Obesity linked to higher risk for Barrett’s esophagus progression to dysplasia, cancer
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Key takeaways:
- Pooled annual progression rates were 0.02% and 0.01% among men and women, respectively, with Barrett’s esophagus.
- Every 5 kg/m2 increase in BMI was associated with up to a 6% higher risk for progression.
Among patients with Barrett’s esophagus, every 5 kg/m2 increase in BMI was associated with up to a 6% relative increase in the risk for malignant progression, according to a systematic review and meta-analysis.
“Obesity has been implicated in the pathogenesis of many reflux-related esophageal disorders such as gastroesophageal reflux disease, BE and esophageal adenocarcinoma (EAC),” Mie Thu Ko, of the department of gastroenterology at Norfolk and Norwich University Hospitals NHS Foundation Trust, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Guidelines advocate obesity as a criterion for targeted screening for BE in patients with chronic reflux symptoms.
“While obesity is a recognized risk factor for both BE and EAC, it is however unclear whether obesity per se is a risk factor for progression to high-grade dysplasia or EAC in patients with BE.”
In a systematic review and meta-analysis, Ko and colleagues evaluated data from 20 studies published between 2005 and 2022 to investigate the relationship between obesity and the risk for malignant progression in BE. The studies included 38,565 patients (74.4% men), of whom 1,684 received a diagnosis of high-grade dysplasia, EAC or esophageal cancer. The researchers considered 19 studies moderate to high quality.
According to results, eight cohort studies reported on 6,647 men and 1,992 women with nondysplastic BE or low-grade dysplasia at baseline, of whom 555 and 110, respectively, progressed to high-grade dysplasia or EAC. The results corresponded with pooled annual progression rates of 0.02% (95% CI, 0.01-0.03) and 0.01% (95% CI, 0.01-0.02), with no significant difference between sexes.
Analyses also demonstrated that obesity, as measured by BMI, was associated with a 4% (unadjusted OR = 1.04; 95% CI, 1-1.07) and 6% (adjusted OR = 1.06; 95% CI, 1.02-1.1) increased risk for disease progression with every 5 kg/m2 increase in BMI.
Abdominal obesity, measured by waist-to-hip ratio, also was significantly linked to a higher risk for malignant progression in patients with BE (OR = 2.44; 95% CI 1.2-4.9), according to results from a case-control control study.
“This research provides some evidence obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship,” Ko and colleagues wrote. “The association remained broadly consistent across subgroup analyses.”
They continued: “The research has implications for risk stratification of patients with BE and supports future mechanistic and interventional research in the role of obesity in malignant progression.”
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