title: Measures of adiposity are associated with increased risk of peptic ulcer.
abstract: OBJECTIVE
  Obesity is associated with systemic inflammation, alterations in the intestinal microbiome, and decreased epithelial integrity. The association between obesity and peptic ulcer has not been investigated thoroughly.
  
  
  METHODS
  We conducted a prospective cohort study of 47,120 men enrolled in the Health Professionals Follow-Up Study (mean age at baseline, 54 y). Biennially, we updated information on body mass index (BMI), physical activity, smoking, and use of nonsteroidal anti-inflammatory drugs or aspirin. Self-reported waist and hip measurements were validated among a subsample of participants. Self-reported cases of gastric and duodenal ulcers were confirmed by medical record review. Helicobacter pylori status was determined from endoscopic biopsy specimens, serum antibody measurements, and/or stool antigen assays documented in the medical record. We used Cox proportional hazards modeling to calculate hazard ratios and 95% confidence intervals (CIs).
  
  
  RESULTS
  We documented 272 gastric and 320 duodenal ulcers over 24 years of follow-up evaluation. The multivariate-adjusted hazard ratio for gastric ulcer was 1.83 (95% CI, 1.20-2.78; P(trend) < .01) for obese men (BMI, ≥30.0 kg/m(2)), compared with men with BMIs of 23.0 to 24.9 kg/m(2), and 1.88 (95% CI, 1.06-3.33; P(trend) = .04) for men with waist-to-hip ratios (WHR) of 1.00 or higher, compared with men with a WHR of 0.85 to 0.89. The risk of duodenal ulcer was not associated with BMI (P(trend) = .24) or WHR (P(trend) = .68). In secondary analyses, increased BMI and WHR each were associated with increased risk of H pylori-negative, but not H pylori-positive, ulcers. The effect of BMI on ulcer risk did not change with use of aspirin or nonsteroidal anti-inflammatory drugs, alcohol consumption, physical activity, or smoking.
  
  
  CONCLUSIONS
  In a large prospective cohort of male health professionals, central and total obesity were associated with increased risk of peptic ulcer-particularly gastric and H pylori-negative ulcers.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; State University of New York Downstate Medical Center, Brooklyn, New York.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Hamed
authors.initials: H
authors.lastname: Khalili
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View, California.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Huang
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: achan@mgh.harvard.edu.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D056808:Biostatistics; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal; D005500:Follow-Up Studies; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010437:Peptic Ulcer / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Body Mass Index; Obesity; Peptic Ulcer Disease; Waist-To-Hip Ratio