Body mass index had different effects on premenopausal and postmenopausal breast cancer risks: a dose-response meta-analysis with 3,318,796 subjects from 31 cohort studies

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Abstract

Background

There is sufficient evidence supporting a relationship between increased body mass index (BMI) and an increased risk for breast cancer among postmenopausal women. However, most studies have found a decreased risk for premenopausal breast cancer. This study was conducted to find out the different effects of BMI on the risk of breast cancer among premenopausal and postmenopausal women, and explore the potential factors that influence the associations.

Methods

A dose-response meta-analysis with 3,318,796 participants from 31 articles was conducted. Cohort studies that included BMI and corresponding breast cancer risk were selected through various databases including PubMed, Medline, Web of Science, the China National Knowledge Infrastructure (CNKI) and Chinese Scientific Journals (VIP). Random effects models were used for analyzing the data.

Results

The summary relative risks (RRs) were 1.33 (95%CI: 1.20–1.48) and 0.94(95%CI: 0.80–1.11) among postmenopausal and premenopausal women, respectively. The dose-response meta-analysis indicated a positive non-linear association between BMI and breast cancer risk among postmenopausal women, and compared to the mean level of the normal BMI category (21.5 kg/m ²) the RR in total postmenopausal women were1.03 (95% CI: 1.02–1.05) per 1 kg/m ² increment. However, no statistically significant association among total premenopausal women was detected. In subgroup analysis among European premenopausal women, the summary RR was 0.79(95%CI: 0.70–0.88). The non-linear relationship showed a negative non-linear association between BMI and breast cancer risk among European premenopausal women. When compared to the mean level of the normal BMI category, the RRs were 0.98 (95%CI: 0.96–1.00) per 1 kg/m ² increment, respectively.

Conclusions

In line with previous studies BMI had different effects on pre-menopausal and postmenopausal breast cancer risk. However, contrary to previous studies, a high BMI was not associated with decreased risk in total pre-menopausal women. More research is needed to better understand these differences.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4953-9) contains supplementary material, which is available to authorized users.

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Most cited references 44

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Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.

Jaime Peters, Alex J Sutton, David Jones … (2007)

The trim and fill method allows estimation of an adjusted meta-analysis estimate in the presence of publication bias. To date, the performance of the trim and fill method has had little assessment. In this paper, we provide a more comprehensive examination of different versions of the trim and fill method in a number of simulated meta-analysis scenarios, comparing results with those from usual unadjusted meta-analysis models and two simple alternatives, namely use of the estimate from: (i) the largest; or (ii) the most precise study in the meta-analysis. Findings suggest a great deal of variability in the performance of the different approaches. When there is large between-study heterogeneity the trim and fill method can underestimate the true positive effect when there is no publication bias. However, when publication bias is present the trim and fill method can give estimates that are less biased than the usual meta-analysis models. Although results suggest that the use of the estimate from the largest or most precise study seems a reasonable approach in the presence of publication bias, when between-study heterogeneity exists our simulations show that these estimates are quite biased. We conclude that in the presence of publication bias use of the trim and fill method can help to reduce the bias in pooled estimates, even though the performance of this method is not ideal. However, because we do not know whether funnel plot asymmetry is truly caused by publication bias, and because there is great variability in the performance of different trim and fill estimators and models in various meta-analysis scenarios, we recommend use of the trim and fill method as a form of sensitivity analysis as intended by the authors of the method. Copyright 2007 John Wiley & Sons, Ltd.

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Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

Dagfinn Aune, Ola Saugstad, Tore Henriksen … (2014)

Evidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known. To conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death. The PubMed and Embase databases were searched from inception to January 23, 2014. Cohort studies reporting adjusted relative risk (RR) estimates for fetal death, stillbirth, or infant death by at least 3 categories of maternal BMI were included. Data were extracted by 1 reviewer and checked by the remaining reviewers for accuracy. Summary RRs were estimated using a random-effects model. Fetal death, stillbirth, and neonatal, perinatal, and infant death. Thirty eight studies (44 publications) with more than 10,147 fetal deaths, more than 16,274 stillbirths, more than 4311 perinatal deaths, 11,294 neonatal deaths, and 4983 infant deaths were included. The summary RR per 5-unit increase in maternal BMI for fetal death was 1.21 (95% CI, 1.09-1.35; I2 = 77.6%; n = 7 studies); for stillbirth, 1.24 (95% CI, 1.18-1.30; I2 = 80%; n = 18 studies); for perinatal death, 1.16 (95% CI, 1.00-1.35; I2 = 93.7%; n = 11 studies); for neonatal death, 1.15 (95% CI, 1.07-1.23; I2 = 78.5%; n = 12 studies); and for infant death, 1.18 (95% CI, 1.09-1.28; I2 = 79%; n = 4 studies). The test for nonlinearity was significant in all analyses but was most pronounced for fetal death. For women with a BMI of 20 (reference standard for all outcomes), 25, and 30, absolute risks per 10,000 pregnancies for fetal death were 76, 82 (95% CI, 76-88), and 102 (95% CI, 93-112); for stillbirth, 40, 48 (95% CI, 46-51), and 59 (95% CI, 55-63); for perinatal death, 66, 73 (95% CI, 67-81), and 86 (95% CI, 76-98); for neonatal death, 20, 21 (95% CI, 19-23), and 24 (95% CI, 22-27); and for infant death, 33, 37 (95% CI, 34-39), and 43 (95% CI, 40-47), respectively. Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death. Weight management guidelines for women who plan pregnancies should take these findings into consideration to reduce the burden of fetal death, stillbirth, and infant death.

