Cancer Causes & Control

, Volume 23, Issue 2, pp 371–378 | Cite as

Measured body mass index in adolescence and the incidence of pancreatic cancer in a cohort of 720,000 Jewish men

  • Zohar Levi
  • Jeremy D. Kark
  • Arnon Afek
  • Estela Derazne
  • Dorit Tzur
  • Moshe Furman
  • Barak Gordon
  • Micha Barchana
  • Irena Liphshitz
  • Yaron Niv
  • Ari Shamiss
Original paper



The increasing prevalence of adolescent obesity affects adult health. We investigated the association of adolescent overweight with pancreatic cancer incidence in a cohort of 720,927 Jewish Israeli men.


Body mass index (BMI) was measured during a general health examination at ages 16–19 between the years 1967 and 1995. Overweight was defined as BMI ≥ 85th percentile of the reference US-CDC distribution in adolescence. Pancreatic cancer was identified by linkage with the Israel National Cancer Registry up to 2006.


The mean follow-up period was 23.3 ± 8.0 years. During 16.8 million person-years, 98 cases of pancreatic cancer were detected. Using Cox proportional hazards modeling, overweight in adolescence predicted an increased risk of pancreatic cancer [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.26–3.50, p = 0.005]. Compared with adolescents with ‘normal’ range BMI Z-scores (−1 to +1), adolescents with Z-scores > 1 showed significantly increased risk [HR, 2.28 (95% CI: 1.43–3.64), p = 0.001]. Lower education level (10 or less years of schooling vs. 11–12 years) was also associated with increased risk of pancreatic cancer [HR 1.90 (95% CI: 1.27–2.86, p = 0.002)], whereas height, country of origin and immigration status were not.


Adolescent overweight is substantially associated with pancreatic cancer incidence in young to middle-aged adults. Applying our point estimates to the 16.8% prevalence of excess weight in Israeli adolescents in the past decade suggests a population fraction of 15.5% (95% CI: 4.2–29.6%) for pancreatic cancer attributable to adolescent overweight in Israel.


Adolescence Obesity Pancreatic cancer 



Body mass index


United States Center for Disease Control


Hazard ratio


Confidence interval



This study was supported by the Israel Cancer Research Fund.


