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Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, Washington, U.S.A. I have no conflicts to disclose.

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Page 1: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Anthropometry: What Can We

Measure & What Does It Mean?

Anne McTiernan, MD, PhD

Fred Hutchinson Cancer Research Center

Seattle, Washington, U.S.A.

I have no conflicts to disclose.

Page 2: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Anthropometry in Human Studies

• Height

• Weight

• Circumferences

– Waist

– Hip

• Indices

– Body mass index (BMI): kg/m2

– Waist-to-hip ratio

– Waist-to-height ratio

– A body shape index (ABSI)

• Change over time

• Duration of overweight/obesity

Page 3: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Body Mass Index (BMI) • Classifications (WHO)

– Obese > 30; overweight 25 - < 30; normal 18.5 - < 25; underweight < 18.5

– Obesity classes • 1: 30.0 - 34.99

• 2: 35.0 - 35.99

• 3: > 40.0

– Correlates with mortality, heart disease, diabetes

– Cutpoints for cancer risk not established

• Race/ethnicity/gender considerations

• Physical fitness, lean mass

Page 4: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Cancer site BMI Waist Waist-

hip

Wt

gain

Height

Stomach

(cardia)

Kidney

Gallbladder

Liver

Prostate

(advanced)

Ovarian

Endometrial

Pancreatic

Colorectal

Breast

(postmeno)

Breast

(premeno)

Oesophageal

(adenoca)

Cancer Risk & Adiposity, Adult Weight Gain &

Height: WCRF Continuous Update Project

convincing increased, probable increased, probable decreased risk

Bandera et al for WCRF International CUP Panel. Int J Ca 2016 June 28 (epub)

Page 5: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Figure 3

The Lancet 2014 384, 755-765DOI: (10.1016/S0140-6736(14)60892-8)

Clinic Measured BMI & Risk of Cancer:

population-based cohort study of 5·24 million UK adults

Bhaskaran et al. Lancet 2014;384(9945):775-65

Page 6: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Overweight (BMI ≥ 25 kg/m2) Duration Since Age 18 y

& Risk of Cancer: Women’s Health Initiative

Arnold M, Jiang L, Stefanick ML, Johnson KC, Lane DS, et al. (2016) Duration of Adulthood Overweight, Obesity, and Cancer Risk in

the Women’s Health Initiative: A Longitudinal Study from the United States. PLoS Med 13(8): e1002081.

Page 7: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Overweight (BMI ≥ 25 kg/m2) Duration Since Age 18 y

& Risk of Postmenopausal Breast and Endometrial Cancer by

Postmenopausal Hormone Use: WHI

Arnold M, Jiang L, Stefanick ML, Johnson KC, Lane DS, et al. (2016) Duration of Adulthood Overweight, Obesity, and Cancer Risk

in the Women’s Health Initiative: A Longitudinal Study from the United States. PLoS Med 13(8): e1002081.

Page 8: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Neuhouser et al. JAMA Oncol. 2015;1(5):611-621. doi:10.1001/jamaoncol.2015.1546

Overall and Tumor Specific Incidence of Invasive Breast Cancer and

Other Breast Cancer Outcomes (No., Annualized %) and

Multivariablea Adjusted HRs by Baseline BMI in the WHI Clinical Trial

Page 9: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Risk of Breast Cancer by Change in BMI

between Age 18 and Study Entry: WHI

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

<= 0 1.-3.4 3.5-6.1 6.2-9.7 > 9.7

Weight Change (kg.)

Rela

tiv

e R

isk

Never used HRT

Ever used HRT

*P trend = .002

*

Morrimoto et al. Cancer Causes and Control. 2002;13:741-751

Page 10: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Measurement Issues

• Self-report vs. measured

• Method of measurement

– Clothed vs. unclothed

– Site of circumference measures

– Fasting status

• Within-person variability

Page 11: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

BMC Public Health. 2009 Nov 19;9:421.

Underestimation of Self-reported Height & Weight U.S. NHANES & NHIS

Page 12: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Perry et al. Epidemiology 1995;6(1): 61-6.

