Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium.
OBJECTIVE
Barrett's oesophagus is a precursor lesion of oesophageal adenocarcinoma, a cancer that, in the USA, has increased in incidence over 600% during the past 40 years. Barrett's oesophagus and oesophageal adenocarcinoma are much more common among men than among women; this finding is unexplained and most earlier studies lacked sufficient numbers of women to evaluate sex-specific risk factors. We leveraged the power of an international consortium to assess sex-specific relationships between body mass index (BMI), abdominal circumference and Barrett's oesophagus.


METHODS
Four case-control studies provided a total of 1102 cases (316 women, 786 men) and 1400 population controls (436 women, 964 men) for analysis. Study-specific estimates, generated using individual participant data, were combined using random effects meta-analysis.


RESULTS
Waist circumference was significantly associated with Barrett's oesophagus, even after adjustment for BMI; persons in the highest versus the lowest quartiles of waist circumference had approximately 125% and 275% increases in the odds of Barrett's oesophagus among men and women, respectively (OR 2.24, 95% CI 1.08 to 4.65, I(2)=57; OR 3.75, 95% CI 1.47 to 9.56, I(2)=0). In contrast, there was no evidence of a significant association between BMI and the risk of Barrett's oesophagus, with or without adjustment for waist circumference.


CONCLUSIONS
Waist circumference, independent of BMI, was found to be a risk factor for Barrett's oesophagus among both men and women. Future studies examining the biological mechanisms of this association will extend our knowledge regarding the pathogenesis of Barrett's oesophagus.
Division of Research, Northern California Kaiser Permanente, , Oakland, California, USA.
Ai
A
Kubo
Michael Blaise
MB
Cook
Nicholas J
NJ
Shaheen
Thomas L
TL
Vaughan
David C
DC
Whiteman
Liam
L
Murray
Douglas A
DA
Corley
D000230:Adenocarcinoma / Q000209:etiology; D001471:Barrett Esophagus / Q000209:etiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D055105:Waist Circumference
Barrett's Oesophagus; Gastroesophageal Reflux Disease; Nutrition; Obesity