title: Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: a case-control study.
abstract: OBJECTIVE
  Abdominal obesity has been associated with increased risk of Barrett's oesophagus (BE) but the underlying mechanism is unclear. We examined the association between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the risk of BE.
  
  
  METHODS
  A case-control study among eligible patients scheduled for elective oesophagastroduodenoscopy (EGD) and in a sample of patients eligible for screening colonoscopy recruited at the primary care clinic. All cases with definitive BE and a random sample of controls without BE were invited to undergo standardised mid-abdomen non-contrast computerised axial tomography images, which were analysed by semiautomated image segmentation software. The effect of VAT and SAT surface areas and their ratio (VAT to SAT) on BE were analysed in logistic regression models.
  
  
  RESULTS
  A total of 173 BE cases, 343 colonoscopy controls and 172 endoscopy controls underwent study EGD and CT scan. Participants with BE were more than twice as likely to be in the highest tertile of VAT to SAT ratio (OR: 2.42 (1.51 to 3.88) and adjusted OR 1.47 (0.88 to 2.45)) than colonoscopy controls, especially for those long (≥3 cm) segment BE (3.42 (1.67 to 7.01) and adjusted OR 1.93 (0.92 to 4.09)) and for white men (adjusted OR 2.12 (1.15 to 3.90)). Adjustment for gastroesophageal reflux disease (GERD) symptoms and proton pump inhibitors (PPI) use attenuated this association, but there was a significant increase in BE risk even in the absence of GERD or PPI use.
  
  
  CONCLUSIONS
  Large amount of visceral abdominal fat relative to subcutaneous fat is associated with a significant increase in the risk of BE. GERD may mediate some but not all of this association.
authors: Houston VA HSR&D Center of Excellence Section, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, , Houston, Texas, USA.
authors: Hashem B
authors: HB
authors: El-Serag
authors: Ali
authors: A
authors: Hashmi
authors: Jose
authors: J
authors: Garcia
authors: Peter
authors: P
authors: Richardson
authors: Abeer
authors: A
authors: Alsarraj
authors: Stephanie
authors: S
authors: Fitzgerald
authors: Marcelo
authors: M
authors: Vela
authors: Yasser
authors: Y
authors: Shaib
authors: Neena S
authors: NS
authors: Abraham
authors: Maria
authors: M
authors: Velez
authors: Rhonda
authors: R
authors: Cole
authors: Margot B
authors: MB
authors: Rodriguez
authors: Bhupinderjit
authors: B
authors: Anand
authors: David Y
authors: DY
authors: Graham
authors: Jennifer R
authors: JR
authors: Kramer
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000000981:diagnostic imaging / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging; D012307:Risk Factors; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D013781:Texas; D014057:Tomography, X-Ray Computed
keywords: Epidemiology; Obesity