ORIGINAL PAPER Measured body mass index in adolescence and the incidence of pancreatic cancer in a cohort of 720,000 Jewish men Zohar Levi • Jeremy D. Kark • Arnon Afek • Estela Derazne • Dorit Tzur • Moshe Furman • Barak Gordon • Micha Barchana • Irena Liphshitz • Yaron Niv • Ari Shamiss Received: 12 September 2011 / Accepted: 16 December 2011 / Published online: 3 January 2012 Ó Springer Science+Business Media B.V. 2011 Abstract Purpose The increasing prevalence of adolescent obesity affects adult health. We investigated the association of adolescent overweight with pancreatic cancer incidence in a cohort of 720,927 Jewish Israeli men. Methods Body mass index (BMI) was measured during a general health examination at ages 16–19 between the years 1967 and 1995. Overweight was defined as BMI C 85th percentile of the reference US-CDC distri- bution in adolescence. Pancreatic cancer was identified by linkage with the Israel National Cancer Registry up to 2006. Results The mean follow-up period was 23.3 ± 8.0 years. During 16.8 million person-years, 98 cases of pan- creatic cancer were detected. Using Cox proportional hazards modeling, overweight in adolescence predicted an increased risk of pancreatic cancer [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.26–3.50, p = 0.005]. Compared with adolescents with ‘normal’ range BMI Z-scores (-1 to ?1), adolescents with Z- scores [ 1 showed significantly increased risk [HR, 2.28 (95% CI: 1.43–3.64), p = 0.001]. Lower education level (10 or less years of schooling vs. 11–12 years) was also associated with increased risk of pancreatic cancer [HR 1.90 (95% CI: 1.27–2.86, p = 0.002)], whereas height, country of origin and immigration status were not. Conclusions Adolescent overweight is substantially associated with pancreatic cancer incidence in young to middle-aged adults. Applying our point estimates to the 16.8% prevalence of excess weight in Israeli adolescents in the past decade suggests a population fraction of 15.5% (95% CI: 4.2–29.6%) for pancreatic cancer attributable to adolescent overweight in Israel. Keywords Adolescence  Obesity  Pancreatic cancer Abbreviations BMI Body mass index US-CDC United States Center for Disease Control HR Hazard ratio CI Confidence interval Background Pancreatic cancer is the fourth leading cause of cancer- related death for both men and women in the United States [1] and is the third leading cause of cancer death in Israel [2, 3]. Identifying high-risk individuals may contribute to the primary prevention of this usually rapidly fatal disease. Z. Levi  A. Afek  E. Derazne  D. Tzur  M. Furman  B. Gordon Medical Corps, Israeli Defense Force, Tel Hashomer, Israel Z. Levi (&)  Y. Niv The Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel e-mail: Zohar_levi@012.net.il Z. Levi  A. Afek  E. Derazne  Y. Niv  A. Shamiss Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel J. D. Kark Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel A. Afek  A. Shamiss Sheba Medical Center, Tel Hashomer, Israel M. Barchana  I. Liphshitz The National Cancer Registry, Jerusalem, Israel 123 Cancer Causes Control (2012) 23:371–378 DOI 10.1007/s10552-011-9886-5