Pancreatic cancer and obesity: epidemiology, mechanism, and preventive strategies


The prevalence of obesity has seen a global increase in the past decades, escalating to one of the major epidemiological challenges today. Global economic growth has caused changes in dietary and physical activity patterns fueling obesity across age, gender, and income groups. The implications are many, as obesity has been associated with numerous serious health conditions, ultimately affecting morbidity and mortality. There is a growing recognition of the risk a high body mass index confers on the development and outcome of several malignancies, including pancreatic cancer. Pancreatic cancer is a highly lethal disease with exceptionally poor outcome, with incidences rising worldwide. Due to vague symptoms and no screening recommendations, a vast majority of patients are diagnosed at late stages, with already advanced disease and no opportunity for surgical intervention. Obesity mediates risk for pancreatic cancer through insufficiently understood mechanisms, possibly including inflammation and hormonal misbalance. As excess abdominal adiposity is among the few modifiable risk factors for pancreatic cancer onset, enduring weight loss could manifest an effective preventive measure. Lifestyle modifications on a population level aimed to reduce obesity could also scale down the grim pancreatic cancer rates. In cases when these measures alone are insufficiently effective, bariatric surgery can be an advantageous alternative. Extremely obese patients exhibit many health benefits following bariatric surgery along with weight loss, consequently reducing the chances of pancreatic cancer, especially if additionally adopting healthy lifestyle habits.

This is a preview of subscription content, access via your institution.

Fig. 1

(Reproduced with permission from [36])


  1. 1.

    Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin North Am. 2016;45:571–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33:673–89.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Polednak AP. Estimating the number of U.S. incident cancers attributable to obesity and the impact on temporal trends in incidence rates for obesity-related cancers. Cancer Detect Prev. 2008;32:190–9.

    Article  PubMed  Google Scholar 

  4. 4. Accessed 15 Jan 2019.

  5. 5.

    Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32:1431–7.

    Article  CAS  Google Scholar 

  6. 6.

    von Ruesten A, Steffen A, Floegel A, et al. Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015. PLoS One. 2011;6:e27455.

    Article  CAS  Google Scholar 

  7. 7.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.

    Article  Google Scholar 

  9. 9.

    Liang YJ, Xi B, Song AQ, et al. Trends in general and abdominal obesity among Chinese children and adolescents 1993–2009. Pediatr Obes. 2012;7:355–64.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Biadgilign S, Mgutshini T, Haile D, et al. Epidemiology of obesity and overweight in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open. 2017;7:e017666.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Nishida C, Mucavele P. Monitoring the rapidly emerging public health problem of overweight and obesity: the WHO global database on body mass index. SCN News 2005;29:5–11.

    Google Scholar 

  12. 12.

    Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol. 2016;22:9694–705.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Michaud DS. Obesity and pancreatic cancer. Recent Results Cancer Res. 2016;208:95–105.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  Google Scholar 

  15. 15.

    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    Article  CAS  Google Scholar 

  16. 16.

    Vrieling A, Bueno-de-Mesquita HB, Boshuizen HC, et al. Cigarette smoking, environmental tobacco smoke exposure and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2010;126:2394–403.

    CAS  PubMed  Google Scholar 

  17. 17.

    Michaud DS. Epidemiology of pancreatic cancer. Minerva Chir. 2004;59:99–111.

    CAS  PubMed  Google Scholar 

  18. 18.

    Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–61.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55:1158–60.

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Bosetti C, Bertuccio P, Negri E, et al. Pancreatic cancer: overview of descriptive epidemiology. Mol Carcinog. 2012;51:3–13.

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Fogel EL, Shahda S, Sandrasegaran K, et al. A multidisciplinary approach to pancreas cancer in 2016: a review. Am J Gastroenterol. 2017;112:537–54.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Arslan AA, Helzlsouer KJ, Kooperberg C, et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch Intern Med. 2010;170:791–802.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Genkinger JM, Spiegelman D, Anderson KE, et al. A pooled analysis of 14 cohort studies of anthropometric factors and pancreatic cancer risk. Int J Cancer. 2011;129:1708–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Jiao L, Berrington de Gonzalez A, Hartge P, et al. Body mass index, effect modifiers, and risk of pancreatic cancer: a pooled study of seven prospective cohorts. Cancer Causes Control. 2010;21:1305–14.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer. 2003;89:519–23.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007;120:1993–8.

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Pang Y, Holmes MV, Kartsonaki C, et al. Young adulthood and adulthood adiposity in relation to incidence of pancreatic cancer: a prospective study of 0.5 million Chinese adults and a meta-analysis. J Epidemiol Community Health. 2017;71:1059–67.

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    Carreras-Torres R, Johansson M, Gaborieau V, et al. The role of obesity, type 2 diabetes, and metabolic factors in pancreatic cancer: a mendelian randomization study. J Natl Cancer Inst 2017;109:djx012.

    Article  CAS  PubMed Central  Google Scholar 

  29. 29.

    Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 2011;105(Suppl 2):77–81.

    Article  Google Scholar 

  30. 30.

    Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million women study: cohort study. BMJ. 2007;335:1134.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012;23:843–52.

