BMJ 1998;316:499-504 (14 February)

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Childhood energy intake and adult mortality from cancer: the boyd orr cohort study

Stephen Frankel, professor of epidemiology and public health medicine,a David J Gunnell, senior lecturer in epidemiology and public health medicine,a Tim J Peters, reader in medical statistics,a Maria Maynard, research student,a George Davey Smith, professor of clinical epidemiology a

a Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: Professor Frankel stephen.frankel.@bristol.ac.uk

Objective: To examine the relation between energy intake in childhood and adult mortality from cancer.
Study design: Cohort study.
Setting: 16 rural and urban centres in England and Scotland.
Subjects: 3834 people who took part in Lord Boyd Orr's Carnegie survey of family diet and health in prewar Britain between 1937 and 1939 who were followed up with the NHS central register. Standardised methods were used to measure household dietary intake during a one week period.
Main outcome measures: Cancer mortality.
Results: Significant associations between childhood energy intake and cancer mortality were seen when the confounding effects of social variables were taken into account in proportional hazards models (relative hazard for all cancer mortality 1.15 (95% confidence interval 1.06 to 1.24), P=0.001, for every MJ increase in adult equivalent daily intake in fully adjusted models). This effect was essentially limited to cancers not related to smoking (relative hazard 1.20; 1.07 to 1.34; P=0.001), with similar effects seen in men and women.
Conclusion: This positive association between childhood energy intake and later cancer is consistent with animal evidence linking energy restriction with reduced incidence of cancer and the association between height and human cancer, implying that higher levels of energy intake in childhood increase the risk of later development of cancer. This evidence for long term effects of early diet confirm the importance of optimal nutrition in childhood and suggest that the unfavourable trends seen in the incidence of some cancers may have their origins in early life.

Key messages

  • Animal studies have shown that energy restriction results in a reduced risk of cancer. Some cancers are more common in taller people, suggesting that the same effect may be important in humans

  • The association between diet in childhood and later cancer was examined on the basis of detailed dietary data collected from a cohort of children in the late 1930s

  • A positive association emerged between childhood energy intake and later cancer (other than cancer related to smoking), once adjustment for socioeconomic variables had been made

  • This evidence for long term effects of early diet confirms the importance of optimal childhood nutrition by implying that higher levels of energy intake in childhood increase the risk of the later development of cancer


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