Endocrinol Metab.  2024 Dec;39(6):921-931. 10.3803/EnM.2024.2071.

Comparison of Population Attributable Fractions of Cancer Incidence and Mortality Linked to Excess Body Weight in Korea from 2015 to 2030

• Hong Y
• An J
• Jung J
• Lee HS
• Sung S
• Moon S
• Kim I
• Lee JE
• Shin A
• Jee SH
• Kweon SS
• Shin MH
• Park S
• Ryu SH
• Yang SY
• Choi SH
• Kim J
• Yi SW
• Choi YJ
• Lee S
• Lim W
• Kim K
• Park S
• Im JS
• Seo HG
• Ko KP
• Park SK

• KMID: 2562720
• DOI: http://doi.org/10.3803/EnM.2024.2071

Abstract

Background
The increasing rate of excess body weight (EBW) in the global population has led to growing health concerns, including cancer-related EBW. We aimed to estimate the population attributable fraction (PAF) of cancer incidence and deaths linked to EBW in Korean individuals from 2015 to 2030 and to compare its value with various body mass index cutoffs.
Methods
Levin’s formula was used to calculate the PAF; the prevalence rates were computed using the Korean National Health and Nutrition Examination Survey data, while the relative risks of specific cancers related to EBW were estimated based on the results of Korean cohort studies. To account for the 15-year latency period when estimating the PAF in 2020, the prevalence rates from 2015 and attributable cases or deaths from 2020 were used.
Results
The PAF attributed to EBW was similar for both cancer incidence and deaths using either the World Health Organization (WHO) Asian-Pacific region standard or a modified Asian standard, with the WHO standard yielding the lowest values. In the Korean population, the PAFs of EBW for cancer incidence were 2.96% in men and 3.61% in women, while those for cancer deaths were 0.67% in men and 3.06% in women in 2020. Additionally, PAFs showed a gradual increase in both sexes until 2030.
Conclusion
The EBW continues to have a significant impact on cancer incidence and deaths in Korea. Effective prevention strategies targeting the reduction of this modifiable risk factor can substantially decrease the cancer burden.

Keyword

Excess body weight; Body mass index; Population attributable fractions; Prevalence rates

Figure

• 

  Fig. 1. Comparison of cancer population attributable fraction (PAF, %) attributed to excess body weight (EBW) when using different criteria (A: men, B: women, C: total population). MPL, mouth, pharynx, and larynx; WHO, World Health Organization.

• 

  Fig. 2. Population attributable fraction (PAF, %) of cancer cases and deaths of excess body weight (EBW) for cancer cases and deaths from 2015 to 2030. (A) All cancer cases and death. (B) Specific cancer cases in men. (C) Specific cancer death in men. (D) Specific cancer cases in women. (E) Specific cancer death in women.

• 

Reference

1. Romieu I, Dossus L, Willett WC. Energy balance and obesity. Lyon: International Agency for Research on Cancer;2017. Chapter 6, Physical activity, sedentary behaviour, and obesity; p. 43-8.

2. International Agency for Research on Cancer. Absence of excess body fatness: IARC handbooks of cancer prevention. Vol. 16. Lyon: IARC;2018. [cited 2024 Sep 19]. Available from: https://publications.iarc.fr/570.

3. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body fatness and cancer: viewpoint of the IARC Working Group. N Engl J Med. 2016; 375:794–8.

4. International Agency for Research on Cancer. Weight control and physical activity: IARC handbooks of cancer prevention. Vol. 6. Lyon: IARC;2002. [cited 2024 Sep 19]. Available from: https://publications.iarc.fr/Book-And-Report-Series/Iarc-Handbooks-Of-Cancer-Prevention/WeightControl-And-Physical-Activity-2002.

5. World Cancer Research Fund International. Alcoholic drinks and cancer risk [Internet]. London: WCRF;2018. [cited 2024 Sep 19]. Available from: https://www.wcrf.org/dietandcancer/alcoholic-drinks.

6. Korea Center for Disease Control. Korea National Health and Nutrition Examination Survey (KNHANES) fact sheet: changes in health behaviors and chronic diseases over 20 years (1998-2018). Cheongju: KCDC;2020.

7. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894:1–253.

8. World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. Geneva: WHO;2000.

9. Korean Statistical Information Service. Korea National Health and Nutrition Examination Survey (KNHANES), 1998-2008 [Internet]. Daejeon: KOSIS;2024. [cited 2024 Sep 19]. Available from: https://kosis.kr/index/index.do.

