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1 March 1995 | Volume 122 Issue 5 | Pages 327-334
Objective: To determine whether physical inactivity and obesity increase risk for colon cancer and adenomas, which are precursors of cancer, and whether the abdominal distribution of obesity is an independent risk factor for these events.
Design: Prospective cohort study.
Setting: United States.
Patients: 47 723 male health professionals, 40 to 75 years of age, who responded to a questionnaire mailed in 1986.
Measurements: Questionnaires in 1986 about physical activity level and body mass index, and questionnaires in 1987 (31 055 respondents) about waist and hip circumferences. Between 1986 and 1992, 203 new patients were diagnosed with colon cancer and 586 were diagnosed with adenomas.
Results: Physical activity was inversely associated with risk for colon cancer (high compared with low quintiles of average energy expenditure from leisure-time activities: relative risk, 0.53 [95% CI, 0.32 to 0.88], P for trend = 0.03) after adjustment for age; history of colorectal polyp; previous endoscopy; parental history of colorectal cancer; smoking; body mass; use of aspirin; and intake of red meat, dietary fiber, folate, and alcohol. Body mass index was directly associated with risk for colon cancer independently of physical activity level. Waist circumference and waist-to-hip ratio were strong risk factors for colon cancer (waist-to-hip ratio
Conclusions: The results support an inverse association between physical activity and risk for colon cancer, whereas height and obesity, particularly abdominal adiposity, are associated with an elevated risk.
Author and Article Information
From Harvard University Medical School, Harvard University School of Public Health, and Brigham and Women's Hospital, Boston, Massachusetts.
ARTICLE
Physical Activity, Obesity, and Risk for Colon Cancer and Adenoma in Men
0.99 compared with waist-to-hip ratio < 0.90: multivariate relative risk, 3.41 [CI, 1.52 to 7.66], P for trend = 0.01; waist circumference 43 inches compared with waist circumference < 35 inches: relative risk, 2.56 [CI, 1.33 to 4.96], P for trend < 0.001). These associations persisted even after adjustment for body mass and physical activity. Similar associations were seen between obesity and physical inactivity and adenomas of 1 cm or more, but no association was observed for smaller adenomas. Height was also associated with a higher risk for colon cancer (height 73 inches compared with height 
68 inches: multivariate relative risk, 1.76 [CI, 1.13 to 2.74], P for trend = 0.02).
Requests for Reprints: Dr. Edward Giovannucci, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115.
Acknowledgments: The authors thank Mira Koyfman, Mildred Wolff, Elizabeth Frost-Hawes, Kerry Pillsworth, and Jill Arnold for expert help.
Grant Support: In part by research grants HL35464 and CA 55075 from the National Institutes of Health and Special Institution Grant no. 18 from the American Cancer Society. Dr. Colditz is supported by a Faculty Research Award (FRA-398) from the American Cancer Society.
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M. B. Terry, A. I. Neugut, R. M. Bostick, R. S. Sandler, R. W. Haile, J. S. Jacobson, C. M. Fenoglio-Preiser, and J. D. Potter Risk Factors for Advanced Colorectal Adenomas: A Pooled Analysis Cancer Epidemiol. Biomarkers Prev., July 1, 2002; 11(7): 622 - 629. [Abstract] [Full Text] [PDF]
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L. A. Colangelo, S. M. Gapstur, P. H. Gann, A. R. Dyer, and K. Liu Colorectal Cancer Mortality and Factors Related to the Insulin Resistance Syndrome Cancer Epidemiol. Biomarkers Prev., April 1, 2002; 11(4): 385 - 391. [Abstract] [Full Text] [PDF]
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E. Giovannucci Insulin, Insulin-Like Growth Factors and Colon Cancer: A Review of the Evidence J. Nutr., November 1, 2001; 131(11): 3109S - 3120. [Abstract] [Full Text] [PDF]
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 A. E Hardman Physical activity and health: current issues and research needs Int. J. Epidemiol., October 1, 2001; 30(5): 1193 - 1197. [Full Text] [PDF]
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I. Akedo, H. Ishikawa, T. Ioka, I. Kaji, H. Narahara, S. Ishiguro, T. Suzuki, and T. Otani Evaluation of Epithelial Cell Proliferation Rate in Normal-appearing Colonic Mucosa as a High-Risk Marker for Colorectal Cancer Cancer Epidemiol. Biomarkers Prev., September 1, 2001; 10(9): 925 - 930. [Abstract] [Full Text] [PDF]
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D. S. Michaud, E. Giovannucci, W. C. Willett, G. A. Colditz, M. J. Stampfer, and C. S. Fuchs Physical Activity, Obesity, Height, and the Risk of Pancreatic Cancer JAMA, August 22, 2001; 286(8): 921 - 929. [Abstract] [Full Text] [PDF]
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J. J. Keysor and A. M. Jette Have We Oversold the Benefit of Late-Life Exercise? J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2001; 56(7): M412 - 423. [Abstract] [Full Text] [PDF]
