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1.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults.  N Engl J Med. 2003;348(17):1625-163812711737PubMedGoogle ScholarCrossref
2.
Samanic C, Gridley WH, Chow J, Lubin RN, Hoover RN, Fraumeni JF Jr. Obesity and cancer risk among white and black United States veterans.  Cancer Causes Control. 2004;15(1):35-4314970733PubMedGoogle ScholarCrossref
3.
Larsson SC, Permert J, Hakansson N, Näslund I, Bergkvist L, Wolk A. Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts.  Br J Cancer. 2005;93(11):1310-131516288300PubMedGoogle ScholarCrossref
4.
Rapp K, Schroeder J, Klenk J,  et al.  Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria.  Br J Cancer. 2005;93(9):1062-106716234822PubMedGoogle ScholarCrossref
5.
Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS. Physical activity,obesity, height, and the risk of pancreatic cancer.  JAMA. 2001;286(8):921-92911509056PubMedGoogle ScholarCrossref
6.
Stolzenberg-Solomon RZ, Adams K, Leitzmann M,  et al.  Adiposity, physical activity, and pancreatic cancer in the National Institutes of Health–AARP Diet and Health Cohort.  Am J Epidemiol. 2008;167(5):586-59718270373PubMedGoogle ScholarCrossref
7.
Patel AV, Rodriguez C, Bernstein L, Chao A, Thun MJ, Calle EE. Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort.  Cancer Epidemiol Biomarkers Prev. 2005;14(2):459-46615734973PubMedGoogle ScholarCrossref
8.
Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies.  Int J Cancer. 2007;120(9):1993-199817266034PubMedGoogle ScholarCrossref
9.
Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms.  Nat Rev Cancer. 2004;4(8):579-59115286738PubMedGoogle ScholarCrossref
10.
Hassan MM, Bondy ML, Wolff RA,  et al.  Risk factors for pancreatic cancer: case-control study.  Am J Gastroenterol. 2007;102(12):2696-270717764494PubMedGoogle ScholarCrossref
11.
Greene FL, ed, Page DL, ed, Fleming ID, ed,  et al.  Exocrine pancreas. In: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002:157-164
12.
Beine J. The Social Security Death Index: a genealogy records guide. http://www.deathindexes.com/ssdi.html. Accessibility verified May 18, 2009
13.
Berrington de Gonzalez A, Sweetland S, Spencer EA. A meta-analysis of obesity and the risk of pancreatic cancer.  Br J Cancer. 2003;89(3):519-52312888824PubMedGoogle ScholarCrossref
14.
Eberle CA, Bracci PM, Holly EA. Anthropometric factors and pancreatic cancer in a population-based case-control study in the San Francisco Bay area.  Cancer Causes Control. 2005;16(10):1235-124416215874PubMedGoogle ScholarCrossref
15.
Fryzek JP, Schenk M, Kinnard M, Greenson JK, Garabrant DH. The association of body mass index and pancreatic cancer in residents of southeastern Michigan, 1996–1999.  Am J Epidemiol. 2005;162(3):222-22815987732PubMedGoogle ScholarCrossref
16.
Silverman DT, Swanson CA, Gridley G,  et al.  Dietary and nutritional factors and pancreatic cancer: a case-control study based on direct interviews.  J Natl Cancer Inst. 1998;90(22):1710-17199827525PubMedGoogle ScholarCrossref
17.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000.  JAMA. 2002;288(14):1723-172712365955PubMedGoogle ScholarCrossref
18.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Overweight and obesity among US children, adolescents, and adults, 1999-2002.  JAMA. 2004;291(23):2847-285015199035PubMedGoogle ScholarCrossref
19.
Berkey CS, Gardner J, Colditz GA. Blood pressure in adolescence and early adulthood related to obesity and birth size.  Obes Res. 1998;6(3):187-1959618122PubMedGoogle ScholarCrossref
20.
Smith DE, Lewis CE, Caveny JL, Perkins LL, Burke GL, Bild DE. Longitudinal changes in adiposity associated with pregnancy, the CARDIA Study: Coronary Artery Risk Development in Young Adults Study.  JAMA. 1994;271(22):1747-17518196117PubMedGoogle ScholarCrossref
21.
Schienkiewitz A, Schulze MB, Hoffmann K, Kroke A, Boeing H. Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam Study.  Am J Clin Nutr. 2006;84(2):427-43316895894PubMedGoogle Scholar
