Abstract
Obesity and alcohol consumption are both important modifiable risk factors for cancer. We examined the joint association of adiposity and alcohol consumption with alcohol- and obesity-related cancer incidence. This prospective cohort study included cancer-free UK Biobank participants aged 40-69 years. Alcohol consumption was categorised based on current UK guidelines into four groups. We defined three markers of adiposity: body fat percentage (BF %), waist circumference and BMI and categorised each into three groups. We derived a joint alcohol consumption and adiposity marker variable with twelve mutually exclusive categories. Among 399 575 participants, 17 617 developed alcohol-related cancer and 20 214 developed obesity-related cancer over an average follow-up of 11·8 (SD 0·9) years. We found relatively weak evidence of independent associations of alcohol consumption with cancer outcomes. However, the joint association analyses showed that across all adiposity markers, above guideline drinkers who were in the top two adiposity groups had elevated cancer incidence risk (e.g. HR for alcohol-related cancer was 1·53 (95 % CI (1·24, 1·90)) for within guideline drinkers and 1·61 (95 % CI (1·30, 2·00)) for above guideline drinkers among participants who were in the top tertile BF %. Regardless of alcohol consumption status, the risk of obesity-related cancer increased with higher adiposity in a dose-response manner within alcohol consumption categories. Our study provides guidance for public health priorities aimed at lowering population cancer risk via two key modifiable risk factors.