title: Influence of body mass index on the prevalence and progression of dysplasia in Barrett's esophagus: a retrospective analysis (.).
abstract: OBJECTIVE
  High body mass index (BMI) is a risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Our aim was to determine if prevalence of dysplasia in BE varies by BMI and study the effect of BMI on progression to high-grade dysplasia (HGD) or EAC.
  
  
  METHODS
  This is a retrospective review of patients with endoscopic evidence of BE confirmed by presence of intestinal metaplasia on histology from January 2000 to December 2012 at Cleveland Clinic. Patient demographics, BMI and endoscopic findings such as length of BE, dysplasia in BE and size of hiatal hernia were reviewed. Dysplasia was classified as no dysplasia (NDBE), low-grade dysplasia (LGD), HGD and EAC.
  
  
  RESULTS
  In this cohort of 1239 patients, average BMI was 29.8 ± 6 kg/m(2). There were 228 (18.4%) in group with BMI <25, 236 (19%) in BMI group 25-27.4, 262 (21.1%) in BMI 27.5-29.9, 303 (24.5%) in BMI 30-34.9, 126 (10.2%) in BMI 35-39.9 and 86 (6.8%) in BMI ≥40. Lower BMI groups had lower prevalence of dysplasia while higher BMI groups had higher prevalence of dysplasia (p = 0.002). During mean follow up of 31.6 ± 26 months, there were 14 cases of HGD/EAC in NDBE group and 29 cases of HGD/EAC in LGD group. BMI or BMI change was not associated with progression to HGD/EAC in NDBE.
  
  
  CONCLUSIONS
  High BMI was associated with higher prevalence of dysplasia in BE. But once in a surveillance program, higher BMI is not associated with progression of dysplasia in NDBE.
authors.affiliation: a Center of Excellence for Barrett's Esophagus, Digestive Disease Institute, Cleveland Clinic , Cleveland , OH , USA ;
authors.forename: Prashanthi Nagavenkata
authors.initials: PN
authors.lastname: Thota
authors.affiliation: a Center of Excellence for Barrett's Esophagus, Digestive Disease Institute, Cleveland Clinic , Cleveland , OH , USA ;
authors.forename: Zubin
authors.initials: Z
authors.lastname: Arora
authors.affiliation: a Center of Excellence for Barrett's Esophagus, Digestive Disease Institute, Cleveland Clinic , Cleveland , OH , USA ;
authors.forename: Tanmayee
authors.initials: T
authors.lastname: Benjamin
authors.affiliation: a Center of Excellence for Barrett's Esophagus, Digestive Disease Institute, Cleveland Clinic , Cleveland , OH , USA ;
authors.forename: Mangesh
authors.initials: M
authors.lastname: Pagadala
authors.affiliation: b Department of Biostatistics , JJ North-3, Cleveland Clinic , Cleveland , OH , USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: a Center of Excellence for Barrett's Esophagus, Digestive Disease Institute, Cleveland Clinic , Cleveland , OH , USA ;
authors.forename: Madhusudhan Rao
authors.initials: MR
authors.lastname: Sanaka
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D015992:Body Mass Index; D018450:Disease Progression; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000473:pathology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Barrett’s esophagus; body mass index; dysplasia; esophageal cancer; progression