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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Medical Corps, Israeli Defense Force, Tel Hashomer, Israel. Zohar_levi@012.net.il
Zohar
Z
Levi
Jeremy D
JD
Kark
Arnon
A
Afek
Estela
E
Derazne
Dorit
D
Tzur
Moshe
M
Furman
Barak
B
Gordon
Micha
M
Barchana
Irena
I
Liphshitz
Yaron
Y
Niv
Ari
A
Shamiss
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000706:statistics & numerical data*; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D050177:Overweight / Q000453:epidemiology* / Q000208:ethnology; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D012307:Risk Factors; D055815:Young Adult