Association of Abdominal Visceral Adiposity and Total Fat Mass with Cancer Incidence and Mortality in White and Black Adults

Abstract

Background: Race modifies the association between anthropometric measures of obesity and cancer risk. However, the degree to which abdominal visceral adipose tissue (VAT) and total fat mass (FM) are associated with cancer risk is not known.

Methods: The sample included 3,017 White and 1,347 Black adults who were assessed between 1995 and 2016 and followed for outcome assessment through 2017. Abdominal VAT and FM were measured using imaging techniques. The co-primary endpoints were diagnosis of histologically confirmed invasive cancer (excluding nonmelanoma skin cancer) or death from cancer. Multivariable Cox proportional hazards models quantified the HR of incident cancer and cancer mortality.

Results: There were 353 incident cancer cases and 75 cancer deaths in an average of 12.9 years of follow-up. Both VAT [HR, 1.21; 95% confidence interval (CI), 1.09-1.36] and FM (HR, 1.25; 95% CI, 1.10-1.43) were significantly associated with incident cancer, while VAT (HR, 1.28; 95% CI, 1.01-1.61) was significantly associated with cancer mortality after adjustment for several covariates. VAT remained significantly associated with cancer incidence (HR, 1.22; 95% CI, 1.03-1.46) after additional inclusion of FM in the multivariable model, but not vice versa. There were no significant sex- or race-interactions.

Conclusions: VAT was associated with risk of cancer and cancer mortality in this cohort, and the associations did not differ by sex or race. The association between VAT and incident cancer was largely independent of total FM.

Impact: Our results suggest that utility of anthropometry in assessing obesity-related cancer risk may need to be further refined by including more direct measures of adiposity.

Conflict of interest statement

Conflict of Interest: The authors declare no conflicts of interest.

©2022 American Association for Cancer Research.

Figures

Figure 1.

Hazard ratios for incident cancer across levels of visceral adipose tissue (VAT) and fat mass derived from multivariable cubic splines analysis. Model 1 includes age, sex, race, and exam year as covariates, and Model 2 includes these covariates in addition to smoking status and the other primary exposure (i.e. fat mass or VAT). Shaded regions indicate 95% confidence bands and the histogram atop the figures indicate the distribution of the exposure variable in the sample.

Figure 2.

Hazard ratios for cancer mortality across levels of visceral adipose tissue (VAT) and fat mass derived from multivariable cubic splines analysis. Model 1 includes age, sex, race, and exam year as covariates, and Model 2 includes these covariates in addition to smoking status and the other primary exposure (i.e. fat mass or VAT). Shaded regions indicate 95% confidence bands and the histogram atop the figures indicate the distribution of the exposure variable in the sample.