Joint associations of physical activity and body mass index with the risk of established excess body fatness-related can
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ORIGINAL PAPER
Joint associations of physical activity and body mass index with the risk of established excess body fatness‑related cancers among postmenopausal women Maret L. Maliniak1 · Susan M. Gapstur2 · Lauren E. McCullough1 · Erika Rees‑Punia2 · Mia M. Gaudet2 · Caroline Y. Um2 · Mark A. Guinter2 · W. Dana Flanders1,2 · Alpa V. Patel2 Received: 11 June 2020 / Accepted: 3 November 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose Excess body fatness and physical activity independently influence the risk of several types of cancer. However, few studies have examined whether physical activity mitigates the excess risk associated with higher body mass index (BMI). Methods We examined the individual and joint associations between BMI (kg/m2) and leisure-time moderate-to-vigorous physical activity (MVPA, MET-hours/week) with the risk of three established excess body fatness-related cancers (breast, colon, and endometrial) among 43,795 postmenopausal women in the Cancer Prevention Study II (CPS-II) Nutrition Cohort (1992/1993–2015). Further exclusions for women without an intact uterus resulted in 31,805 women for endometrial cancer analyses. Multivariable Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence intervals (CIs) with interaction terms to assess multiplicative interaction. The relative excess risk due to interaction (RERI) was calculated to assess additive interaction. Results BMI and MVPA were individually associated with breast and endometrial cancer risk, but only BMI was associated with colon cancer risk. In joint analyses, increasing levels of MVPA did not lower the risk of these cancers among obese women. For example, compared to the common referent (BMI 18.5– 0– 0–
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