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August 16, 2026JAMA Network OpenOpen Access

Body Mass Index at Diagnosis, Prediagnostic Weight Loss, and Survival in Colorectal Cancer

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Authors

MMMarko MandicDWDurgesh WankhedeFSFatemeh Safizadeh

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Overview

Case-control study with prospective follow-up reveals prediagnostic weight loss drives the obesity paradox in colorectal cancer, indicating excess weight confers no true survival benefit.

Key Points

  • To evaluate whether the survival advantage associated with elevated body mass index in colorectal cancer is explained by prediagnostic cancer-associated weight loss.
  • Multicenter, population-based case-control study with prospective follow-up of 5521 patients with histologically confirmed colorectal cancer recruited across more than 20 hospitals in Germany (median follow-up 5.2 years).
  • Evaluated BMI at diagnosis and percentage weight change occurring 5 to 14 years before diagnosis, analyzing overall, CRC-specific, and recurrence-free survival using multivariable Cox proportional hazards regression models.
  • Before adjustment for weight loss, overweight at diagnosis was associated with modestly higher overall survival compared to normal weight (HR, 0.89; 95% CI, 0.81-0.98), whereas obesity showed no survival association.
  • Prediagnostic weight loss exceeding 10% was strongly associated with poorer overall survival (HR, 1.55; 95% CI, 1.39-1.72).
  • Mutual adjustment for at-diagnosis BMI and prediagnostic weight change attenuated the apparent survival benefit of overweight and obesity to null.

Cite This Study

Mandic et al. (2026) studied this question.

synapsesocial.com/papers/6a8179dcf2fb91fc834ad46dhttps://doi.org/10.1001/jamanetworkopen.2026.29571
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