Central adiposity, obesity during early adulthood, and pancreatic cancer mortality in a pooled analysis of cohort studies.
BACKGROUND
Body mass index (BMI), a measure of obesity typically assessed in middle age or later, is known to be positively associated with pancreatic cancer. However, little evidence exists regarding the influence of central adiposity, a high BMI during early adulthood, and weight gain after early adulthood on pancreatic cancer risk.


METHODS
We conducted a pooled analysis of individual-level data from 20 prospective cohort studies in the National Cancer Institute BMI and Mortality Cohort Consortium to examine the association of pancreatic cancer mortality with measures of central adiposity (e.g. waist circumference; n = 647 478; 1947 pancreatic cancer deaths), BMI during early adulthood (ages 18-21 years) and BMI change between early adulthood and cohort enrollment, mostly in middle age or later (n = 1 096 492; 3223 pancreatic cancer deaths). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models.


RESULTS
Higher waist-to-hip ratio (HR = 1.09, 95% CI 1.02-1.17 per 0.1 increment) and waist circumference (HR = 1.07, 95% CI 1.00-1.14 per 10 cm) were associated with increased risk of pancreatic cancer mortality, even when adjusted for BMI at baseline. BMI during early adulthood was associated with increased pancreatic cancer mortality (HR = 1.18, 95% CI 1.11-1.25 per 5 kg/m(2)), with increased risk observed in both overweight and obese individuals (compared with BMI of 21.0 to <23 kg/m(2), HR = 1.36, 95% CI 1.20-1.55 for BMI 25.0 < 27.5 kg/m(2), HR = 1.48, 95% CI 1.20-1.84 for BMI 27.5 to <30 kg/m(2), HR = 1.43, 95% CI 1.11-1.85 for BMI ≥30 kg/m(2)). BMI gain after early adulthood, adjusted for early adult BMI, was less strongly associated with pancreatic cancer mortality (HR = 1.05, 95% CI 1.01-1.10 per 5 kg/m(2)).


CONCLUSIONS
Our results support an association between pancreatic cancer mortality and central obesity, independent of BMI, and also suggest that being overweight or obese during early adulthood may be important in influencing pancreatic cancer mortality risk later in life.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York jg3081@columbia.edu.
J M
JM
Genkinger
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
C M
CM
Kitahara
Division of Cancer Etiology, City of Hope National Medical Center, Duarte.
L
L
Bernstein
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
A
A
Berrington de Gonzalez
Westat, Rockville.
M
M
Brotzman
Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, Bethesda, USA.
J W
JW
Elena
Cancer Epidemiology Centre, Cancer Council of Victoria, and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
G G
GG
Giles
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
P
P
Hartge
Department of Epidemiology, Biostatistics and Population Medicine and The Center for Health Research, Loma Linda University School of Medicine, Loma Linda, USA.
P N
PN
Singh
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
R Z
RZ
Stolzenberg-Solomon
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø Department of Research, Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
E
E
Weiderpass
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Epidemiology, Harvard School of Public Health, Boston.
H-O
HO
Adami
Division of Epidemiology and Community Health, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis.
K E
KE
Anderson
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
L E
LE
Beane-Freeman
Department of Epidemiology, Harvard School of Public Health, Boston Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
J E
JE
Buring
Department of Epidemiology, Biostatistics and Population Medicine and The Center for Health Research, Loma Linda University School of Medicine, Loma Linda, USA.
G E
GE
Fraser
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
C S
CS
Fuchs
Epidemiology Research Program, American Cancer Society, Atlanta.
S M
SM
Gapstur
Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts Veterans Epidemiology Research and Information Center, Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston.
J M
JM
Gaziano
The Prevention & Research Center, Mercy Medical Center, Baltimore Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.
K J
KJ
Helzlsouer
Division of Cancer Etiology, City of Hope National Medical Center, Duarte.
J V
JV
Lacey
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
M S
MS
Linet
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
J J
JJ
Liu
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda Division of Public Health Sciences, Washington University School of Medicine, St Louis.
Y
Y
Park
Fred Hutchinson Cancer Research Center, Seattle Department of Epidemiology, University of Washington, Seattle.
U
U
Peters
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
M P
MP
Purdue
Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington.
K
K
Robien
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda.
C
C
Schairer
Department of Epidemiology, Harvard School of Public Health, Boston Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston.
H D
HD
Sesso
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Department of Medical Oncology, Sidney Kimmel Cancer Center, John Hopkins School of Medicine, Baltimore, USA.
K
K
Visvanathan
Fred Hutchinson Cancer Research Center, Seattle Department of Epidemiology, University of Washington, Seattle.
E
E
White
Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
A
A
Wolk
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
B M
BM
Wolpin
Department of Population Health and Perlmutter Cancer Center, New York University, New York, USA.
A
A
Zeleniuch-Jacquotte
Epidemiology Research Program, American Cancer Society, Atlanta.
E J
EJ
Jacobs
D000293:Adolescent; D015331:Cohort Studies; D006801:Humans; D009765:Obesity / Q000175:diagnosis / Q000401:mortality*; D056128:Obesity, Abdominal / Q000175:diagnosis / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality*; D012307:Risk Factors; D055105:Waist Circumference; D055815:Young Adult
BMI; central adiposity; pancreatic cancer; pooled analysis