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Waist circumference elevated risk for Barrett’s esophagus regardless of sex, BMI
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Men and women with greater waist circumferences were at an increased risk for developing Barrett’s esophagus, independent of BMI, in a recent study.
Researchers evaluated data collected from four case-control studies on 1,102 patients (316 women, 786 men) and 1,400 controls (436 women, 964 men). The incorporated studies were selected from the Barrett’s and Esophageal Adenocarcinoma Consortium.
Significant associations were observed between Barrett’s esophagus (BE) and waist circumference (WC) for both sexes, and these remained after adjustment for BMI. An increased risk for BE was identified among those in the highest WC quartile compared with those in the lowest (HR=2.24; 95% CI, 1.08-4.65, for men; OR=3.75; 95% CI, 1.47-9.56, for women). Analysis of WC as a continuous variable indicated trends toward significance for men and women (P=.07), and dose-effect associations were observed before (P=.03) and after (P=.01) adjustment for GERD when data from men and women were combined and sex-specific quartile cutoff points were used.
No significant associations were observed between Barrett’s esophagus and BMI among men or women, regardless of adjustment for WC.
Investigators also noted an association for men between BE risk and being in the lowest waist–hip ratio quartile (OR=0.44; 95% CI, 0.29-0.67) with nonsignificant associations observed for those in the third (OR=0.96; 95% CI, 0.66-1.40) and fourth quartiles (OR=1.07; 95% CI, 0.60-1.91). No similar associations were observed among women.
“This is the first study to evaluate the sex-specific associations between BMI, waist circumference and the risk of Barrett’s esophagus within a large population-based sample,” the researchers wrote. “Abdominal obesity is a risk factor for Barrett’s esophagus among both men and women, independent of BMI; individuals with higher waist circumferences were at a 1.5–2.8-fold increased risk of having Barrett’s esophagus among general populations. Further studies examining the biological mechanisms of this association will extend our knowledge regarding the pathogenesis of Barrett’s esophagus.”
Perspective
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Joel H. Rubenstein, MD, MSc, FACG, FASGE
This study has a number of notable findings. Importantly, the authors found that the risk of obesity for Barrett’s esophagus is from abdominal obesity, not body mass index. This is consistent with findings in other diseases that obesity localized to the abdomen is the important risk factor. We really should start implementing measuring abdominal circumference in clinical practice rather than simply recording BMI. Another important finding is that the risk of abdominal obesity was independent of GERD symptoms, suggesting that circulating factors related to obesity may promote Barrett’s esophagus.
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