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C. M. Friedenreich Physical Activity and Cancer Prevention: From Observational to Intervention Research Cancer Epidemiol. Biomarkers Prev., April 1, 2001; 10(4): 287 - 301. [Abstract] [Full Text]
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D. Gunnell Commentary: Early insights into height, leg length, proportionate growth and health Int. J. Epidemiol., April 1, 2001; 30(2): 221 - 222. [Full Text] [PDF]
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L. H. Colbert, T. J. Hartman, N. Malila, P. J. Limburg, P. Pietinen, J. Virtamo, P. R. Taylor, and D. Albanes Physical Activity in Relation to Cancer of the Colon and Rectum in a Cohort of Male Smokers Cancer Epidemiol. Biomarkers Prev., March 1, 2001; 10(3): 265 - 268. [Abstract] [Full Text]
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W. C. Willett Diet and Cancer: One View at the Start of the Millennium Cancer Epidemiol. Biomarkers Prev., January 1, 2001; 10(1): 3 - 8. [Abstract] [Full Text]
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 I. Baik, G. C. Curhan, E. B. Rimm, A. Bendich, W. C. Willett, and W. W. Fawzi A Prospective Study of Age and Lifestyle Factors in Relation to Community-Acquired Pneumonia in US Men and Women Arch Intern Med, November 13, 2000; 160(20): 3082 - 3088. [Abstract] [Full Text] [PDF]
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T. K. Murphy, E. E. Calle, C. Rodriguez, H. S. Kahn, and M. J. Thun Body Mass Index and Colon Cancer Mortality in a Large Prospective Study Am. J. Epidemiol., November 1, 2000; 152(9): 847 - 854. [Abstract] [Full Text] [PDF]
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R. Kaaks, P. Toniolo, A. Akhmedkhanov, A. Lukanova, C. Biessy, H. Dechaud, S. Rinaldi, A. Zeleniuch-Jacquotte, R. E. Shore, and E. Riboli Serum C-Peptide, Insulin-Like Growth Factor (IGF)-I, IGF-Binding Proteins, and Colorectal Cancer Risk in Women J Natl Cancer Inst, October 4, 2000; 92(19): 1592 - 1600. [Abstract] [Full Text] [PDF]
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E. A. Platz, S. E. Hankinson, B. W. Hollis, G. A. Colditz, D. J. Hunter, F. E. Speizer, and E. Giovannucci Plasma 1,25-Dihydroxy- and 25-Hydroxyvitamin D and Adenomatous Polyps of the Distal Colorectum Cancer Epidemiol. Biomarkers Prev., October 1, 2000; 9(10): 1059 - 1065. [Abstract] [Full Text]
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I. Baik, A. Ascherio, E. B. Rimm, E. Giovannucci, D. Spiegelman, M. J. Stampfer, and W. C. Willett Adiposity and Mortality in Men Am. J. Epidemiol., August 1, 2000; 152(3): 264 - 271. [Abstract] [Full Text] [PDF]
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E. Giovannucci, M. N. Pollak, E. A. Platz, W. C. Willett, M. J. Stampfer, N. Majeed, G. A. Colditz, F. E. Speizer, and S. E. Hankinson A Prospective Study of Plasma Insulin-like Growth Factor-1 and Binding Protein-3 and Risk of Colorectal Neoplasia in Women Cancer Epidemiol. Biomarkers Prev., April 1, 2000; 9(4): 345 - 349. [Abstract] [Full Text]
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J. T. Fine, G. A. Colditz, E. H. Coakley, G. Moseley, J. E. Manson, W. C. Willett, and I. Kawachi A Prospective Study of Weight Change and Health-Related Quality of Life in Women JAMA, December 8, 1999; 282(22): 2136 - 2142. [Abstract] [Full Text] [PDF]
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B. Rockhill, W. C. Willett, D. J. Hunter, J. E. Manson, S. E. Hankinson, and G. A. Colditz A Prospective Study of Recreational Physical Activity and Breast Cancer Risk Arch Intern Med, October 25, 1999; 159(19): 2290 - 2296. [Abstract] [Full Text] [PDF]
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R. E. Schoen, C. M. Tangen, L. H. Kuller, G. L. Burke, M. Cushman, R. P. Tracy, A. Dobs, and P. J. Savage Increased Blood Glucose and Insulin, Body Size, and Incident Colorectal Cancer J Natl Cancer Inst, July 7, 1999; 91(13): 1147 - 1154. [Abstract] [Full Text] [PDF]
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J. D. Potter Colorectal Cancer: Molecules and Populations J Natl Cancer Inst, June 2, 1999; 91(11): 916 - 932. [Abstract] [Full Text] [PDF]
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M. E. Martinez, D. Heddens, D. L. Earnest, C. L. Bogert, D. Roe, J. Einspahr, J. R. Marshall, and D. S. Alberts Physical Activity, Body Mass Index, and Prostaglandin E2 Levels in Rectal Mucosa J Natl Cancer Inst, June 2, 1999; 91(11): 950 - 953. [Abstract] [Full Text] [PDF]
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I. Thune, I. Njolstad, M.-L. Lochen, and O. H. Forde Physical Activity Improves the Metabolic Risk Profiles in Men and Women: The Tromso Study Arch Intern Med, August 10, 1998; 158(15): 1633 - 1640. [Abstract] [Full Text]
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W. Burke, G. Petersen, P. Lynch, J. Botkin, M. Daly, J. Garber, M. J. E. Kahn, A. McTiernan, K. Offit, E. Thomson, et al. Recommendations for Follow-up Care of Individuals With an Inherited Predisposition to Cancer: I. Hereditary Nonpolyposis Colon Cancer JAMA, March 19, 1997; 277(11): 915 - 919. [Abstract] [PDF]
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