10. Kim KN, Hwang Y, Kim KH, Lee KE, Park YJ, Kim SJ, et al. Adolescent overweight and obesity and the risk of papillary thyroid cancer in adulthood: a large-scale case-control study. Sci Rep. 2020; 10:5000.

11. Shin A, Cho S, Jang D, Abe SK, Saito E, Rahman MS, et al. Body mass index and thyroid cancer risk: a pooled analysis of half a million men and women in the Asia Cohort Consortium. Thyroid. 2022; 32:306–14.

12. Lee S, Ko KP, Lee JE, Kim I, Jee SH, Shin A, et al. The Korea Cohort Consortium: the future of pooling cohort studies. J Prev Med Public Health. 2022; 55:464–74.

13. Seong SC, Kim YY, Park SK, Khang YH, Kim HC, Park JH, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open. 2017; 7:e016640.

14. Yoo KY, Shin HR, Chang SH, Lee KS, Park SK, Kang D, et al. Korean Multi-center Cancer Cohort Study including a Biological Materials Bank (KMCC-I). Asian Pac J Cancer Prev. 2002; 3:85–92.

15. Kweon SS, Shin MH, Jeong SK, Nam HS, Lee YH, Park KS, et al. Cohort profile: the Namwon Study and the Donggu Study. Int J Epidemiol. 2014; 43:558–67.

16. Jee YH, Emberson J, Jung KJ, Lee SJ, Lee S, Back JH, et al. Cohort profile: the Korean Cancer Prevention Study-II (KCPS-II) Biobank. Int J Epidemiol. 2018; 47:385–6. f.

17. Kim J. Cancer screenee cohort study of the National Cancer Center in South Korea. Epidemiol Health. 2014; 36:e2014013.

18. Rhee EJ, Park SE, Chang Y, Ryu S, Lee WY. Baseline glycemic status and mortality in 241,499 Korean metropolitan subjects: a Kangbuk Samsung Health Study. Metabolism. 2016; 65:68–77.

19. Kim Y, Han BG; KoGES group. Cohort profile: the Korean Genome and Epidemiology Study (KoGES) Consortium. Int J Epidemiol. 2017; 46:e20.

20. Kim IS, Ohrr H, Jee SH, Kim H, Lee Y. Smoking and total mortality: Kangwha cohort study, 6-year follow-up. Yonsei Med J. 1993; 34:212–22.

21. Hong Y, Lee S, Moon S, Sung S, Lim W, Kim K, et al. Projection of cancer incidence and mortality from 2020 to 2035 in the Korean population aged 20 years and older. J Prev Med Public Health. 2022; 55:529–38.

22. Lee S, Jang J, Abe SK, Rahman S, Saito E, Islam R, et al. Association between body mass index and oesophageal cancer mortality: a pooled analysis of prospective cohort studies with >800 000 individuals in the Asia Cohort Consortium. Int J Epidemiol. 2022; 51:1190–203.

23. Ahn H, Kim HJ, Jeon SS, Kwak C, Sung GT, Kwon TG, et al. Establishment of Korean prostate cancer database by the Korean Urological Oncology Society. Investig Clin Urol. 2017; 58:434–9.

24. Neuhouser ML, Aragaki AK, Prentice RL, Manson JE, Chlebowski R, Carty CL, et al. Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the women’s health initiative randomized clinical trials. JAMA Oncol. 2015; 1:611–21.

25. Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, et al. Dual effects of weight and weight gain on breast cancer risk. JAMA. 1997; 278:1407–11.

26. Alexandre L, Long E, Beales IL. Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma. World J Gastrointest Pathophysiol. 2014; 5:534–49.

27. Soerjomataram I, Shield K, Marant-Micallef C, Vignat J, Hill C, Rogel A, et al. Cancers related to lifestyle and environmental factors in France in 2015. Eur J Cancer. 2018; 105:103–13.

28. Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018; 68:31–54.

29. Flegal KM, Panagiotou OA, Graubard BI. Estimating population attributable fractions to quantify the health burden of obesity. Ann Epidemiol. 2015; 25:201–7.

30. Poirier AE, Ruan Y, Volesky KD, King WD, O’Sullivan DE, Gogna P, et al. The current and future burden of cancer attributable to modifiable risk factors in Canada: summary of results. Prev Med. 2019; 122:140–7.

31. Xu L, Yang Z, Li T, Yu L, Zhu Z, Wu Y, et al. Estimation of cancer mortality attributable to excess body weight during 2006-2015 in China. Cancer Epidemiol. 2023; 84:102358.