Obesity, socioeconomic status in adolescence may influence gastrointestinal cancer risk

Levi Z. Cancer. 2013;doi:10.1002/cncr.28241.

  • November 5, 2013

Adult men who were obese during adolescence were at an increased risk for esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma, according to results of a study conducted in Israel.

Low educational level and parental socioeconomic status also were associated with an increased risk for noncardia gastric cancer, the study found.

"Adolescents who are overweight and obese are prone to esophageal cancer, probably due to reflux that they have throughout their life,” researcher Zohar Levi, MD, MHA, of Rabin Medical Center in Israel, said in a press release. “Also, a lower socioeconomic position as a child has a lot of impact upon incidence of gastric cancer as an adult. We look at obesity as dangerous from cardiovascular aspects at ages 40 and over, but here we can see that it has effects much earlier."

Levi and colleagues analyzed data from more than 1 million adolescent males who underwent a general health examination at a median age of 17.3 years (range, 16-19) between 1967 and 2005.

At baseline, 12.2% of the study population was overweight, 25% were from low socioeconomic status and 11.4% had received ≤9 years of schooling.

Median follow-up was 18.8 years.

Researchers used the Israel National Cancer Registry to identify 182 cancer incidences among the study population. Of them, 52 were esophageal or gastroesophageal junction cancers, which the researchers assessed collectively. The remaining 130 cancer incidences were noncardia gastric cancer.

Results showed patients who were overweight or obese — defined as BMI ≥25 mg/k2 — were at increased risk for esophageal and gastroesophageal junction cancers (HR=2.2; 95% CI, 1.1-4.5). That level of BMI also was associated with increased risk for gastroesophageal junction cancer alone (HR=2.9; 95% CI, 1.15-7.37).

The risk for esophageal and gastroesophageal junction cancer increased when researchers evaluated the population with a baseline BMI ≥30 kg/m2 (HR=7.6; 95% CI, 2.68-21.5).

Results showed low baseline parental socioeconomic status (HR=1.95; 95% CI, 1.12-3.40) and low education levels (HR=1.53; 95% CI, 1.01-2.13) were associated with increased risk for noncardia gastric cancer.

Researchers also determined an association between risk for noncardia gastric cancer and birth country in Asia (HR=3.0; 95% CI, 1.64-5.48) and the former Soviet Union (HR=2.68; 95% CI, 1.33-5.40).

Helicobacter pylori infection status could play a role in those associations, researchers said.

“Although confounding by H. pylori infection status or dietary and lifestyle factors may not have been fully accounted for in the analyses, lower socioeconomic status as well as immigration from higher-risk countries are important determinants in noncardia gastric cancer,” Levi and colleagues wrote.

Disclosure: The researchers report no relevant financial disclosures.