title: General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition.
abstract: General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Steffen
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: José-Maria
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Cancer Registry of Norway, Oslo, Norway.|Samfundet Folkhalsan, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H B As
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: May
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Neamat-Allah
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.affiliation: Dipartmento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Cancer Registry and Histopathology Unit, "Civic-M.P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Human Genetics Foundation (HuGeF), Torino, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Naccarati
authors.affiliation: Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, Vitoria, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Spain.|Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Spain.|Navarre Public Health Institute, Pamplona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: Division of Internal Medicine, Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Ohlsson
authors.affiliation: Department for Biobank Research, Umeå University, Umeå, Sweden.|International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Mattias
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Wallner
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Jytte
authors.initials: J
authors.lastname: Halkjaer
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France.|Univ Paris Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France.|Univ Paris Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Racine
authors.affiliation: Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France.|Univ Paris Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: University of Cambridge, Cambridge, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Department of Epidemiology, Harvard School of Public Health, Boston, MA.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Heinz
authors.initials: H
authors.lastname: Freisling
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: Unit of Nutrition, Environment and Cancer, Programme of Epidemiological Research, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Gonzalez
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001837:Body Weights and Measures; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D056128:Obesity, Abdominal / Q000150:complications*; D011159:Population Surveillance; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology*
keywords: abdominal obesity; body mass index; esophageal cancer; gastric cancer; general obesity; waist circumference