22.
Michaud DS, Fuchs CS. Obesity and pancreatic cancer: overall evidence and latency period.  Cancer Epidemiol Biomarkers Prev. 2005;14(11 pt 1):2678-267916284397PubMedGoogle ScholarCrossref
23.
Berrington de González A, Spencer EA, Bueno-de-Mesquita HB,  et al.  Anthropometry, physical activity, and the risk of pancreatic cancer in the European prospective investigation into cancer and nutrition.  Cancer Epidemiol Biomarkers Prev. 2006;15(5):879-88516702364PubMedGoogle ScholarCrossref
24.
Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF Jr. Relation of body mass index to cancer risk in 362,552 Swedish men.  Cancer Causes Control. 2006;17(7):901-90916841257PubMedGoogle ScholarCrossref
25.
Nöthlings U, Wilkens LR, Murphy SP, Hankin JH, Henderson BE, Kolonel LN. Body mass index and physical activity as risk factors for pancreatic cancer: the Multiethnic Cohort Study.  Cancer Causes Control. 2007;18(2):165-17517219012PubMedGoogle ScholarCrossref
26.
Lin Y, Kikuchi S, Tamakoshi A,  et al; JACC Study Group.  Obesity, physical activity and the risk of pancreatic cancer in a large Japanese cohort.  Int J Cancer. 2007;120(12):2665-267117304505PubMedGoogle ScholarCrossref
27.
Hanley AJ, Johnson KC, Villeneuve PJ, Mao Y.Canadian Cancer Registries Epidemiology Research Group.  Physical activity, anthropometric factors and risk of pancreatic cancer: results from the Canadian enhanced cancer surveillance system.  Int J Cancer. 2001;94(1):140-14711668489PubMedGoogle ScholarCrossref
28.
McWilliams RR, Bamlet WR, Rabe KG, Olson JE, de Andrade M, Petersen GM. Association of family history of specific cancers with a younger age of onset of pancreatic adenocarcinoma.  Clin Gastroenterol Hepatol. 2006;4(9):1143-114716861052PubMedGoogle ScholarCrossref
29.
James TA, Sheldon DG, Rajput A,  et al.  Risk factors associated with earlier age of onset in familial pancreatic carcinoma.  Cancer. 2004;101(12):2722-272615534880PubMedGoogle ScholarCrossref
30.
Hillier TA, Pedula KL. Characteristics of an adult population with newly diagnosed type 2 diabetes: the relation of obesity and age of onset.  Diabetes Care. 2001;24(9):1522-152711522693PubMedGoogle ScholarCrossref
31.
Dawood S, Broglio K, Gonzalez-Angulo AM,  et al.  Prognostic value of body mass index in locally advanced breast cancer.  Clin Cancer Res. 2008;14(6):1718-172518347172PubMedGoogle ScholarCrossref
32.
Efstathiou JA, Bae K, Shipley WU,  et al.  Obesity and mortality in men with locally advanced prostate cancer: analysis of RTOG 85-31.  Cancer. 2007;110(12):2691-269917999404PubMedGoogle ScholarCrossref
33.
Park SM, Lim MK, Jung KW,  et al.  Prediagnosis smoking, obesity, insulin resistance, and second primary cancer risk in male cancer survivors: National Health Insurance Corporation Study.  J Clin Oncol. 2007;25(30):4835-484317947733PubMedGoogle ScholarCrossref
34.
Fleming JB, Gonzalez RJ, Petzel MQ,  et al.  Influence of obesity on cancer-related outcomes after pancreatectomy for pancreatic adenocarcinoma.  Arch Surg. 2009;144(3):216-22119289659PubMedGoogle ScholarCrossref
35.
Noun R, Riachy E, Ghorra C,  et al.  The impact of obesity on surgical outcome after pancreaticoduodenectomy.  JOP. 2008;9(4):468-47618648138PubMedGoogle Scholar
36.
Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas.  Gastroenterology. 2007;132(6):2208-222517498513PubMedGoogle ScholarCrossref
37.
Stunkard AJ, Albaum JM. The accuracy of self-reported weights.  Am J Clin Nutr. 1981;34(8):1593-15997270483PubMedGoogle Scholar
38.
Stevens J, Keil JE, Waid LR, Gazes PC. Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population.  Am J Epidemiol. 1990;132(6):1156-11632260547PubMedGoogle Scholar
39.
Casey VA, Dwyer JT, Berkey CS, Coleman KA, Gardner J, Valadian I. Long-term memory of body weight and past weight satisfaction: a longitudinal follow-up study.  Am J Clin Nutr. 1991;53(6):1493-14982035478PubMedGoogle Scholar
Original Contribution
June 24, 2009

