.00 (REF) | 1.06 (0.98-1.15) | 1.03 (0.96-1.11) | 1.03 (0.94-1.12) | 1.15 (0.95-1.40) | 0.18 | 0.23 | 27% | <0.01 | 1.03 (0.99-1.06) | 0.30 | 18% | |
| BMI change | <25kg/m2 in early adulthood, <30kg/m2 at baseline | ≥25kg/m2 in early adulthood, <30kg/m2 at baseline | <25kg/m2 in early adulthood, ≥30kg/m2 at baseline | ≥25kg/m2 in early adulthood, ≥30kg/m2 at baseline | ||||||||||
| All case N | 30024 | 3281 | 3308 | 1878 | ||||||||||
| Prostate Cancer mortality case N | 1760 | 189 | 188 | 98 | ||||||||||
| All | 1.00 (REF) | 0.96 (0.92-1.01) | 0.94 (0.91-0.97) | 0.90 (0.83-0.97) | 0.05 | 49% | ||||||||
| By stage | ||||||||||||||
| Localized6 | 1.00 (REF) | 0.95 (0.91-0.99) | 0.93 (0.88-0.99) | 0.85 (0.77-0.93) | 0.03 | 54% | ||||||||
| Advanced7 | 1.00 (REF) | 1.00 (0.88-1.14) | 1.09 (0.96-1.24) | 1.13 (0.93-1.38) | 0.25 | 22% | 0.01 | |||||||
| Restricted8 | 1.00 (REF) | 0.96 (0.81-1.14) | 0.98 (0.83-1.17) | 1.02 (0.81-1.28) | 0.54 | 0% | 0.15 | |||||||
| Prostate Cancer Mortality9 | 1.00 (REF) | 1.05 (0.90-1.23) | 1.27 (1.09-1.49) | 1.20 (0.95-1.52) | 0.32 | 14% | 0.01 | |||||||
| By grade | ||||||||||||||
| Low10 | 1.00 (REF) | 0.96 (0.91-1.02) | 0.91 (0.87-0.95) | 0.87 (0.79-0.95) | 0.03 | 54% | ||||||||
| High11 | 1.00 (REF) | 1.00 (0.91-1.09) | 1.04 (0.94-1.16) | 0.97 (0.87-1.08) | 0.92 | 0% | 0.12 | |||||||
| Absolute BMI change (kg/m2) | Loss > 2 | +/− 2 | 2-<5 | 5-<10 | ≥10 | |||||||||
| All case N | 936 | 8846 | 14177 | 12170 | 2362 | |||||||||
| Prostate Cancer Mortality N | 58 | 588 | 803 | 651 | 135 | |||||||||
| All | 1.00 (0.90-1.11) | 1.00 (REF) | 1.03 (1.00-1.07) | 0.99 (0.94-1.04) | 0.95 (0.91-1.00) | 0.22 | 0.93 | 0% | ||||||
| By stage | ||||||||||||||
| Localized6 | 0.94 (0.86-1.02) | 1.00 (REF) | 1.03 (0.99-1.08) | 0.97 (0.91-1.03) | 0.94 (0.89-0.99) | 0.07 | 0.89 | 0% | ||||||
| Advanced7 | 0.94 (0.74-1.18) | 1.00 (REF) | 0.97 (0.84-1.12) | 1.02 (0.88-1.19) | 1.20 (0.93-1.55) | 0.36 | 0.04 | 50% | 0.11 | |||||
| Restricted8 | 0.96 (0.72-1.30) | 1.00 (REF) | 0.98 (0.84-1.15) | 0.98 (0.85-1.12) | 1.08 (0.77-1.52) | 0.95 | 0.05 | 52% | 0.46 | |||||
| Prostate Cancer Mortality9 | 1.01 (0.77-1.34) | 1.00 (REF) | 0.93 (0.78-1.11) | 1.01 (0.84-1.20) | 1.31 (0.99-1.74) | 0.38 | 0.10 | 42% | 0.02 | |||||
| By grade | ||||||||||||||
| Low10 | 0.99 (0.87-1.14) | 1.00 (REF) | 1.04 (0.99-1.08) | 0.97 (0.91-1.03) | 0.92 (0.86-0.97) | 0.04 | 0.99 | 0% | ||||||
| High11 | 1.07 (0.91-1.25) | 1.00 (REF) | 1.01 (0.93-1.09) | 1.03 (0.96-1.11) | 1.04 (0.93-1.16) | 0.37 | 0.41 | 4% | 0.06 | |||||
Multivariable relative risks (MVRR) were adjusted for race (Caucasian, African-American, Asian, Hispanic, other), education (<high school, high school, >high school), marital status (married, never married, widowed, divorced), alcohol (0,>0-<5, 5-<15, 15-<30 and ≥30g/day), smoking habits (never, past smoker and <15 pack years, past smoker and ≥15 pack years, current smoker and <40 pack years, and current smoker and ≥40 pack years), height (<1.70, 1.70–<1.75, 1.75–<1.80, 1.80–<1.85, >1.85m except for JPHC1 and JPHC2 in which the .05m category increments ranged from <1.60 to >1.75m), physical activity (low, medium, high), prostate cancer family history (no, yes), personal history of diabetes (no, yes), multiple vitamin use (no, yes), and dietary calcium (quintiles), dietary lycopene (quintiles), and total energy intake (kcal/d, continuous); for adjustment, these variables were entered directly into the multivariable model or, for studies with less than 200 cases, these variables were modeled using propensity scores.
P-value, test for trend is evaluated using the wald test
P-value, test for between-studies heterogeneity is based on the highest category
I2 value is based on the highest category
P-value, test for common effects, is based on the highest category and compared the following: 1)advanced to localized, 2) advanced restricted to localized, 3) prostate cancer mortality to localized, and 4) high grade to low grade.
”Localized”: defined as cancers with information on stage but are not defined as “periprostatic”, i.e. cancers confined within the prostate;
”Advanced”: defined as cancers with extension to or fixation to adjacent structures other than seminal vesicles, i.e. T4, N1, M1 or fatal;
”Advanced (restricted)”: same as “advanced” but excluding prostate cancer mortality cases that were initially diagnosed as localized cases or cases with missing stage information at diagnosis
”Prostate Cancer Mortality”: defined when prostate cancer was the underlying cause of death
”Low grade”: Gleason score <8 or well/moderately differentiated
”High grade”: Gleason score ≥8 or poorly differentiated/undifferentiated
Continuous estimates were not calculated as the p-value, test for nonlinearity<0.05