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Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults.

Ismael F. Freitas, John E. Rush, Lindsay Plank (2009)

Although there is evidence that Asian Indians, Polynesians and Europeans differ in their body fat (BF)-BMI relationships, detailed comparative analysis of their underlying body composition and build characteristics is lacking. We investigated differences in the relationships between body fatness and BMI, fat distribution, muscularity, bone mineral mass, leg length and age-related changes in body composition between these ethnic groups. Cross-sectional analysis of 933 European, Maori, Pacific Island and Asian Indian adult volunteers was performed for total and percentage of BF, abdominal fat, thigh fat, appendicular muscle mass, bone mineral content and leg length measured by dual-energy X-ray absorptiometry. Asian Indian men and women (BMI of 24 and 26 kg/m2, respectively) had the same percentage of BF as Europeans with a BMI of 30 kg/m2 or Pacific men and women with BMI of 34 and 35 kg/m2, respectively. Asian Indians had more fat, both total and in the abdominal region, with less lean mass, skeletal muscle and bone mineral than all other ethnic groups. Leg length was relatively longer in Pacific men and Asian and Pacific women than in other ethnic groups. In Asian Indians, abdominal fat increased with increasing age, while the percentage of BF showed little change. In the other ethnic groups, both abdominal and total BF increased with age. In conclusion, ethnic differences in fat distribution, muscularity, bone mass and leg length may contribute to ethnic-specific relationships between body fatness and BMI. The use of universal BMI cut-off points may not be appropriate for the comparison of obesity prevalence between ethnic groups.

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Author and article information

Contributors

Yanzi Chen: 15225191773@163.com

Li Liu: liuli1030@163.com

Quan Zhou: zhouquan402@163.com

Mustapha Umar Imam: mustyimam@gmail.com

Jialin Cai: 1030865976@qq.com

Yaxuan Wang: 504632131@qq.com

Minjie Qi: 1094057877@qq.com

Panpan Sun: zhiyin_s@126.com

Zhiguang Ping:

ORCID: http://orcid.org/0000-0001-8924-0761

ping_zhg@163.com

Xiaoli Fu: fuxiaoli@zzu.edu.cn

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 8 December 2017

Publication date PMC-release: 8 December 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 936

Affiliations

[1 ]ISNI 0000 0001 2189 3846, GRID grid.207374.5, College of Public Health, Zhengzhou University, ; Zhengzhou, Henan China

[2 ]ISNI 0000 0001 2189 3846, GRID grid.207374.5, School of Basic Medical Sciences, , Zhengzhou University, ; Zhengzhou, Henan China

[3 ]ISNI 0000 0004 1757 2179, GRID grid.459514.8, Department of Science and Education, , The First People’s Hospital of Changde City, ; Changde, Hunan China

Author information

Zhiguang Ping http://orcid.org/0000-0001-8924-0761

Article

Publisher ID: 4953

DOI: 10.1186/s12889-017-4953-9

PMC ID: 5721381

PubMed ID: 29216920

SO-VID: 621116e5-4dd7-4be5-b02d-563d6021b807

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 August 2016

Date accepted : 28 November 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81001280

Award ID: 81202277

Award ID: 81373096

Award Recipient : Li Liu Zhiguang Ping Xiaoli Fu

Custom metadata

ScienceOpen disciplines: Public health

Keywords: body mass index (bmi),breast cancer,dose-response relationship,meta-analysis,cohort study

Data availability:

ScienceOpen disciplines: Public health

Keywords: body mass index (bmi), breast cancer, dose-response relationship, meta-analysis, cohort study

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Body mass index had different effects on premenopausal and postmenopausal breast cancer risks: a dose-response meta-analysis with 3,318,796 subjects from 31 cohort studies

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Abstract

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Methods

Results

Conclusions

Electronic supplementary material

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Karger: Oncology

Most cited references 44

Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.

Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults.

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