Increased risk of young-onset pancreatic cancer among adults aged 20-39 years with overweight or obesity, but not underweight: A nationwide cohort study

초록

Background and aims The incidence of young-onset pancreatic cancer is rapidly increasing worldwide. However, the association between body mass index (BMI), particularly overweight and mild obesity, and the risk of young-onset pancreatic cancer remains poorly defined. This study aimed to investigate the dose-response relationship between BMI and the risk of young-onset pancreatic cancer. Methods This nationwide cohort study included 6,315,055 adults aged 20-39 years who underwent national health screenings between 2009 and 2012. BMI categories were defined according to World Health Organization Asia-Pacific guidelines. Participants were followed until December 2020. Multivariable-adjusted Cox proportional hazards models estimated pancreatic cancer risk. Results During 59,159,572 person-years of follow-up, 1533 incident pancreatic cancer cases were identified. Compared with individuals with normal weight status, individuals with overweight or class I obesity had a significantly higher risk of pancreatic cancer (adjusted hazard ratio [aHR], 1.389; 95 % CI, 1.210-1.595 and aHR, 1.388; 95 % CI, 1.213-1.588, respectively). Individuals with class II obesity had the highest risk (aHR, 1.958; 95 % CI, 1.585-2.421), whereas underweight individuals had no significantly increased risk (aHR, 1.068; 95 % CI, 0.840-1.360).These associations did not differ significantly across subgroups defined by age, sex, smoking status, alcohol intake, physical activity, or diabetes (all P > 0.05 for interaction). Conclusions Overweight and class I obesity during early adulthood may serve as previously underrecognized yet modifiable risk factors for young-onset pancreatic cancer. Proactive weight-control interventions among young adults, starting from overweight status, may help reduce the increasing burden of pancreatic cancer in younger populations.

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