Body mass index and risk of lung cancer: Systematic review and dose-response meta-analysis

Questions remain about the significance of the dose-response relationship between body mass index (BMI) and lung cancer (LC) risk. Pertinent studies were identified through a search in EMBASE and PUBMED from July 2014 until March 2015. The summary relative risk (SRR) and confidence interval (CI) were estimated. The dose-response relationship was assessed using a restricted cubic spline. The overall meta-analysis showed evidence of a nonlinear association between BMI and LC risk (P(nonlinearity) < 0.001). The SRR were 0.98 (95%CI: 0.95–1.01) for 25 kg/m(2), 0.91 (95%CI: 0.85–0.98) for 30 kg/m(2) and 0.81 (95% CI: 0.72–0.91) for 35 kg/m(2), with mild between-study heterogeneity (I(2) = 5%). The results of the stratified analysis by gender were comparable to those of the overall meta-analysis. When stratified by smoking status, linear dose-response associations were observed for current smokers, ex-smokers and non-smokers (P(nonlinearity) > 0.05), whereas the effects were attenuated when restricting analysis to non-smokers, and at the point of 30 kg/m(2), the SRR was 0.96 (95%CI: 0.86–1.07) for males and 0.95 (95%CI: 0.89–1.02) for females. This meta-analysis provides quantitative evidence that increasing BMI is a protective factor against LC. Keeping normal-to-moderate BMI should be prescribed as an evidence-based lifestyle tip for LC prevention in smokers.