CORRESPONDENCE

Re: Body Mass Index and Risk of Malignant Lymphoma in Scandinavian Men and Women

Cristina Bosetti, Luigino Dal Maso, Eva Negri, Renato Talamini, Maurizio Montella, Silvia Franceschi, Carlo La Vecchia

Affiliations of authors: Istituto di Ricerche Farmacologiche "Mario Negri." Milan, Italy (CB, CLV, EN); Servizio di Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, Aviano (PN), Italy (LDM, RT); Servizio di Epidemiologia, Istituto Tumori "Fondazione Pascale," Naples, Italy (MM); International Agency for Research on Cancer, Lyon, France (SF); Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan, Italy (CLV)

Correspondence to: Dr. Cristina Bosetti, Laboratorio di Epidemiologia, Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea 62, 20157 Milan, Italy (e-mail: bosetti{at}marionegri.it).

Incidence and mortality from non-Hodgkin lymphoma (NHL) have increased over the last few decades in most developed countries. Having an overweight or obesity status, which have also increased in most populations, have been identified as a possible risk factor.

Direct associations between body mass index (BMI) and NHL have been reported in the American Cancer Society Cancer Prevention Study II (1) and other cohort and case–control studies (2). The evidence is, however, still limited and controversial (3,4). The largest study, a case–control investigation of malignant lymphoma from Denmark and Sweden (5) that included 3055 case patients with NHL, 618 case patients with Hodgkin lymphoma (HL), and 3187 population-based control subjects found no association between BMI and the risk of NHL or HL.

We have analyzed the combined data of two case–control studies conducted in Italy between 1985 and 2002. Briefly, these studies included 671 case patients with incident, histologically confirmed NHL (376 men and 295 women; median age = 58 years and range = 17–84 years) and 220 case patients of HL (124 men and 96 women; median age = 37 years and range = 14–77 years) admitted to reference hospitals in the province of Pordenone, the greater Milan area, and the town of Naples (3,6,7). Control subjects were 1799 individuals (1132 men and 667 women; median age = 58 years and range = 17–85 years) admitted to the same hospitals for a wide range of acute, non-neoplastic diseases. Information on BMI was available on 633 NHL case patients, 210 HL case patients, and 1769 control subjects.

In both studies, trained interviewers administered a structured questionnaire to case patients and control subjects in a hospital setting. Study subjects were asked to report their height and weight 1 year before cancer diagnosis (for case patients) or interview (for control subjects). In a the multivariable analysis of quintiles of BMI, we found that NHL was not associated with BMI (compared with subjects in the first quintile of BMI [i.e., <22.3 kg/m2], odds ratio [OR] for NHL for subsequent quintiles = 0.99 [95% confidence interval [CI] = 0.74 to 1.32], 0.67 [95% CI = 0.49 to 0.92], 0.77 [95% CI = 0.57 to 1.05], and 0.81 [95% CI = 0.60 to 1.10]) (Table 1). We also found that HL was not associated with BMI (compared with subjects in the first quintile of BMI [i.e., <22.3 kg/m2], OR for HL = 0.90 [95% CI = 0.57 to 1.40], 0.86 [95% CI = 0.53 to 1.38], 0.55 [95% CI = 0.32 to 0.96], and 0.83 [95% CI = 0.49 to 1.39]). In a multivariable analysis using BMI categories as defined by the World Health Organization standards and healthy subjects as the referent category, we also found that NHL was not associated with BMI (OR = 0.70 [95% CI = 0.56 to 0.86] for overweight subjects and OR = 0.79 [95% CI = 0.58 to 1.07] for obese subjects) and that HL was also not associated with BMI (OR = 0.75 [95% CI = 0.52 to 1.08] and 0.71 [95% CI = 0.39 to 1.27]). The odds ratios for subjects in the highest tertile of BMI (i.e., ≥27.9 kg/m2), compared with the lowest tertile (i.e., <24.5 kg/m2), were 0.48 (95% CI = 0.24 to 0.97) for low-grade B-cell NHL (65 cases), 0.66 (95% CI = 0.38 to 1.15) for intermediate/high-grade B-cell NHL (104 cases), and 1.19 (95% CI = 0.28 to 5.07) for T-cell NHL (14 cases). When BMI at ages 30 years and 50 years [available only in the more recent study (7)] was considered, no excess risk was found for either NHL or HL.


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Table 1.  Distribution of 633 case patients with non-Hodgkin lymphoma (NHL), 210 case patients with Hodgkin lymphoma (HL), and 1769 control subjects, with corresponding odds ratios (ORs) and 95% confidence intervals (CIs), according to body mass index (BMI), Italy 1985–2002

 
The present data confirm that BMI is not a relevant risk factor for lymphomas. The slight inverse association between BMI and the risk of lymphomas in our study may result from some weight loss of case patients in the period before diagnosis. No relation was, however, found with BMI at ages 30 years and 50 years. Other potential biases of our study should be limited, given the almost complete response rate, the administration of a standard questionnaire under similar conditions, and the same catchment area for case patients and control subjects.

NOTES

Editor's note: Chang et al. declined to respond.

We thank Mrs. M. P. Bonifacino for editorial assistance. This work was funded by the Italian Association for Cancer Research and the Italian League Against Cancer.

REFERENCES

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(2) Holly EA, Lele C, Bracci PM, McGrath MS. Case-control study of non-Hodgkin's lymphoma among women and heterosexual men in the San Francisco Bay Area, California. Am J Epidemiol 1999;150:375–89.[Abstract]

(3) Franceschi S, Serraino D, Bidoli E, Talamini R, Tirelli U, Carbone A, et al. The epidemiology of non-Hodgkin's lymphoma in the North-East of Italy: a hospital-based case-control study. Leuk Res 1989;13:465–72.[CrossRef][ISI][Medline]

(4) Samanic C, Gridley G, Chow WH, Lubin J, Hoover RN, Fraumeni JF Jr. Obesity and cancer risk among white and black United States veterans. Cancer Causes Control 2004;15:35–43.[CrossRef][ISI][Medline]

(5) Chang ET, Hjalgrim H, Smedby KE, Akerman M, Tani E, Johnsen HE, et al. Body mass index and risk of malignant lymphoma in Scandinavian men and women. J Natl Cancer Inst 2005;97:210–8.[Abstract/Free Full Text]

(6) Talamini R, Montella M, Crovatto M, Dal Maso L, Crispo A, Negri E, et al. Non-Hodgkin's lymphoma and hepatitis C virus: a case-control study from northern and southern Italy. Int J Cancer 2004;110:380–5.[CrossRef][ISI][Medline]

(7) Dal Maso L, Talamini R, Montella M, Crovatto M, Franceschi S. Hepatitis B and C viruses and Hodgkin lymphoma: a case-control study from Northern and Southern Italy. Haematologica 2004;89:ELT17.[Medline]



             
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