Recent-onset diabetes, weight loss associated with increased pancreatic cancer risk

Unintentional weight loss and weight loss in those with a body mass index already in the normal range were particularly associated with risk of pancreatic cancer among patients with recent-onset diabetes, a study found.

Patients with recent-onset diabetes and weight loss had a substantially increased risk for pancreatic cancer compared with those who hadn't recently lost weight, a study found.

To evaluate the association of diabetes and recent weight change with pancreatic cancer, researchers used data from female participants in the Nurses' Health Study and male participants in the Health Professionals Follow-Up Study gathered over more than 30 years, through the end of 2018. Weight was collected at enrollment and then every two years, and researchers looked at weight loss and duration of physician-diagnosed diabetes to assess hazard ratios (HRs) for pancreatic cancer. Results were published by JAMA Oncology on Aug. 13.

Among the 112,818 women and 46,207 men in the cohort (4.5 million person-years of follow-up), there were 1,116 cases of pancreatic cancer. Compared to those with no diabetes, those with recent-onset diabetes had nearly a three-fold age-adjusted risk for pancreatic cancer (HR, 2.97; 95% CI, 2.31 to 3.82), while those with long-standing diabetes had a more than twofold age-adjusted risk (HR, 2.16; 95% CI, 1.78 to 2.60). Compared with those with no weight loss, age-adjusted HRs for pancreatic cancer were 1.25 (95% CI, 1.03 to 1.52) for those who lost one to four pounds, 1.33 (95% CI, 1.06 to 1.66) for those who lost five to eight pounds, and 1.92 (95% CI, 1.58 to 2.32) for those who lost more than eight pounds.

In patients with both recent-onset diabetes and weight loss of one to eight pounds or more than eight pounds, the HRs were 3.61 (95% CI, 2.14 to 6.10) and 6.75 (95% CI, 4.55 to 10.00), respectively. Incidence rates were higher among patients with both these factors plus a body mass index of less than 25 kg/m2 before weight loss or weight loss judged to be unintentional as it was not linked with increased physical activity or healthier dietary choices. Older age was also associated with increased risk, the authors noted.

“Previous research has demonstrated that adipose tissue and skeletal muscle wasting were early events in pancreatic cancer development,” the authors wrote. “The present study found that weight loss before a pancreatic cancer diagnosis was associated with recent-onset diabetes, because individuals with long-standing diabetes or with no diabetes experienced substantially less prediagnostic weight loss. Overall, these changes suggest the potential for tumor-induced alterations in the metabolism of the host to indicate the presence of early-stage pancreatic cancer.”