Obesity

Data from large cohorts of U.S. adults have shown that over the past decade, obesity and its related chronic conditions have been steadily increasing in the United States.63,64 Incidence of pancreatic cancer may be affected by the increase in these conditions over time. Results from epi-demiologic studies that have evaluated the association between BMI and pancreatic cancer have been mixed. The most consistent associations reported have shown elevated risk estimates among men and among obese men and women (BMI > 30).28,29,32,65-67 A large cohort study of cancer mortality and BMI showed increased pancreatic cancer morality rates associated with increasing BMI both for women and for men, and for men and women who had not smoked during the 16 years of follow-up.68 However, in a meta-analysis of data collected in epidemiologic studies of pancreatic cancer, BMI was only weakly associated with pancreatic cancer.69 In two recent studies, increased risk estimates for pancreatic cancer were related to increasing BMI after adjustment for potential confounding factors including smoking, diabetes, physical activity, and total caloric intake.28,29 Although the biologic mechanism to explain this potential relationship is unclear, it has been hypothesized that obesity's association with insulin resistance, glucose intolerance, and the resultant hyperinsulinemia may be an important factor in the development of pancreatic cancer. In animal studies, peripheral insulin resistance is associated with hyperinsulinemia and islet cell hyperplasia. However, it is unknown whether islet cell hyperplasia, which may make the pancreas more vulnerable to carcinogens, occurs in obese people.20,21 Insulin resistance and hyperinsulinemia are associated with abdominal adiposity, a fat distribution pattern more common in men than in women that may partly explain the differences oberved by sex. Further research that can measure fat distribution in addition to other factors that influence obesity may provide etiologic clues to fat metabolism in relation to pancreatic carcinogenesis.

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