Unravelling the obesity paradox in cancer: An umbrella review of protective associations and evidence credibility across 13 malignancies.
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[BACKGROUND] The "obesity paradox" in cancer remains controversial amid inconsistent meta-analyses.
- 95% CI 0.91-0.96
APA
Yu L, Yuan J, et al. (2026). Unravelling the obesity paradox in cancer: An umbrella review of protective associations and evidence credibility across 13 malignancies.. Metabolism: clinical and experimental, 175, 156461. https://doi.org/10.1016/j.metabol.2025.156461
MLA
Yu L, et al.. "Unravelling the obesity paradox in cancer: An umbrella review of protective associations and evidence credibility across 13 malignancies.." Metabolism: clinical and experimental, vol. 175, 2026, pp. 156461.
PMID
41338475
Abstract
[BACKGROUND] The "obesity paradox" in cancer remains controversial amid inconsistent meta-analyses. This umbrella review re-analyses evidence across 13 malignancies using pre-specified credibility criteria to clarify associations.
[METHODS] We conducted an umbrella review of systematic reviews and meta-analyses investigating obesity and cancer incidence or prognosis. PubMed, Embase, and Cochrane Library were searched from inception to August 2025. Evidence credibility was graded using the following criteria: statistical significance, heterogeneity, 95 % prediction intervals, small-study effects, excess significance bias, and methodological quality assessment.
[FINDINGS] Based on 33 included articles (comprising 145 associations across 13 cancer types), only two associations met the convincing evidence criteria: higher BMI was associated with a reduced incidence of oral cancer (relative risk [RR] = 0.93, 95 % CI: 0.91-0.96), and excess weight was associated with a reduced incidence of lung cancer in the Chinese population (odds ratio [OR] = 0.68, 95 % CI: 0.59-0.79). Highly suggestive evidence has revealed associations in lung cancer (reduced incidence, fewer surgical complications and prolonged cancer-specific survival), breast cancer (reduced incidence and decreased likelihood of lymph node metastasis), renal cell carcinoma (prolonged overall survival) and prostate cancer (prolonged overall survival). Of the remaining associations, 20 were suggestive, 51 weak, and 53 non-significant.
[CONCLUSIONS] Only 21 (14 %) meta-analyses provided convincing or highly suggestive evidence, demonstrating potential associations of obesity in specific oncological contexts pertaining to both reduced incidence risk and improved prognostic outcomes. This synthesis also highlights critical gaps in current evidence, emphasising the need for standardised adiposity metrics, more prudent stratification, and rigorous methodology.
[METHODS] We conducted an umbrella review of systematic reviews and meta-analyses investigating obesity and cancer incidence or prognosis. PubMed, Embase, and Cochrane Library were searched from inception to August 2025. Evidence credibility was graded using the following criteria: statistical significance, heterogeneity, 95 % prediction intervals, small-study effects, excess significance bias, and methodological quality assessment.
[FINDINGS] Based on 33 included articles (comprising 145 associations across 13 cancer types), only two associations met the convincing evidence criteria: higher BMI was associated with a reduced incidence of oral cancer (relative risk [RR] = 0.93, 95 % CI: 0.91-0.96), and excess weight was associated with a reduced incidence of lung cancer in the Chinese population (odds ratio [OR] = 0.68, 95 % CI: 0.59-0.79). Highly suggestive evidence has revealed associations in lung cancer (reduced incidence, fewer surgical complications and prolonged cancer-specific survival), breast cancer (reduced incidence and decreased likelihood of lymph node metastasis), renal cell carcinoma (prolonged overall survival) and prostate cancer (prolonged overall survival). Of the remaining associations, 20 were suggestive, 51 weak, and 53 non-significant.
[CONCLUSIONS] Only 21 (14 %) meta-analyses provided convincing or highly suggestive evidence, demonstrating potential associations of obesity in specific oncological contexts pertaining to both reduced incidence risk and improved prognostic outcomes. This synthesis also highlights critical gaps in current evidence, emphasising the need for standardised adiposity metrics, more prudent stratification, and rigorous methodology.
MeSH Terms
Humans; Obesity; Neoplasms; Body Mass Index; Incidence; Prognosis; Obesity Paradox
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