Body mass index and pancreatic adenocarcinoma: A nationwide registry-based cohort study

Abstract

Background and objective: An association between body mass index (BMI) and pancreatic cancer is suggested in observational studies. However, further studies are required to substantiate available evidence. The aim of this study was to explore the association between BMI and pancreatic ductal adenocarcinoma (PDAC) risk, treatment, and mortality. Methods: A registry-based cohort study was performed by combining data from four registries in Norway. Baseline data were collected between 1963 and 1975 with follow-up data collected until 2018. Kaplan–Meier curves and multivariable Cox regressions were estimated. Chi-square tests were used to analyze differences between groups. Results: The study cohort consisted of 1,723,692 individuals. A total of 8973 PDAC cases were identified during 55,744,749 person-years of follow-up. A 5 kg/m2 increase in BMI was associated with an increased risk of PDAC if high BMI at young age (16–29 years) (hazard ratio (HR): 1.21, 95% confidence interval (CI): 1.13–1.31), both for men (HR: 1.30, 95% CI: 1.15–1.46) and women (HR: 1.16, 95% CI: 1.05–1.28). In men, there was a 52% increase in risk of early-onset PDAC (<age 50) (HR: 1.52, 95% CI: 1.13-2.03) with 5 kg/m2 increase in BMI. A total of 2645 individuals were diagnosed with stage 1–3 disease, of whom 1131 underwent curative surgery. In all, 49% of normal weight, 38% overweight, and 30% obese individuals with stage 1–3 PDAC underwent surgery with curative intent (p < 0.001). Cancer survival was lower in overweight and obese individuals for both sexes. Analysis adjusted for sex, age, and period of diagnosis confirmed increased risk of cancer death in obese individuals. Conclusion: This study suggests that increased BMI in young adults may increase the risk of PDAC, and higher BMI in men is associated with an increased risk of early onset PDAC (<age 50). Overweight and obese individuals were less likely to undergo curative surgery and obese individuals had a higher risk of cancer-related death.

The Warburg effect drives cachectic states in patients with pancreatobiliary adenocarcinoma

“…Seventy‐four patients without cancer were recruited as a group of non‐cancer control. The three groups of cancer and non‐cancer patients had similar body weight indexes (Table 2), which was consistent with the knowledge that body weight may not decrease early in pancreatobiliary cancer 32 . Nevertheless, decreased albumin, increased CRP, and increased CRP‐to‐albumin ratio were seen in group HG but not group LG, compared to the non‐cancer control (Table 2).…”

“…[12][13][14] Only patients with early pancreatobiliary cancer are eligible for curative surgery, and such patients may not have cachectic states. 32 However, the patients with early may show nutritional impairment that forecasts cancer cachexia. [27][28][29][30][31] In the present study, we divided 74 surgically removed pancreatobiliary adenocarcinomas into a group LG and a group HG.…”

“…The three groups of cancer and non-cancer patients had similar body weight indexes (Table 2), which was consistent with the knowledge that body weight may not decrease early in pancreatobiliary cancer. 32 Nevertheless, F I G U R E 1 Glycolytic abilities in pancreatobiliary adenocarcinomas. Western blotting assays were performed to quantify glucose transporter-1 (Glut1), hexokinase-2 (HK-2), phosphofrucokinase-1 (PFK1), pyruvate kinase M2 (PKM2), and lactate dehydrogenase A (LDHA) in 74 pancreatobiliary adenocarcinomas, using β-Actin as a loading control.…”

Pancreatoduodenectomy after Roux-en-Y gastric bypass surgery: Single-center experience and literature review

“…1 Obesity has been shown to be associated with an increased risk of several cancers, including pancreatic cancer. 2,3 In-line with the rising obesity epidemic, the application of bariatric procedures has increased and is a durable solution to both obesity and obesity-associated morbidities. 4 This leads to increasing odds of encountering such patients during a pancreatoduodenectomy (PD), which makes it imperative to understand the Roux-en-Y gastric bypass (RYGB) anatomy and anticipate challenging surgical considerations regarding resection and reconstruction.…”

Multi-omic characterization reveals a distinct molecular landscape in young-onset pancreatic cancer

“…2 PDAC is typically diagnosed in the seventh decade of life, referred to as average-onset pancreatic cancer (AOPC); 1,3 however, young-onset pancreatic cancer (YOPC)—defined as diagnosis at less than 50 years of age 4,5 —constitutes 6-9% of newly detected PDAC and has steadily increased in incidence over the last two decades, 5-11 as was recently highlighted by a new analysis of data from the National Program of Cancer Registries database. 12 Emerging data indicates that smoking, 4,5 alcohol use, 13 obesity 14 , and family history 13,15,16 are risk factors for YOPC. YOPC also skews toward male sex, 7,11 although rates in women—particularly Black women—are rising faster than in men.…”