Adolescent obesity and midlife cancer risk: a population-based cohort study of 2·3 million adolescents in Israel.,The Lancet Diabetes & Endocrinology

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Adolescent obesity and midlife cancer risk: a population-based cohort study of 2·3 million adolescents in Israel.
The Lancet Diabetes & Endocrinology ( IF 44.0 ) Pub Date : 2020-02-03 , DOI: 10.1016/s2213-8587(20)30019-x
Ariel Furer ₁ , Arnon Afek ₂ , Adir Sommer ₃ , Lital Keinan-Boker ₄ , Estela Derazne ₅ , Zohar Levi ₆ , Dorit Tzur ₃ , Shmuel Tiosano ₇ , Avi Shina ₈ , Yuval Glick ₃ , Jeremy D Kark ₉ , Amir Tirosh ₁₀ , Gilad Twig ₁₁

Affiliation

Reseach and Academic Division, Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Jerusalem, Israel.
Department of Medical Management, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reseach and Academic Division, Israel Defense Forces Medical Corps, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel.
Department of Medicine, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reseach and Academic Division, Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Jerusalem, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reseach and Academic Division, Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Jerusalem, Israel; Department of Medicine, Sheba Medical Center, Ramat Gan, Israel; The Dr Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.

BACKGROUND Obesity has been established as a causal factor for several types of cancer, and adolescent obesity is increasing worldwide. We examined associations between measured body-mass index (BMI) at age 17 years and cancer incidence, and with mortality among those who developed cancer. METHODS In a nationwide, population-based cohort of adolescents, height and weight were measured at pre-recruitment mandatory medical examination during 1967-2010. BMI was classified according to US Center for Disease Control and Prevention percentiles. We applied Cox proportional hazard models to estimate the hazard ratios (HRs) and 95% CIs for incident cases of cancer using the 5th-49th BMI percentile group as a reference. The primary outcome was any cancer diagnosis between Jan 1, 1967, and Dec 31, 2012, as recorded in the Israeli National Cancer Registry. Participants with a diagnosis of cancer at baseline (before military recruitment assessment) were excluded from this analysis. The secondary outcome of this study was all-cause mortality among cohort members who had cancer, between Jan 1, 1967, and Dec 31, 2017. FINDINGS Of the 2 458 170 participants examined between Jan 1, 1967, and Dec 31, 2010, 160 040 were excluded. 2 298 130 participants of which 928 110 were women and 1 370 020 were men. During 29 542 735 person-years of follow-up in men, 26 353 incident cases of cancer were recorded and in 18 044 863 person-years of follow-up in women, 29 488 incident cases of cancer were recorded. Cancer incidence increased gradually across BMI percentiles. The adjusted HR was 1·26 (95% CI 1·18-1·35) among men with adolescent obesity. Among women, we found no association between obesity and overall cancer, driven by inverse associations of obesity with cervical and breast cancers. When these cancers were excluded, the adjusted HR for cancer was 1·27 (1·13-1·44) among women with adolescent obesity. In both sexes, high BMI (≥85th percentile) was associated with an increased cancer risk after 10 years. This association was accentuated in the late period of the cohort versus the early period of the cohort. BMI was positively associated with a higher risk of mortality. The projected population attributable risk for high BMI was 5·1% (4·2-6·1) for men and 5·7% (4·2-7·3) for women. INTERPRETATION The increasing prevalence of adolescent obesity and the possible association between adolescent BMI and cancer incidence might increase the future burden of obesity-related cancers. BMI among adolescents could constitute an important intervention target for cancer prevention. FUNDING None.

中文翻译：

青少年肥胖症和中年癌症风险：一项基于人群的队列研究，研究了以色列2·300万青少年。

背景技术肥胖已经被确定为几种类型的癌症的病因，并且青少年肥胖在世界范围内正在增加。我们检查了17岁时测得的身体质量指数（BMI）与癌症发生率之间的关联，以及与罹患癌症的人群中的死亡率之间的关联。方法在1967-2010年招募前的强制性医学检查中，对全国范围内以人口为基础的青少年队列进行了测量。BMI根据美国疾病控制和预防中心的分类。我们使用Cox比例风险模型，以第5至第49个BMI百分位数组为参考，估计癌症事件病例的风险比（HRs）和95％CI。主要结果是在1967年1月1日至2012年12月31日期间进行的任何癌症诊断，如以色列国家癌症登记处所记录。在分析中不包括基线诊断为癌症的参与者（在军事招募评估之前）。这项研究的次要结果是1967年1月1日至2017年12月31日期间患有癌症的队列成员的全因死亡率。结果在1967年1月1日至2010年12月31日期间接受检查的2458170名参与者中， 160040被排除在外。2 298 130名参与者，其中928 110名是女性，1 370 020名是男性。在男性的29 542 735人年的随访期间，记录了26 353例癌症事件，在女性的18 044 863人的年随访中，记录了29 488例癌症事件。BMI百分位数的癌症发病率逐渐增加。青少年肥胖男性的校正后HR为1·26（95％CI 1·18-1·35）。在女性中我们发现，肥胖与子宫颈癌和乳腺癌的逆相关性并未导致肥胖与整体癌症之间的关联。如果排除这些癌症，则青春期肥胖妇女的癌症校正HR为1·27（1·13-1·44）。在男女中，高BMI（≥85％）与10年后癌症风险增加相关。在队列的后期与队列的早期相比，这种关联更加突出。BMI与较高的死亡风险呈正相关。预计的男性高BMI人群归因风险为男性为5·1％（4·2-6·1），女性为5·7％（4·2-7·3）。解释青少年肥胖的患病率上升以及青少年BMI与癌症发病率之间可能存在关联可能会增加与肥胖相关的癌症的未来负担。青少年的BMI可能构成预防癌症的重要干预目标。资金无。

更新日期：2020-02-19

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