The Role of BMI in Allostatic Load and Risk of Cancer Death

Sydney E. Andrzejak, Marquita W. Lewis-Thames, Marvin E. Langston, Yunan Han, Saira Khan, Darryl A. Nettles, Lindsay N. Fuzzell, Martha S. Tingen, Justin X. Moore

Research output: Contribution to journalArticlepeer-review


Introduction: Obesity and proinflammatory conditions are associated with increased risks of cancer. The associations of baseline allostatic load with cancer mortality and whether this association is modified by body mass index (BMI) were examined. Methods: A retrospective analysis was performed in March–September 2022 using National Health and Nutrition Examination Survey years 1988 through 2010 linked with the National Death Index through December 31, 2019. Fine and Gray Cox proportional hazard models were stratified by BMI status to estimate subdistribution hazard ratios of cancer death between high and low allostatic load status (adjusted for age, sociodemographics, and health factors). Results: In fully adjusted models, high allostatic load was associated with a 23% increased risk of cancer death (adjusted subdistribution hazard ratio=1.23; 95% CI=1.06, 1.43) among all participants, a 3% increased risk of cancer death (adjusted subdistribution hazard ratio=1.03; 95% CI=0.78, 1.34) among underweight/healthy weight adults, a 31% increased risk of cancer death (adjusted subdistribution hazard ratio=1.31; 95% CI=1.02, 1.67) among overweight adults, and a 39% increased risk of death (adjusted subdistribution hazard ratio=1.39; 95% CI=1.04, 1.88) among obese adults, when compared to those with low allostatic load. Conclusions: The risk of cancer death is highest among those with high allostatic load and obese BMI, but this effect was attenuated among those with high allostatic load and underweight/healthy or overweight BMI.

Original languageEnglish
Pages (from-to)417-426
Number of pages10
JournalAmerican Journal of Preventive Medicine
Issue number3
StatePublished - Sep 2023

Bibliographical note

Funding Information:
JXM was supported by the National Institute on Minority Health and Health Disparities of the NIH under Award Number K01MD015304 . MEL was supported by the National Institute of Diabetes and Digestive and Kidney Diseases under Award Number K01DK129405 . MWLT was supported by a grant from the National Cancer Institute under Award Number K01CA262342 , a Northwestern University Clinical and Translational Sciences Institute grant ( UL1TR001422 , principal investigator: D'Aquilla), a Respiratory Health Association of Metropolitan Chicago grant ( RHA2020-01 ), a NIH ’s National Institute on Aging ( P30AG059988 ), and funds from the Northwestern University Center for Community Health . DN was supported by the American Heart Association - Research Supplement to Promote Diversity in Science under Award Number 966990 . SK was supported by grant W81XWH-18-1-0168 from the U.S. Department of Defense Prostate Cancer Research Program.

Publisher Copyright:
© 2023 American Journal of Preventive Medicine

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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