  1. 1.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics (2010). CA Cancer J Clin 60:277–300PubMedCrossRefGoogle Scholar
  2. 2.
  3. 3.
    Rozen P, Liphshitz I, Rosner G, Barchana M, Lachter J, Pel S, Shohat T, Santo E (2009) Israeli Pancreatic Cancer Consortium Pancreatic cancer in Israel: the epidemiology, possibilities of prevention, early detection and screening. Isr Med Assoc J 11(12):710–713PubMedGoogle Scholar
  4. 4.
    Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS (2001) Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 286(8):921–929PubMedCrossRefGoogle Scholar
  5. 5.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348(17):1625–1638PubMedCrossRefGoogle Scholar
  6. 6.
    Samanic C, Gridley WH, Chow J, Lubin RN, Hoover RN, Fraumeni JF Jr (2004) Obesity and cancer risk among white and black United States veterans. Cancer Causes Control 15(1):35–43PubMedCrossRefGoogle Scholar
  7. 7.
    Larsson SC, Permert J, Hakansson N, Näslund I, Bergkvist L, Wolk A (2005) Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts. Br J Cancer 93(11):1310–1315PubMedCrossRefGoogle Scholar
  8. 8.
    Rapp K, Schroeder J, Klenk J (2005) Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. Br J Cancer 93(9):1062–1067PubMedCrossRefGoogle Scholar
  9. 9.
    Patel AV, Rodriguez C, Bernstein L, Chao A, Thun MJ, Calle EE (2005) Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort. Cancer Epidemiol Biomarkers Prev 14(2):459–466PubMedCrossRefGoogle Scholar
  10. 10.
    Stolzenberg-Solomon RZ, Adams K, Leitzmann M, Schairer C, Michaud DS, Hollenbeck A, Schatzkin A, Silverman DT (2008) Adiposity, physical activity, and pancreatic cancer in the National Institutes of Health–AARP Diet and Health Cohort. Am J Epidemiol 167(5):586–597PubMedCrossRefGoogle Scholar
  11. 11.
    Larsson SC, Orsini N, Wolk A (2007) Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer 120(9):1993–1998PubMedCrossRefGoogle Scholar
  12. 12.
    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578PubMedCrossRefGoogle Scholar
  13. 13.
    Jiao L, Berrington de Gonzalez A, Hartge P, Pfeiffer RM, Park Y, Freedman DM, Gail MH, Alavanja MC, Albanes D, Beane Freeman LE, Chow WH, Huang WY et al (2010) Body mass index, effect modifiers, and risk of pancreatic cancer: a pooled study of seven prospective cohorts. Cancer Causes Control 21(8):1305–1314PubMedCrossRefGoogle Scholar
  14. 14.
    Arslan AA, Helzlsouer KJ, Kooperberg C, Shu XO, Steplowski E, Bueno-de-Mesquita HB, Fuchs CS, Gross MD, Jacobs EJ, Lacroix AZ, Petersen GM, Stolzenberg-Solomon RZ et al (2010) Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium (PanScan). Arch Intern Med 170(9):791–802PubMedCrossRefGoogle Scholar
  15. 15.
    Li D, Morris JS, Liu J, Hassan MM, Day RS, Bondy ML, Abbruzzese JL (2009) Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 301(24):2553–2562PubMedCrossRefGoogle Scholar
  16. 16.
    Genkinger JM, Spiegelman D, Anderson KE, Bernstein L, van den Brandt PA, Calle EE, English DR, Folsom AR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E et al (2011) A pooled analysis of 14 cohort studies of anthropometric factors and pancreatic cancer risk. Int J Cancer 129(7):1708PubMedCrossRefGoogle Scholar
  17. 17.
    US Preventive Services Task Force, Barton M (2010) Screening for obesity in children and adolescents: US preventive services task force recommendation statement. Pediatrics 125(2):361–367PubMedCrossRefGoogle Scholar
  18. 18.
    Wang Y, Beydoun MA (2007) The obesity epidemic in the United States: gender, age, socioeconomic, racial/ethnic, and geographic characteristics—a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28PubMedCrossRefGoogle Scholar
  19. 19.
    Ogden CL, Carroll MD, Flegal KM (2008) High body mass index for age among US children and adolescents, 2003–2006. JAMA 299:2401–2405PubMedCrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention (2000) CDC growth charts: United States. National Center for Health Statistics, Hyattsville, MD; 2000. Available at: Accessed June 2011
  21. 21.
    2000 CDC growth charts for the United States: methods and development. Available at
  22. 22.
    Stevens J, Keil JE, Waid LR, Gazes PC (1990) Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol 132:1156–1163PubMedGoogle Scholar
  23. 23.
    Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF (1995) The validity of self-reports of past body weights by US adults. Epidemiology 6:61–66PubMedCrossRefGoogle Scholar
  24. 24.
    Troy LM, Hunter DJ, Manson JE, Colditz GA, Stampfer MJ, Willett WC (1995) The validity of recalled weight among younger women. Int J Obes Relat Metab Disord 19:570–572PubMedGoogle Scholar
  25. 25.
    Huerta M, Gdalevich M, Haviv J, Bibi H, Scharf S (2006) Ten-year trends in obesity among Israeli schoolchildren: 1990–2000. Acta Pediatrica 95:444–449CrossRefGoogle Scholar
  26. 26.
    Gross R, Brammli-Greenberg S, Gordon B, Rabinowitz J, Afek A (2009) Population based trends in male adolescent obesity Israel: 1967–2003. J Adolesc Health 44(2):195–198PubMedCrossRefGoogle Scholar
  27. 27.
    Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, Hartge P, Canzian F, Steplowski E, Arslan AA, Gross M, Helzlsouer K, Jacobs EJ et al (2009) Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. Am J Epidemiol 170(4):403–413PubMedCrossRefGoogle Scholar
  28. 28.
    The national report about smoking in Israel 2009–2010. Available at and Accessed Aug 2011
  29. 29.
    Kastrinos F, Mukherjee B, Tayob N, Wang F, Sparr J, Raymond VM, Bandipalliam P, Stoffel EM, Gruber SB, Syngal S (2009) Risk of pancreatic cancer in families with Lynch syndrome. JAMA 302(16):1790–1795 28PubMedCrossRefGoogle Scholar
  30. 30.
    Friedman GD, van den Eeden SK (1993) Risk factors for pancreatic cancer: exploratory study. Int J Epidemiol 22:30–37PubMedCrossRefGoogle Scholar
  31. 31.
    Berrington de González A, Spencer EA, Bueno-de-Mesquita HB, Roddam A, Stolzenberg-Solomon R, Halkjaer J, Tjønneland A, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Boeing H, Pischon T et al (2006) Anthropometry, physical activity, and the risk of pancreatic cancer in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 15:879–885PubMedCrossRefGoogle Scholar
  32. 32.
    Gapstur SM, Gann PH, Lowe W, Liu K, Colangelo L, Dyer A (2000) Abnormal glucose metabolism and pancreatic cancer mortality. JAMA 283:2552–2558PubMedCrossRefGoogle Scholar
  33. 33.
    Renehan AG, Roberts DL, Dive C (2008) Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem 114(1):71–83PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Zohar Levi
    • 1
    • 2
    • 3
  • Jeremy D. Kark
    • 4
  • Arnon Afek
    • 1
    • 3
    • 5
  • Estela Derazne
    • 1
    • 3
  • Dorit Tzur
    • 1
  • Moshe Furman
    • 1
  • Barak Gordon
    • 1
  • Micha Barchana
    • 6
  • Irena Liphshitz
    • 6
  • Yaron Niv
    • 2
    • 3
  • Ari Shamiss
    • 3
    • 5
  1. 1.Medical Corps, Israeli Defense ForceTel HashomerIsrael
  2. 2.The Gastroenterology DepartmentRabin Medical CenterPetach TikvaIsrael
  3. 3.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  4. 4.Hebrew University-Hadassah School of Public Health and Community MedicineJerusalemIsrael
  5. 5.Sheba Medical CenterTel HashomerIsrael
  6. 6.The National Cancer RegistryJerusalemIsrael

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