U.S. NHANES: Recalled vs. Measured Weight Change

in Men & Women

Page 13: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Variability in Waist Circumference Measurements According to Anatomic Measurement Site

(223 men and 319 women, 20–67 years, Canadian)

Mason C et al. Obesity 2012;17(9): 1789-1795

Women

Men

Page 14: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

How Waist Circumference is Measured Affects Abdominal

Obesity Prevalence

(N= 223 men & 319 women, 20–67 years, Canadian)

Mason C et al. Obesity 2012;17(9): 1789-1795

Page 15: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

What Do We Really Want to Know?

• Adipose tissue

– Amount

– Distribution

– Secreted proteins/lipids

• Growth trajectory

• Lean mass, muscle, bone

• Genetics

• Diet & lifestyle correlates

Page 16: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Intra-abdominal Fat

Subcutaneous Fat

Page 17: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Intra-abdominal Fat

Subcutaneous Fat

Page 18: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Spearman Correlations of Serum Estrogens with

Adipose Measures

BMI Weight

% body

fat (DXA)

Intra-abd

fat (CT)

Subcut

abd fat

(CT)

Total abd

fat (CT)

Estrone

0.419

(<.0001)

0.387

(<.0001)

0.349

(<.0001)

0.163

(0.03)

0.357

(<.0001)

0.360

(<.0001)

Estradiol

0.387

(<.0001)

0.383

(<.0001)

0.275

(0.0003)

0.060

(0.43)

-0.107

(0.158)

0.298

(<.0001)

SHBG

-0.363

(<.0001)

-0.365

(<.0001)

-0.150

(0.04)

-0.376

(<.0001)

-0.196

(0.01)

-0.333

(<.0001)

Free

estradiol

0.456

(<.0001)

0.460

(<.0001)

0.297

(<.0001)

0.183

(0.01)

0.365

(<.0001)

0.373

(<.0001)

PATH Study, randomized trial, N=173, postmenopausal women aged 50-75 years, BMI > 25 kg/m2

Page 19: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

1-Year Weight Loss & Exercise Effects on C-reactive Protein

(N=438 postmenopausal women BMI > 25)

-60

-50

-40

-30

-20

-10

0

10

Control Weight loss<5% Weight loss≥5%

Imayama et al. Cancer Research 2012; 72(9); 2314–26

-51.2% P< .001†

-52.0% P< .001†

-27.8% P= .001†

0.9% 0.9% 0.9%

-3.7%

-13.0%

-7.3%

Diet Diet + Exercise Exercise

Page 20: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

% Free Estradiol Change by Weight Change

-35

-30

-25

-20

-15

-10

-5

0

5

10

Diet Only Exercise Only Diet + Exercise

Control

Gain/lost < 5%

Lost >=5%

* * +

*Ptrend<0.0001 vs. CO

+ Ptrend<0.001 vs. CO

Campbell et al. J Clinical Oncology 2012 Jul 1;30(19):2314-26

Page 21: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

White Adipose Tissue Inflammation and Breast Cancer Recurrence

Neil M. Iyengar et al. Clin Cancer Res 2016;22:2283-2289

©2016 by American Association for Cancer Research

Page 22: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Measure Benefits & Drawbacks Benefit Drawback

BMI Portable

Little training needed

Inexpensive

Good reliability

Self-report valid for associations

Dose-response associations seen

for multiple cancers

Works for large pop studies

WHO classifications

Self-report underestimates

Doesn’t measure fat distribution

Doesn’t differentiate fat vs. lean

mass

Race/ethnic/age variation

Physical fitness effects

Waist measure Portable

Inexpensive

Measures abdominal area, could be

more relevant to some cancers

Good reliability

Self-report?

Does not differentiate visceral vs

subcutaneous fat

Validity/reliability depends on site

measured

Waist-to-hip Estimates body fat distribution May not add to waist

circumference information

Weight change,

duration

overweight/obesity

Estimates long-term exposure

Poor correlation self- vs. measured

weight change

Intentionality of weight loss difficult

to prove

Page 23: Anthropometry: What Can We Measure & What Does It Mean? · Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle,

Summary • BMI is a good measure for observational studies of

associations between adiposity and cancer risk

• Waist circumference reasonable measure but unclear advantages vs. BMI for observational data

• Self-report valid for single-measure association studies

• Measured BMI & weight more accurate for change data

• Other data needed to supplement observational study data (human experiments, imaging studies, clinical/biological)