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    The 'obesity paradox' and survival after colorectal cancer: true or false?

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    Authors
    Renehan, Andrew G
    Affiliation
    Department of Surgery, Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK, andrew.renehan@ics.manchester.ac.uk.
    Issue Date
    2014-08-02
    
    Metadata
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    Abstract
    Body mass index (BMI), as an approximation of general adiposity, is an established risk factor for incidence of several adult cancer types, including colorectal cancer (CRC). There is a common perception that these relationships extrapolate directly as adverse prognostic factors after diagnosis, but evidence for this is lacking. The paper from Sclesinger et al. in this issue of the journal adds a new dimension to this debate focusing on relationships of post-diagnosis BMI (as a marker of the steady-state weight among survivors) and survival, and provides evidence on a decreased mortality risk among overweight (post-diagnosis BMI 25.0-29.9 kg/m(2)) compared with normal weight (post-diagnosis BMI 18.5-24.9 kg/m(2)) CRC survivors-an example of an 'obesity paradox.' The observation of the 'obesity paradox' is well documented in the methodology literature, but perhaps, less familiar to the cancer readership. Three broad classes of explanation are posited: (1) the associations are true and plausible; (2) the associations are false and reflect methodological issues; or (3) the observations represent a specific form of selection bias, known as collider bias. The present author argues that the obesity paradox reflects the latter-a product of a statistical bias-and emphasizes that, while these findings are hypothesis generating, they will not alter clinical practice or recommendations.
    Citation
    The 'obesity paradox' and survival after colorectal cancer: true or false? 2014: Cancer Causes Control
    Journal
    Cancer Causes & Control
    URI
    http://hdl.handle.net/10541/326336
    DOI
    10.1007/s10552-014-0436-9
    PubMed ID
    25084751
    Type
    Article
    Language
    en
    ISSN
    1573-7225
    ae974a485f413a2113503eed53cd6c53
    10.1007/s10552-014-0436-9
    Scopus Count
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