    Article  CAS  Google Scholar 

  32. 32.

    Calle EE, Rodriguez C, Jacobs EJ, et al. The American cancer society cancer prevention study II nutrition cohort: rationale, study design, and baseline characteristics. Cancer. 2002;94:2490–501.

    Article  PubMed  Google Scholar 

  33. 33.

    Luo J, Margolis KL, Adami HO, et al. Obesity and risk of pancreatic cancer among postmenopausal women: the Women’s Health Initiative (United States). Br J Cancer. 2008;99:527–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Genkinger JM, Kitahara CM, Bernstein L, et al. Central adiposity, obesity during early adulthood, and pancreatic cancer mortality in a pooled analysis of cohort studies. Ann Oncol. 2015;26:2257–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Olinto MTA, Theodoro H, Canuto R. Epidemiology of abdominal obesity. 2017.

  36. 36.

    Cascetta P, Cavaliere A, Piro G, et al. Pancreatic cancer and obesity: molecular mechanisms of cell transformation and chemoresistance. Int J Mol Sci. 2018;19:3331.

    Article  CAS  PubMed Central  Google Scholar 

  37. 37.

    Incio J, Liu H, Suboj P, et al. Obesity-induced inflammation and desmoplasia promote pancreatic cancer progression and resistance to chemotherapy. Cancer Discov. 2016;6:852–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Aleman JO, Eusebi LH, Ricciardiello L, et al. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology. 2014;146:357–73.

    Article  Google Scholar 

  39. 39.

    Larsson SC, Wolk A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies. Br J Cancer. 2012;106:603–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Coss A, Cantor KP, Reif JS, et al. Pancreatic cancer and drinking water and dietary sources of nitrate and nitrite. Am J Epidemiol. 2004;159:693–701.

    Article  PubMed  Google Scholar 

  41. 41.

    Risch HA. Etiology of pancreatic cancer, with a hypothesis concerning the role of N-nitroso compounds and excess gastric acidity. J Natl Cancer Inst. 2003;95:948–60.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm. 2013;2013:139239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Harbuzariu A, Rampoldi A, Daley-Brown DS, et al. Leptin-Notch signaling axis is involved in pancreatic cancer progression. Oncotarget. 2017;8:7740–52.

    Article  PubMed  Google Scholar 

  44. 44.

    Loebig M, Klement J, Schmoller A, et al. Evidence for a relationship between VEGF and BMI independent of insulin sensitivity by glucose clamp procedure in a homogenous group healthy young men. PLoS One. 2010;5:e12610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Chang HH, Moro A, Takakura K, et al. Incidence of pancreatic cancer is dramatically increased by a high fat, high calorie diet in KrasG12D mice. PLoS One. 2017;12:e0184455.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Cormie P, Spry N, Jasas K, et al. Exercise as medicine in the management of pancreatic cancer: a case study. Med Sci Sports Exerc. 2014;46:664–70.

    Article  PubMed  Google Scholar 

  47. 47.

    Niels T, Tomanek A, Schneider L, et al. Exercise improves patient outcomes in advanced pancreatic cancer patient during medical treatment. Pancreat Disord Ther. 2018;8:193.

    Google Scholar 

  48. 48.

    M. D. Anderson Cancer Center. PancFit: multimodal exercise during preoperative therapy for pancreatic cancer. 2019. NLM identifier: NCT03187951. Accessed 1 Feb 1 2019.

  49. 49.

    Puzziferri N, Roshek TB III, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312:934–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653–62.

    Article  PubMed  Google Scholar 

  51. 51.

    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Christou NV, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4:691–5.

    Article  PubMed  Google Scholar 

  53. 53.

    Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2019;269:95–101.

    Article  PubMed  Google Scholar 

  54. 54.

    He R, Yin Y, Yin W, et al. Prevention of pancreatic acinar cell carcinoma by Roux-en-Y gastric bypass surgery. Nat Commun. 2018;9:4183.

    Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Zhou X, Qian B, Ji N, et al. Pancreatic hyperplasia after gastric bypass surgery in a GK rat model of non-obese type 2 diabetes. J Endocrinol. 2016;228:13–23.

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    Jiao L, Chen L, White DL, et al. Low-fat dietary pattern and pancreatic cancer risk in the women’s health initiative dietary modification randomized controlled trial. J Natl Cancer Inst 2018;110:49–56.

    Article  CAS  Google Scholar 

Download references


No funding to disclose.

Author information




Conception and design, analysis and interpretation, drafting of the article, critical revision of the article and final approval of the article: PR, KCT, TS.

Corresponding author

Correspondence to Prashanth Rawla.

Ethics declarations

Conflict of interest

None of the authors have a conflict of interest.

Ethics approval

No ethics approval needed.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rawla, P., Thandra, K. & Sunkara, T. Pancreatic cancer and obesity: epidemiology, mechanism, and preventive strategies. Clin J Gastroenterol 12, 285–291 (2019).

Download citation


  • Obesity
  • Pancreatic cancer
  • Epidemiology
  • Weight loss
  • Bariatric surgery