title: Adolescent weight and height are predictors of specific non-Hodgkin lymphoma subtypes among a cohort of 2,352,988 individuals aged 16 to 19 years.
abstract: BACKGROUND
  The age-adjusted annual incidence of non-Hodgkin lymphoma (NHL) has risen worldwide. This trend may be affected by the secular increase in height and the sharp upswing in adolescent overweight; these drive increased insulinlike growth factor 1 and chronic inflammation, which may play an etiologic role. This study examined the association of the body mass index (BMI) and height of adolescents with NHL subtypes, which have been insufficiently evaluated.
  
  
  METHODS
  Health-related data on 2,352,988 Israeli adolescents, aged 16 to 19 years, who were examined between 1967 and 2011 were linked to the Israel National Cancer Registry to derive the NHL incidence up to December 31, 2012 (4021 cases). Cox proportional hazards modeling was used to estimate the multivariate-adjusted hazard ratio (HR) for NHL subtypes associated with the BMI and height of adolescents.
  
  
  RESULTS
  Adolescent overweight and obesity were associated with an HR of 1.25 (95% confidence interval [CI], 1.13-1.37; P = 1.14 × 10(-5) ) for NHL in comparison with normal weight. There was a graded association of height with NHL (P = 4.29 × 10(-9) ), with the tallest adolescents (≥ 95th percentile vs 25th to < 50th percentiles [US Centers for Disease Control and Prevention]) exhibiting an HR of 1.28 (95% CI, 1.04-1.56). Marginal zone lymphoma, primary cutaneous lymphoma (PCL), and diffuse large B-cell lymphoma (DLBCL) showed the strongest associations for overweight/obesity, and DLBCL and PCL showed the strongest associations for height.
  
  
  CONCLUSIONS
  The findings of this large cohort study add to the growing body of evidence showing that higher body weight and taller stature during adolescence are associated with an increased risk of NHL and may modestly contribute to its increasing incidence. Further studies are needed to elucidate the mechanisms linking anthropometric measures and NHL risk.
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Merav
authors.initials: M
authors.lastname: Leiba
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Surgeon General Headquarters, Medical Corps, Israel Defense Forces, Haifa, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.affiliation: Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.|School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Avigdor
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Surgeon General Headquarters, Medical Corps, Israel Defense Forces, Haifa, Israel.
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel.|Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Hagai
authors.initials: H
authors.lastname: Levine
authors.affiliation: Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D000293:Adolescent; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords: adolescence; epidemiology; height; non-Hodgkin lymphoma (NHL); obesity; risk factors