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ORIGINAL RESEARCH article

Front. Nutr.
Sec. Nutritional Epidemiology
Volume 11 - 2024 | doi: 10.3389/fnut.2024.1433632

Navigating the Obesity Paradox in Bladder Cancer Prognosis -Insights from the Taiwan National Health Insurance System Database

Provisionally accepted
Wen-Hsin Tseng Wen-Hsin Tseng 1,2Ting-Yi Chiang Ting-Yi Chiang 2*Chung-Han Ho Chung-Han Ho 3,4Steven K Huang Steven K Huang 2*Allen W Chiu Allen W Chiu 5*Chien-Feng Li Chien-Feng Li 3,6Yow-Ling Shiue Yow-Ling Shiue 1,7*
  • 1 Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
  • 2 Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
  • 3 Department of Medical Research, Chi Mei Medical Center, Yongkang, Tainan County, Taiwan
  • 4 Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
  • 5 Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  • 6 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
  • 7 Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan Province, China

The final, formatted version of the article will be published soon.

    Purpose: This study investigates the complex relationship between body mass index (BMI) and bladder cancer outcomes, utilizing Taiwan's national database. Bladder cancer remains a significant health concern, especially in Taiwan, prompting a comprehensive retrospective analysis to explore the impact of obesity on survival outcomes. Materials and Methods: A meticulous exclusion process, based on Taiwan National Health Insurance System Database, refined the initial dataset of 15,086 bladder cancer patients to 10,352. Categorizing patients into BMI groups (underweight, normal weight, obesity), the study examined baseline characteristics, comorbidities, and survival outcomes. The analysis involved Cox regression and subgroup assessments stratified by clinical stage. Results: Among our patients, 71.5% are male, 78.5% are over 60 years of age, and 18.8% are between 45 and 60 years old. Despite a higher prevalence of comorbidities, obesity patients exhibited a more favorable prognosis, supporting the obesity paradox. The overall and specific mortality ratio of obesity patients were 0.76 fold and 0.82-fold compared with normal-weight patients (overall: 95% confidence interval [CI], 0.71-0.82, P<0.0001; specific: 95% CI, 0.75-0.90, P<0.0001). Conversely, underweight patients displayed an increased risk of both overall and cancer-specific mortality compared to normal-weight patients (p<0.0001). Conclusion: This study highlights the potential protective role of higher BMI in bladder cancer survival, revealing a more favorable prognosis among obesity patients, highlighting the need for cautious interpretation and suggesting avenues for future research. These insights could guide BMI-targeted intervention strategies, allowing clinicians to consider BMI as a factor in personalized treatment planning for bladder cancer patients. 

    Keywords: Bladder cancer, Obesity paradox, Taiwan Cancer Registry, Mortality, Body Mass Index

    Received: 16 May 2024; Accepted: 25 Nov 2024.

    Copyright: © 2024 Tseng, Chiang, Ho, Huang, Chiu, Li and Shiue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ting-Yi Chiang, Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, 71004, Taiwan
    Steven K Huang, Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, 71004, Taiwan
    Allen W Chiu, Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    Yow-Ling Shiue, Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan Province, China

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