Published online 2 October 2008
Haematologica, Vol 93, Issue 11, 1666-1677 doi:10.3324/haematol.13078
Copyright © 2008 by Ferrata Storti Foundation

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Original Articles

Anthropometric characteristics and non-Hodgkin’s lymphoma and multiple myeloma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Julie A. Britton^1,2, Aneire E. Khan¹, Sabine Rohrmann³, Nikolaus Becker³, Jakob Linseisen³, Alexandra Nieters³, Rudolf Kaaks³, Anne Tjønneland⁴, Jytte Halkjær⁴, Marianne Tang Severinsen⁵, Kim Overvad⁶, Tobias Pischon⁷, Heiner Boeing⁷, Antonia Trichopoulou⁸, Victoria Kalapothaki⁸, Dimitrios Trichopoulos^9,10, Amalia Mattiello¹¹, Giovanna Tagliabue¹², Carlotta Sacerdote¹³, Petra H.M. Peeters¹⁴, H. Bas Bueno-de-Mesquita¹⁵, Eva Ardanaz¹⁶, Carmen Navarro^17,18, Paula Jakszyn¹⁹, Jone M. Altzibar²⁰, Göran Hallmans²¹, Beatrice Malmer²², Göran Berglund²³, Jonas Manjer²⁴, Naomi Allen²⁵, Timothy Key²⁵, Sheila Bingham²⁶, Hervé Besson²⁷, Pietro Ferrari²⁸, Mazda Jenab²⁸, Paolo Boffetta²⁹, Paolo Vineis³⁰, Elio Riboli³⁰

¹ Department of Epidemiology and Public Health, Imperial College London, UK
² Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
³ Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
⁴ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
⁵ Department of Medicine, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
⁶ Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
⁷ Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
⁸ Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
⁹ Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
¹⁰ Hellenic Health Foundation, Greece
¹¹ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
¹² Cancer Registry and Environmental Epidemiology Division, National Cancer Institute, Milan, Italy
¹³ CPO-PIemonte and ISI Foundation, Torino, Italy
¹⁴ Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Netherlands
¹⁵ National Institute for Public Health and the Environment, Centre for Nutrition and Health, Bilthoven, The Netherlands
¹⁶ Public Health Institute of Navarra, Pamplona, Spain
¹⁷ Epidemiology Department, Murcia Health Council, Spain
¹⁸ CIBER en Epidemiologia y Salud Publica (CIBERESP), Spain
¹⁹ Epidemiology Unit, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
²⁰ Department of Public Health of Gipuzkoa, San Sebastian, Spain
²¹ Department of Public Health and Clinical Medicine, Nutrition. Umeå University, Sweden
²² Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
²³ Department of Clinical sciences, Malmö University Hospital, Malmö, Sweden
²⁴ Department of Surgery, Malmö University Hospital, Malmö, Sweden
²⁵ Cancer Research UK, Epidemiology Unit, University of Oxford, UK
²⁶ MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, UK
²⁷ MRC Epidemiology Unit, Elsie Widdowson Laboratory, Cambridge, UK
²⁸ Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
²⁹ Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France
³⁰ Department of Epidemiology and Public Health, Imperial College London, London, UK

Correspondence: Paolo Vineis, Department of Epidemiology and Public Health, Imperial College London, Room 151, St Mary’s Campus, Norfolk Place W2 1PG, London, UK. E-mail:p.vineis{at}imperial.ac.uk

Background: The incidences of non-Hodgkin’s lymphoma and multiple myeloma are increasing steadily. It has been hypothesized that this may be due, in part, to the parallel rising prevalence of obesity. It is biologically plausible that anthropometric characteristics can infuence the risk of non-Hodgkin’s lymphoma and multiple myeloma.

Design and Methods: In the context of the European Prospective Investigation into Cancer and Nutrition (EPIC), anthropometric characteristics were assessed in 371,983 cancer-free individuals at baseline. During the 8.5 years of follow-up, 1,219 histologically confirmed incident cases of non-Hodgkin’s lymphoma and multiple myeloma occurred in 609 men and 610 women. Gender-specific proportional hazards models were used to estimate relative risks and 95% confidence intervals (95% CI) of development of non-Hodgkin’s lymphoma and multiple myeloma in relation to the anthropometric characteristics.

Results: Height was associated with overall non-Hodgkin’s lymphoma and multiple myeloma in women (RR 1.50, 95% CI 1.14–1.98) for highest versus lowest quartile; p-trend < 0.01) but not in men. Neither obesity (weight and body mass index) nor abdominal fat (waist-to-hip ratio, waist or hip circumference) measures were positively associated with overall non-Hodgkin’s lymphoma and multiple myeloma. Relative risks for highest versus lowest body mass index quartile were 1.09 (95% CI 0.85–1.38) and 0.92 (95% CI 0.71–1.19) for men and women, respectively. Women in the upper body mass index quartile were at greater risk of diffuse large B-cell lymphoma (RR 2.18, 95% CI 1.05–4.53) and taller women had an elevated risk of follicular lymphoma (RR 1.25, 95% CI 0.59–2.62). Among men, height and body mass index were non-significantly, positively related to follicular lymphoma. Multiple myeloma risk alone was elevated for taller women (RR 2.34, 95% CI 1.29–4.21) and heavier men (RR 1.77, 95% CI 1.02–3.05).

Conclusions: The EPIC analyses support an association between height and overall non-Hodgkin’s lymphoma and multiple myeloma among women and suggest heterogeneous subtype associations. This is one of the first prospective studies focusing on central adiposity and non-Hodgkin’s lymphoma subtypes.

Key words: non-Hodgkin’s lymphoma, anthropometry, cohort study.

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