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Association between body mass index and obesity-related cancer risk in men and women with type 2 diabetes in primary care in the Netherlands: a cohort study (ZODIAC-56)
  1. Steven H Hendriks1,
  2. Dennis Schrijnders1,2,
  3. Kornelis JJ van Hateren2,
  4. Klaas H Groenier1,3,
  5. Sabine Siesling4,5,
  6. Angela H E M Maas6,
  7. Gijs W D Landman2,7,
  8. Henk J G Bilo1,8,9,
  9. N Kleefstra2,8
  1. 1 Diabetes Centre, Isala, Zwolle, The Netherlands
  2. 2 Langerhans Medical Research Group, Zwolle, The Netherlands
  3. 3 Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
  4. 4 Department of Research, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
  5. 5 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, Universiteit Twente, Enschede, The Netherlands
  6. 6 Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
  7. 7 Department of Internal Medicine, Gelre hospital, Apeldoorn, The Netherlands
  8. 8 Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
  9. 9 Department of Internal Medicine, Isala, Zwolle, The Netherlands
  1. Correspondence to Dr Steven H Hendriks; shhendriks{at}


Objective To investigate the relationship between body mass index (BMI) and obesity-related cancers in men and women with type 2 diabetes (T2D).

Design Observational cohort study.

Setting Primary care.

Participants A total of 52 044 patients with T2D who participated in the ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study between 1998 and 2012 was included (49% women). A dataset of these patients was linked to available information of the Netherlands Cancer Registry to obtain data on cancer incidents.

Primary outcome measures Analyses were performed for the total group of obesity-related cancers and for non-sex-specific and sex-specific obesity-related cancers (in men: advanced prostate cancer, in women: ovarian, endometrial and postmenopausal breast cancer).

Results The median follow-up period in all analyses was 3.1 (1.7–5.0) years in men and 3.1 (1.7–5.1) in women. During follow-up, 689 men and 914 women were diagnosed with an obesity-related cancer. In men, BMI was associated with a higher risk of the total group of obesity-related cancers and non-sex-specific obesity-related cancers (HR (per 5 kg/m2 increase) 1.12 (95% CI 1.02 to 1.23) and HR 1.18 (95% CI 1.06 to 1.31)). No association was found with prostate cancer. In women, an association between BMI and all obesity-related cancers combined and sex-specific obesity-related cancers was present (HR 1.15 (95% CI 1.08 to 1.22) and HR 1.22 (95% CI 1.14 to 1.32)). No association with non-sex-specific cancers was found in women.

Conclusions BMI is associated with obesity-related cancers in men with T2D, except with advanced prostate cancer. The results of this study provide reason to reconsider the classification of advanced prostate cancer as an obesity-related cancer, at least in T2D. In women, BMI is associated with the total group of obesity-related cancers and with sex-specific obesity-related cancers.

  • oncology
  • obesity
  • BMI

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  • Contributors SHH, DS, KJJHvH, KHG, AHEMM, GWDL, HJGB and NK designed the study. SHH and DS acquired the data. SHH, DS and KHG analysed the data. SHH, DS, KJJHH, KHG, SS, AHEMM, GWDL, HJGB and NK interpreted the data. SHH and DS drafted the manuscript. KJJHvH, KHG, SS, AHEMM, GWDL, HJGB and NK reviewed and edited the manuscript. All authors read and approved the final manuscript. SHH is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was supported by a research grant (grant number 836041017) of the research programme Good Use of Medication from the Netherlands Organization for Health Research and Development (ZonMw).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study approved by the Medical Ethics Committee Isala Zwolle, Zwolle, the Netherlands (METC reference number 130765). In the first years ofZODIAC, verbal informed consent was obtained from all patients and the consentwas documented in the patient’s records. According to Dutch law, writteninformed consent was not necessary for this type of study in 1998. Nowadays,written informed consent is obtained. The linking of the ZODIAC cohort with theNetherlands Cancer Registry (NKR) was approved by both the medical ethicscommittee of the Isala as well as the NKR. The linking was performed by atrusted third party.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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