title: Waist-to-hip ratio, but not body mass index, is associated with an increased risk of Barrett's esophagus in white men.
abstract: OBJECTIVE
  Abdominal obesity increases the risk of gastroesophageal reflux disease (GERD) and also might contribute to the development of Barrett's esophagus (BE), although results are inconsistent. We examined the effects of waist-to-hip ratio (WHR) and body mass index (BMI) on the risk of BE and investigated whether race, GERD symptoms, or hiatus hernia were involved.
  
  
  METHODS
  We conducted a case-control study using data from eligible patients who underwent elective esophagogastroduodenoscopy; 237 patients had BE and the other 1021 patients served as endoscopy controls. We also analyzed data and tissue samples from enrolled patients who were eligible for screening colonoscopies at a primary care clinic (colonoscopy controls, n = 479). All patients underwent esophagogastroduodenoscopy, completed a survey, and had anthropometric measurements taken. WHR was categorized as high if it was 0.9 or greater for men or 0.85 or greater for women. Data were analyzed with logistic regression.
  
  
  RESULTS
  There was no association between BMI and BE. However, more patients with BE had a high WHR (92.4%) than endoscopy controls (79.5%) or colonoscopy controls (84.6%) (P < .001 and P = .008, respectively). In adjusted analysis, patients with BE were 2-fold more likely to have a high WHR than endoscopy controls (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.1-3.5), this association was stronger for patients with long-segment BE (OR, 2.81; 95% CI, 1.0-7.9). A high WHR was associated significantly with BE only in whites (OR, 2.5; 95% CI, 1.2-5.4), but not in blacks or Hispanics. GERD symptoms, hiatus hernia, or gastroesophageal valve flap grade could not account for the association.
  
  
  CONCLUSIONS
  High WHR, but not BMI, is associated with a significant increase in the risk of BE, especially long-segment BE and in whites. The association is not caused by GERD symptoms or hiatus hernia.
authors.affiliation: Houston VA Health Services Research and Development Center of Excellence, Houston, Texas 77030, USA. jennifer.kramer@va.gov
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Lori A
authors.initials: LA
authors.lastname: Fischbach
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: Abeer
authors.initials: A
authors.lastname: Alsarraj
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fitzgerald
authors.forename: Yasser
authors.initials: Y
authors.lastname: Shaib
authors.forename: Neena S
authors.initials: NS
authors.lastname: Abraham
authors.forename: Maria
authors.initials: M
authors.lastname: Velez
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cole
authors.forename: Bhupinderjit
authors.initials: B
authors.lastname: Anand
authors.forename: Gordana
authors.initials: G
authors.lastname: Verstovsek
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Paola
authors.initials: P
authors.lastname: Parente
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D049629:Waist-Hip Ratio