title: Higher body mass index in 16-19 year-old Jewish Adolescents of North African, Middle Eastern and European Origins is a Predictor of Acute Myeloid Leukemia: a cohort of 2.3 million Israelis.
abstract: Studies evaluating adolescent risk factors for developing acute myeloid leukemia (AML) are virtually nonexistent. We assessed adolescent predictors of AML in adults, with a main focus on adolescent BMI.
  
  
  
  The study included 2,310,922 16-19-year-old Jewish Israeli adolescents (mean age 17.3 ± 0.4, 59.5% male), called up for an obligatory health examination. Sociodemographic and health data, including measured weight and height, were gathered. Body mass index (BMI) was examined both as a continuous variable and grouped according to the World Health Organization (WHO) classification and US-CDC percentiles. Bone-marrow-biopsy-verified AML cases diagnosed up to 31 December 2012 were identified by linkage to the Israel national cancer registry. Multivariable-adjusted Cox proportional-hazards models were used to model time to diagnosis.
  
  
  
  During 47 million person years of follow-up, 568 AML cases were identified (crude incidence rate 1.21/100,000 person years). There was a multivariable-adjusted hazard ratio (HR) of 1.041 (95% CI 1.015-1.068, p = 0.002) per unit BMI. The association was evident in those of Middle Eastern, North African, and European origin. A graded association was evident across the overweight and obese WHO grouping. With the US-CDC grouping, excess risk was evident in overweight but not in obese adolescents, although a test for trend in percentiles was significant (p = 0.004). Borderline associations were noted for origin (p = 0.065) (higher in the predominantly Ashkenazi European origin), sex (higher in women: HR = 1.24 (95% CI 0.99-1.55), and stature (HR = 1.013, 95% CI 1.000-1.026, per cm).
  
  
  
  Higher BMI in adolescence was associated with increased AML incidence in adulthood in this multiethnic population.
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Ein-Kerem, Hadassah Medical Organization, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel. oded.shamriz@mail.huji.ac.il.
authors.forename: Oded
authors.initials: O
authors.lastname: Shamriz
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Multiple Myeloma Clinic, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.|Sackler School of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.
authors.forename: Merav
authors.initials: M
authors.lastname: Leiba
authors.affiliation: Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem Campus, 91120, Jerusalem, Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Levine
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel.|Medical Corps, Israeli Defense Forces, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel.|School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.affiliation: Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem Campus, 91120, Jerusalem, Israel.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology*; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult
keywords: Acute myeloid leukemia; Adolescence; Ashkenazi; Body mass index; Ethnicity; Middle East; North Africa; Risk factors; Western Asia