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Anthropometry, Physical Activity, and the Risk of Pancreatic Cancer in the European Prospective Investigation into Cancer and Nutrition

¹ Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom; ² Center for Nutrition and Health and ³ Center for Information Technology and Methodology, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; ⁴ Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland; ⁵ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ⁶ Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; ⁷ E3N-Institut National de la Sante et de la Recherche Medicale, Nutrition, Hormones, and Cancer Unit, Institut Gustave Roussy, Villejuif, France; ⁸ German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; ⁹ Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany; ¹⁰ Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece; ¹¹ Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy; ¹² Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Centre, Scientific Institute of Tuscany, Florence, Italy; ¹³ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy; ¹⁴ Cancer Registry, Azienda Ospedaliera Civile-M.P. Arezzo, Ragusa, Italy; ¹⁵ University of Torino, Italy and Imperial College, London, United Kingdom; ¹⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ¹⁷ Institute of Community Medicine, University of Tromsø, Tromsø, Norway; ¹⁸ Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain; ¹⁹ Public Health Division of Gipuzkoa, Health Department of the Basque Country, San Sebastian, Spain; ²⁰ Andalusian School of Public Health, Granada, Spain; ²¹ Epidemiology Department, Murcia Health Council, Murcia, Spain; ²² Health and Health Planning Directorate, Asturias, Spain; ²³ Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden; ²⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; ²⁵ Medical Research Council Dunn Human Nutrition Unit; ²⁶ Clinical Gerontology Unit, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom; and ²⁷ IARC-WHO, Lyon, France

Requests for reprints: Amy Berrington de González, Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, United Kingdom. Phone: 44-1865-289600; Fax: 44-1865-289610. E-mail: aberring{at}jhsph.edu

Tobacco smoking is the only established risk factor for pancreatic cancer. Results from several epidemiologic studies have suggested that increased body mass index and/or lack of physical activity may be associated with an increased risk of this disease. We examined the relationship between anthropometry and physical activity recorded at baseline and the risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (n = 438,405 males and females age 19-84 years and followed for a total of 2,826,070 person-years). Relative risks (RR) were calculated using Cox proportional hazards models stratified by age, sex, and country and adjusted for smoking and self-reported diabetes and, where appropriate, height. In total, there were 324 incident cases of pancreatic cancer diagnosed in the cohort over an average of 6 years of follow-up. There was evidence that the RR of pancreatic cancer was associated with increased height [RR, 1.74; 95% confidence interval (95% CI), 1.20-2.52] for highest quartile compared with lowest quartile (P_trend = 0.001). However, this trend was primarily due to a low risk in the lowest quartile, as when this group was excluded, the trend was no longer statistically significant (P = 0.27). A larger waist-to-hip ratio and waist circumference were both associated with an increased risk of developing the disease (RR per 0.1, 1.24; 95% CI, 1.04-1.48; P_trend = 0.02 and RR per 10 cm, 1.13; 95% CI, 1.01-1.26; P_trend = 0.03, respectively). There was a nonsignificant increased risk of pancreatic cancer with increasing body mass index (RR, 1.09; 95% CI, 0.95-1.24 per 5 kg/m²), and a nonsignificant decreased risk with total physical activity (RR, 0.82; 95% CI, 0.50-1.35 for most active versus inactive). Future studies should consider including measurements of waist and hip circumference, to further investigate the relationship between central adiposity and the risk of pancreatic cancer. (Cancer Epidemiol Biomarkers Prev 2006;15(5):879–85)

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