Body Mass Index and Risk, Age of Onset, and Survival in Patients With Pancreatic Cancer

Author Affiliations

Author Affiliations: Departments of Gastrointestinal Medical Oncology (Drs Li, Hassan, and Abbruzzese), Epidemiology (Dr Bondy), and Biostatistics (Dr Morris and Ms Liu), University of Texas M. D. Anderson Cancer Center, Houston; and School of Public Health, University of Texas, Houston (Dr Day).

JAMA. 2009;301(24):2553-2562. doi:10.1001/jama.2009.886
Abstract

Context Obesity has been implicated as a risk factor for pancreatic cancer.

Objective To demonstrate the association of excess body weight across an age cohort and the risk, age of onset, and overall survival of patients with pancreatic cancer.

Design, Setting, and Participants A case-control study of 841 patients with pancreatic adenocarcinoma and 754 healthy individuals frequency matched by age, race, and sex. The study was conducted at a university cancer center in the United States from 2004 to 2008. Height and body weight histories were collected by personal interview starting at ages 14 to 19 years and over 10-year intervals progressing to the year prior to recruitment in the study.

Main Outcome Measures The associations between patients' body mass index (BMI) and risk of pancreatic cancer, age at onset, and overall survival were examined by unconditional logistic regression, linear regression, and Cox proportional hazard regression models, respectively.

Results Individuals who were overweight (a BMI of 25-29.9) from the ages of 14 to 39 years (highest odds ratio [OR], 1.67; 95% confidence interval [CI], 1.20-2.34) or obese (a BMI ≥30) from the ages of 20 to 49 years (highest OR, 2.58; 95% CI, 1.70-3.90) had an associated increased risk of pancreatic cancer, independent of diabetes status. The association was stronger in men (adjusted OR, 1.80; 95% CI, 1.45-2.23) by mean BMI from the ages of 14 to 59 years than in women (adjusted OR, 1.32; 95% CI, 1.02-1.70) and in ever smokers (adjusted OR, 1.75; 95% CI, 1.37-2.22) than in never smokers (adjusted OR, 1.46; 95% CI, 1.16-1.84). The population-attributable risk percentage of pancreatic cancer based on the mean BMI from the ages of 14 to 59 years was 10.3% for never smokers and 21.3% for ever smokers. Individuals who were overweight or obese from the ages of 20 to 49 years had an earlier onset of pancreatic cancer by 2 to 6 years (median age of onset was 64 years for patients with normal weight, 61 years for overweight patients [P = .02], and 59 years for obese patients [P < .001]). Compared with those with normal body weight and after adjusting for all clinical factors, individuals who were overweight or obese from the ages of 30 to 79 years or in the year prior to recruitment had reduced overall survival of pancreatic cancer regardless of disease stage and tumor resection status (overweight patients: hazard ratio, 1.26 [95% CI, 0.94-1.69], P = .04; obese patients: hazard ratio, 1.86 [95% CI, 1.35-2.56], P < .001).

Conclusions Overweight or obesity during early adulthood was associated with a greater risk of pancreatic cancer and a younger age of disease onset. Obesity at an older age was associated with a lower overall survival in patients with pancreatic cancer.

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