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  • br We conducted stratified analysis by cigarette

    2021-03-03


    We conducted stratified analysis by cigarette smoking status, al-cohol drinking status, betel chewing status, age (18–54, or 55–85), sex and cancer subsites to explore possible differences in association be-tween subgroups. We also ran chi-square tests on gamma-Glu-Cys and vegetable intake and BMI at age 20 in order to investigate the BMI association with diet related intake and assess whether diet contributed to asso-ciations observed for BMI and HNC risk. The fruit/vegetable intake was categorized in to three groups (1–3 times per day, 3–6 times every week, and < 3 times every week or not at all).  Cancer Epidemiology 60 (2019) 208–215
    Table 2
    BMI, height, BMI change and the risk of head and neck cancer.
    Fully adjusted
    Case Control ORa 95%CI
    BMI at interview (kg/m2)
    Missing 2 2
    p for trend
    BMI 2 years before interview (kg/m2)
    p for trend
    BMI 5 years before interview (kg/m2)
    p for trend
    p for trend
    Height quantile
    Missing 2 1
    p for trend
    BMI change from age 20 to 5 years before interview
    p for trend
    a Adjusted for age, sex, ethnicity, education, center, daily cigarettes per day, cigarette years, alcohol drinks per week, alcohol years, betel quid chewed per day and betel years.
    3. Results
    Table 1 shows that most participants were between 45 and 64 years old and recruited from Taiwan and Sichuan. Cases were more likely to be male, to have smoked cigarettes and to drink alcohol, compared to controls.
    Table 3
    BMI, height, BMI change and the risk of HNC by subsite.
    Oral cavity
    Oropharynx
    Hypopharynx
    Larynx
    Unspecified or overlapping
    Ca Co ORa 95%CI
    Ca Co ORa 95%CI
    Ca Co ORa 95%CI
    Ca Co ORa 95%CI
    Ca Co ORa 95%CI
    BMI at interview (kg/m2)
    p for trend
    BMI 5 years before interview (kg/m2)
    p for trend
    p for trend
    Height quantile
    p for trend
    BMI change from age 20 to 5 years before interview
    p for trend
    a Adjusted for age, sex, ethnicity, education, center, daily cigarettes per day, cigarette years, alcohol drinks per week, alcohol years, betel quid chewed per day and betel years.  Y. Chen, et al.
    Table 4
    BMI, height, BMI change and the risk of HNC by cigarette smoking and drinking status.
    Never smoker
    Ever smoker
    Never drinker
    Ever drinker
    ORa
    ORb
    ORc
    ORb
    BMI at interview (kg/m2)
    p for trend
    BMI 2 years before interview (kg/m2)
    p for trend
    BMI 5 years before interview (kg/m2)
    p for trend
    p for trend
    Height quantile
    p for trend
    BMI change from age 20 to 5 years before interview
    p for trend
    a Adjusted for age, sex, ethnicity, education, center, alcohol drinks per week, alcohol years, betel quid chewed per day and betel years.
    b Adjusted for age, sex, ethnicity, education, center, daily cigarettes per day, cigarette years, alcohol drinks per week, alcohol years, betel quid chewed per day and betel years.
    c Adjusted for age, sex, ethnicity, education, center, daily cigarettes per day, cigarette years, betel quid chewed per day and betel years.  Y. Chen, et al.
    lower risk of oral cavity, oropharynx, hypopharynx and unspecified overlapping (Table 3). A positive association between BMI < 18.5 kg/ m2 at age 20 and the risk of unspecified or overlapping head and neck cancer was observed (Table 3). BMI loss from age 20 to 5 years prior to the interview time remained positively associated with hypopharyngeal and laryngeal cancer (Table 3).
    When stratified by age, the results for younger and older groups were similar for BMI at interview (Supplemental Table S1). We further stratified by sex and detected that the positive association between BMI at interview and HNC risk was stronger for males (OR = 9.26, 95% CI 1.95–43.99). However, women at age 20 with a low BMI (< 18.5 kg/ m2) had a high HNC risk (OR = 2.36, 95% CI 1.28–4.36) (Supplemental Table S1). No apparent associations were observed between fruit/ve-getable intake and BMI at age 20 (Supplemental Table S2).
    Ever smokers and both never and ever drinkers had a higher risk of HNC with low BMI (< 18.5 kg/m2) and a lower risk of HNC with being obese (≥30 kg/m2) (Table 4). The inverse associations between BMI 2 years and 5 years prior to the interview and HNC risk only were ob-served among ever smokers and ever drinkers. Higher risks for in-dividuals who were underweight at age 20 were limited to never smokers and never drinkers.
    The risk of HNC decreased by approximately 8% and 6% for every 5 kg/m2 increase of BMI 5 years before interview among ever smokers and ever drinker, respectively (Table 5). Although height in quartiles was not associated with the risk of HNC, there was a 2% reduction in the risk of HNC with every 5 cm increase in height (Table 5). We de-tected an increased risk of HNC (OR = 4.70, 95% CI 1.33–16.58) for every 10% increase among never smokers for BMI change from age 20 to 5 years before interview (Table 5). For potential interactions between BMI and smoking/drinking, we estimated joint and component effects but did not detect any interactions.