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High waist–hip ratio increased risk for Barrett’s esophagus among white men
White men with an elevated waist–hip ratio were more likely to develop Barrett’s esophagus, while high BMI had no impact on this risk, according to recent results.
In a case-control study, researchers administered esophagogastroduodenoscopy to 237 patients with Barrett’s esophagus (BE), 1,021 patients without BE (endoscopy controls)and 479 patients eligible for screening colonoscopy (colonoscopy controls). BMI and waist–hip ratio (WHR) were measured, and participants completed a survey on their consumption of alcohol and tobacco, frequency and severity of GERD symptoms, medication use, physical activity and medical history. Mean age of the cohort, which included 57.4% white, 32.6% black and 7.4% Hispanic participants, was 61.5 years.
Patients with BE had a significantly higher mean WHR than either control group (P<.001 for both comparisons), and high WHR (0.9 or greater for men and 0.85 or greater for women) was more common among those with BE (92.4% of cases) than endoscopy (79.5%; P<.001) and colonoscopy (84.6%; P=.008) controls. No association was observed between BE and BMI, and mean BMI did not differ significantly between groups.
After adjustment for confounders, high WHR was significantly more likely among patients with BE compared with endoscopy controls (OR=1.93; 95% CI, 1.07-3.49), particularly among those with long-segment BE (OR=2.81; 95% CI, 1.0-7.99). The association between BE and high WHR, however, was only observed among white participants (OR=2.5; 95% CI, 1.2-5.4) as opposed to black (OR=1.06; 95% CI, 0.2-5.9) or Hispanic (OR=1.14; 95% CI, 0.4-3.6) patients. Further adjustment for GERD symptoms slightly attenuated the association between BE and high WHR, while adjustment for proton pump inhibitor and/or histamine-2–receptor antagonist medication resulted in a slight increase.
“There are several possible mechanisms for abdominal obesity’s effect on the risk of BE,” the researchers wrote. “Our analyses … could not explain much of the WHR effect on BE.
“Further research needs to be conducted that examines the effect of pro- and anti-inflammatory cytokines, as well as more elaborate means to measure body fat distribution, to further understand the effect of abdominal obesity on the risk of BE.”
Perspective
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Abdominal obesity is known to be associated with GERD symptoms and Barrett’s esophagus. It has not been clear whether this association is entirely due to a mechanical effect.
The study by Kramer and colleagues re-demonstrated the association with Barrett’s esophagus, but found that the effect may be modified by race. There was a strong association among whites, but no significant association was found among African-Americans. The effect did not seem to be mediated by GERD symptoms or hiatal hernia.Their estimate of the effect in African-Americans was fairly imprecise, so it may have simply been that the study was not large enough to detect that association.
Kramer’s study adds to a growing body of literature suggesting that the effects of abdominal obesity on Barrett’s esophagus and esophageal adenocarcinoma are probably not entirely due to mechanical effects. Visceral adipose tissue is metabolically active, secreting many inflammatory mediators which may impact the risk of Barrett’s esophagus. Some of these are differentially secreted in African-Americans than in whites.