Anthropometry and esophageal cancer risk in the European prospective investigation into cancer and nutrition.
BACKGROUND
Increasing evidence suggests that general obesity [measured by body mass index (BMI)] is positively associated with risk of esophageal adenocarcinoma (EAC). In contrast, previous studies have shown inverse relations with esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether body fat distribution, particularly abdominal obesity, is associated with each type of esophageal cancer.


METHODS
We applied multivariable adjusted Cox proportional hazards regression to investigate the association between anthropometric measures and risk of EAC and ESCC among 346,554 men and women participating in the European Prospective Investigation into Cancer and Nutrition. All statistical tests were two sided.


RESULTS
During 8.9 years of follow-up, we documented 88 incident cases of EAC and 110 cases of ESCC. BMI, waist circumference, and waist-to-hip ratio (WHR) were positively associated with EAC risk [highest versus lowest quintile; relative risk (RR), 2.60; 95% confidence interval (95% CI), 1.23-5.51; P(trend) < 0.01; RR, 3.07; 95% CI, 1.35-6.98; P(trend) < 0.003; and RR, 2.12; 95% CI, 0.98-4.57; P(trend) < 0.004]. In contrast, BMI and waist circumference were inversely related to ESCC risk, whereas WHR showed no association with ESCC. In stratified analyses, BMI and waist circumference were significantly inversely related to ESCC only among smokers but not among nonsmokers. However, when controlled for BMI, we found positive associations for waist circumference and WHR with ESCC, and these associations were observed among smokers and nonsmokers.


CONCLUSIONS
General and abdominal obesity were associated with higher EAC risk. Further, our study suggests that particularly an abdominal body fat distribution might also be a risk factor for ESCC.
Steffen
Annika
A
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany. annika.steffen@dife.de
Schulze
Matthias B
MB
Pischon
Tobias
T
Dietrich
Thomas
T
Molina
Esther
E
Chirlaque
Maria-Dolores
MD
Barricarte
Aurelio
A
Amiano
Pilar
P
Quirós
J Ramón
JR
Tumino
Rosario
R
Mattiello
Amalia
A
Palli
Domenico
D
Vineis
Paolo
P
Agnoli
Claudia
C
Misirli
Gesthimani
G
Boffetta
Paolo
P
Kaaks
Rudolf
R
Rohrmann
Sabine
S
Bueno-de-Mesquita
H Bas
HB
Peeters
Petra H M
PH
May
Anne M
AM
Spencer
Elizabeth A
EA
Allen
Naomi E
NE
Bingham
Sheila
S
Tjønneland
Anne
A
Halkjaer
Jytte
J
Overvad
Kim
K
Stegger
Jakob
J
Manjer
Jonas
J
Lindkvist
Björn
B
Hallmanns
Göran
G
Stenling
Roger
R
Lund
Eiliv
E
Riboli
Elio
E
Gonzalez
Carlos A
CA
Boeing
Heiner
H
D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000150:complications / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D049629:Waist-Hip Ratio