**4. Body fatness**

Body fatness and abdominal obesity is normally estimated by body mass index (BMI), waist circumference, and waist-to-hip ratio [7]. There is strong convincing evidence that body fatness increases the risk of colorectal, colon, and rectum cancer [7]. However, cognizance should be taken of the fact that these anthropometric measurements have limitations as they do not distinguish between lean and fat mass [8]. Evidence supporting a clear dose-response association was related to showing a significant increased risk of CRC with an increased BMI [8, 43, 44]. There is evidence of a nonlinear dose response, whereby the increased risk is higher at a BMI beyond 27 kg/m2 for CRC. Significant positive associations were observed for CRC in the dose-response analysis for waist circumference and waist-to-hip ratio [8]; hence, the level of evidence is being referred to as convincing for abdominal obesity [33]. In contrast to the vague findings regarding the role of individual nutrients or foods, the strong consistent association between obesity and CRC (at least in men)

further underscores the importance of combined integrated effects of nutrients/ foods over their individual effects. These effects probably do not only reflect the imbalance between energy intake and expenditure but the often suboptimal quality of the diet associated with the development of obesity [4].
