Explaining the link between adiposity and colorectal cancer risk in men and postmenopausal women in the UK Biobank: A sequential causal mediation analysis.
Mechanisms underlying adiposity-colorectal cancer (CRC) association are incompletely understood. Using UK Biobank data, we investigated the role of C-reactive protein (CRP), hemoglobin-A1c (HbA1c), and (jointly) sex hormone-binding globulin (SHBG) and testosterone, in explaining this association. Total effect of obesity vs normal-weight (based on waist circumference, body mass index, waist-hip ratio) on CRC risk was decomposed into natural direct (NDE) and indirect (NIE) effects using sequential mediation analysis. After a median follow-up of 7.1 years, 2070 incident CRC cases (men = 1,280; postmenopausal women = 790) were recorded. For men, the adjusted risk ratio (RR) for waist circumference (>/=102 vs /=88 vs = 80 cm) was 1.27 (95%CI,1.07-1.50). The RRs(NIE) were 1.08 (95%CI,0.94-1.22) through all biomarkers, 1.08 (95%CI,0.99-1.17) through CRP, 1.00 (95%CI,0.98-1.02) through HbA1c beyond CRP, and 1.00 (95%CI;0.92-1.09) through SHBG and testosterone combined beyond CRP and HbA1c. The RR(NDE) was 1.18 (95%CI,0.96-1.45). For men and women, pathways influenced by CRP explained a small proportion of the adiposity-CRC association. Testosterone and SHBG also explained a small proportion of this association in men. These results suggest that pathways marked by these obesity-related factors may not explain a large proportion of the adiposity-CRC association. This article is protected by copyright. All rights reserved.