Oded Shamriz1, Merav Leiba2,3, Hagai Levine4, Estela Derazne3,5, Lital Keinan-Boker6,7, Jeremy D Kark4. 1. Pediatric Division, Hadassah-Hebrew University Medical Center, Ein-Kerem, Hadassah Medical Organization, POB 12000, Kiryat Hadassah, 91120, Jerusalem, Israel. oded.shamriz@mail.huji.ac.il. 2. Division of Hematology and Bone Marrow Transplantation, Multiple Myeloma Clinic, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. 3. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, 69978, Tel Aviv, Israel. 4. Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem Campus, 91120, Jerusalem, Israel. 5. Medical Corps, Israeli Defense Forces, Tel-Hashomer, Ramat Gan, Israel. 6. Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel. 7. School of Public Health, University of Haifa, Haifa, Israel.
Abstract
PURPOSE: Studies evaluating adolescent risk factors for developing acute myeloid leukemia (AML) are virtually nonexistent. We assessed adolescent predictors of AML in adults, with a main focus on adolescent BMI. METHODS: The study included 2,310,922 16-19-year-old Jewish Israeli adolescents (mean age 17.3 ± 0.4, 59.5% male), called up for an obligatory health examination. Sociodemographic and health data, including measured weight and height, were gathered. Body mass index (BMI) was examined both as a continuous variable and grouped according to the World Health Organization (WHO) classification and US-CDC percentiles. Bone-marrow-biopsy-verified AML cases diagnosed up to 31 December 2012 were identified by linkage to the Israel national cancer registry. Multivariable-adjusted Cox proportional-hazards models were used to model time to diagnosis. RESULTS: During 47 million person years of follow-up, 568 AML cases were identified (crude incidence rate 1.21/100,000 person years). There was a multivariable-adjusted hazard ratio (HR) of 1.041 (95% CI 1.015-1.068, p = 0.002) per unit BMI. The association was evident in those of Middle Eastern, North African, and European origin. A graded association was evident across the overweight and obese WHO grouping. With the US-CDC grouping, excess risk was evident in overweight but not in obese adolescents, although a test for trend in percentiles was significant (p = 0.004). Borderline associations were noted for origin (p = 0.065) (higher in the predominantly Ashkenazi European origin), sex (higher in women: HR = 1.24 (95% CI 0.99-1.55), and stature (HR = 1.013, 95% CI 1.000-1.026, per cm). CONCLUSIONS: Higher BMI in adolescence was associated with increased AML incidence in adulthood in this multiethnic population.
PURPOSE: Studies evaluating adolescent risk factors for developing acute myeloid leukemia (AML) are virtually nonexistent. We assessed adolescent predictors of AML in adults, with a main focus on adolescent BMI. METHODS: The study included 2,310,922 16-19-year-old Jewish Israeli adolescents (mean age 17.3 ± 0.4, 59.5% male), called up for an obligatory health examination. Sociodemographic and health data, including measured weight and height, were gathered. Body mass index (BMI) was examined both as a continuous variable and grouped according to the World Health Organization (WHO) classification and US-CDC percentiles. Bone-marrow-biopsy-verified AML cases diagnosed up to 31 December 2012 were identified by linkage to the Israel national cancer registry. Multivariable-adjusted Cox proportional-hazards models were used to model time to diagnosis. RESULTS: During 47 million person years of follow-up, 568 AML cases were identified (crude incidence rate 1.21/100,000 person years). There was a multivariable-adjusted hazard ratio (HR) of 1.041 (95% CI 1.015-1.068, p = 0.002) per unit BMI. The association was evident in those of Middle Eastern, North African, and European origin. A graded association was evident across the overweight and obese WHO grouping. With the US-CDC grouping, excess risk was evident in overweight but not in obese adolescents, although a test for trend in percentiles was significant (p = 0.004). Borderline associations were noted for origin (p = 0.065) (higher in the predominantly Ashkenazi European origin), sex (higher in women: HR = 1.24 (95% CI 0.99-1.55), and stature (HR = 1.013, 95% CI 1.000-1.026, per cm). CONCLUSIONS: Higher BMI in adolescence was associated with increased AML incidence in adulthood in this multiethnic population.
Entities:
Keywords:
Acute myeloid leukemia; Adolescence; Ashkenazi; Body mass index; Ethnicity; Middle East; North Africa; Risk factors; Western Asia