Measured body mass index in adolescence and the incidence of pancreatic cancer in a cohort of 720,000 Jewish men
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.
KeywordsAdolescence Obesity Pancreatic cancer
Body mass index
United States Center for Disease Control
This study was supported by the Israel Cancer Research Fund.
- 2.Israel National Cancer Registry (www.health.gov.il/icr). Accessed 2011. http://www.old.health.gov.il/Download/pages/probability_Feb_2011.pdf
- 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.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
- 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
- 20.Centers for Disease Control and Prevention (2000) CDC growth charts: United States. National Center for Health Statistics, Hyattsville, MD; 2000. Available at: www.cdc.gov/growthcharts. Accessed June 2011
- 21.2000 CDC growth charts for the United States: methods and development. Available at http://www.cdc.gov/growthcharts
- 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.The national report about smoking in Israel 2009–2010. Available at http://www.health.gov.il/download/pages/smoke10_290511.pdf and http://www.health.gov.il/pages/default.asp?maincat=1&catId=98. Accessed Aug 2011
- 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