Inverse Association Between Gluteofemoral Obesity and Risk of Barrett's Esophagus in a Pooled Analysis.
Gluteofemoral obesity (determined by measurement of subcutaneous fat in the hip and thigh regions) could reduce risks of cardiovascular and diabetic disorders associated with abdominal obesity. We evaluated whether gluteofemoral obesity also reduces the risk of Barrett's esophagus (BE), a premalignant lesion associated with abdominal obesity.



We collected data from non-Hispanic white participants in 8 studies in the Barrett's and Esophageal Adenocarcinoma Consortium. We compared measures of hip circumference (as a proxy for gluteofemoral obesity) from cases of BE (n = 1559) separately with 2 control groups: 2557 population-based controls and 2064 individuals with gastroesophageal reflux disease (GERD controls). Study-specific odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using individual participant data and multivariable logistic regression and combined using a random-effects meta-analysis.



We found an inverse relationship between hip circumference and BE (OR per 5-cm increase, 0.88; 95% CI, 0.81-0.96), compared with population-based controls in a multivariable model that included waist circumference. This association was not observed in models that did not include waist circumference. Similar results were observed in analyses stratified by frequency of GERD symptoms. The inverse association with hip circumference was statistically significant only among men (vs population-based controls: OR, 0.85; 95% CI, 0.76-0.96 for men; OR, 0.93; 95% CI, 0.74-1.16 for women). For men, within each category of waist circumference, a larger hip circumference was associated with a decreased risk of BE. Increasing waist circumference was associated with an increased risk of BE in the mutually adjusted population-based and GERD control models.



Although abdominal obesity is associated with an increased risk of BE, there is an inverse association between gluteofemoral obesity and BE, particularly among men.
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Bradley J
BJ
Kendall
Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Barrett's Esophagus Program, Division of Gastroenterology Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Joel H
JH
Rubenstein
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
Michael B
MB
Cook
Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Thomas L
TL
Vaughan
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Lesley A
LA
Anderson
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Liam J
LJ
Murray
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Nicholas J
NJ
Shaheen
Kaiser Permanente Division of Research, Oakland, California and San Francisco Medical Center.
Douglas A
DA
Corley
Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, Ohio.
Apoorva K
AK
Chandar
Department of Family Medicine, Swetland Center for Environmental Health, Case Western Reserve University, Cleveland, Ohio.
Li
L
Li
Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, Ohio.
Katarina B
KB
Greer
Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, Ohio.
Amitabh
A
Chak
Department of Medicine, Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Hashem B
HB
El-Serag
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
David C
DC
Whiteman
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. Electronic address: aaron.thrift@bcm.edu.
Aaron P
AP
Thrift
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D018570:Risk Assessment
BEACON; Epidemiology; Esophageal Cancer; Obesity; Risk Factors