Table 1.

MONW and associated cancer risks.

Cohort
Cancer TypeNameCharacteristicsMONW ParametersAdiposity MeasuresCancer risk, MONW vs. MHNWReference
Breast cancer, postmenopausalWomen's Health Initiative (USA)3,460 NW FBMI 18.5–24.9 kg/m2 Upper quartiles total fat mass (>22 kg), trunk fat mass (>9.3 kg)DXAQ4 vs. Q1Iyengar et al. (2019)
Total fat mass [HR = 1.89 (1.21–2.95)]
Trunk fat mass [HR = 1.88 (1.18–2.98)]
The Sister Study (USA)43,599 F (16619 NW)BMI < 25 kg/m2 ≥ 1 metabolic abnormalityWC, WHR≥1 metabolic abnormality [HR = 1.26 (1.01–1.56)]Park et al. (2017)
WC ≥ 88 cm [HR = 1.58 (1.02–2.46)]
UK Biobank (UK)149,928 NW (52,729 analyzed)BMI 18.5–24.9 kg/m2, BIA adiposity measures, WC, WHRBIA, WC, WHRQ5 vs. Q1Arthur et al. (2020)
FMI [HR = 1.46 (1.20–1.78)]; TFMI [HR = 1.57 (1.20–1.80)];
WC [HR = 1.32 (1.09–1.60)]
Women's Health Initiative (USA)3,327 FBMI 18.5–24.9 kg/m2 Upper quartiles fasting insulin Upper quartiles HOMA-IRQ3+4 vs. Q1Gunter et al. (2015)
Fasting insulin [HR = 2.06 (1.01–4.22)]
HOMA-IR [HR = 1.80 (0.88–3.70)]
Breast cancerNigerian Breast Cancer Study (Nigeria)2,334 F (1,209 NW)BMI < 25 kg/m2 WHR top quartile (> 0.87)WC, WHRWHR Q4 vs. Q1 [OR = 2.81 (1.90–4.16)]Ogundiran et al. (2012)
WC > 81 cm [OR = 1.91 (1.39–2.61)]
Endometrial cancerAlberta Cancer Registry (Canada)1,477 F (406 NW)BMI < 25 kg/m2, MetSWCWC > 88 cm [OR = 5.09 (1.04–24.95)]Friedenreich et al. (2011)
UK Biobank (UK)149,928 NW (77,738 analyzed)BMI 18.5–24.9 kg/m2, BIA adiposity measures, WC, WHRBIA, WC, WHRTrunk fat mass index Q5 vs. Q1 [HR = 1.72 (1.02–2.89)]Arthur et al. (2020)
Colorectal cancerEPIC Study (Europe)1,474 (790 M, 684 F; 523 NW)BMI < 25 kg/m2 C-peptide top tertile (>4.74 ng/mL)WCC-peptide T3: CRC [HR = 1.59 (1.10–2.28)];Murphy et al. (2016)
Colon [HR = 1.49 (0.92–2.43)]; Rectal [HR = 1.82 (1.02–3.23)]
WC ≥ 80 cm F or ≥ 94 cm M:
CRC [HR = 1.35 (0.95–1.91)]; Colon [HR = 1.18 (0.74–1.88)];
Rectal [HR = 1.76 (1.01–3.05)]
Women's Health Initiative (USA)21,170 F (5,175 NW)BMI 18.5–< 25 kg/m2, MetSWCCRC [HR = 1.65 (0.99–2.74)]Kabat et al. (2018)
Colon [HR = 1.79 (1.02–3.12)]
UK Biobank (UK)149,928 NW (149,928 analyzed)BMI 18.5–24.9 kg/m2, BIA adiposity measures, WC, WHRBIA, WC, WHRMen only:Arthur et al. (2020)
CRC, trunk to leg fat mass Q5 vs. Q1 [HR = 1.63 (1.14–2.32)]
Colon, trunk to leg fat mass Q5 vs. Q1 [HR = 1.92 (1.20–3.07)]
Colon, WC Q5 vs. Q1 [HR = 1.68 (1.05–2.66)]
No significant associations among women
Primary liver cancer (HCC and ICC)Liver Cancer Pooling Project (North America)1,167,244 (707,281 F, 457,755 M; 338,070 NW)BMI 18.5–< 25 kg/m2 WC, WHRWCWC per 5-cm increase [HR = 1.14 (1.07–1.21)]Florio et al. (2020)
Prostate cancerNational Health Check-ups Database (Korea)11,771,252 M (7,391,410 NW)BMI < 25 kg/m2, MetSWCHR = 1.14 (1.12–1.17)Kim et al. (2019)
  • Abbreviations: MONW, metabolic obesity in the normal weight; MHNW, metabolically healthy normal weight; HCC, hepatocellular cancer; ICC, intrahepatic cholangiocarcinoma; EPIC, European Prospective Investigation into Cancer and Nutrition; NW, normal weight; F, female; M, male; BMI, body mass index; BIA, bioelectrical impedance analysis; WC, waist circumference; WHR, waist-to-hip ratio; HOMA-IR, homeostasis model assessment of insulin resistance; MetS, metabolic syndrome; DXA, dual energy X-ray absorptiometry; FMI, fat mass index; TFMI, trunk fat mass index; CRC, colorectal cancer.