Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus

Whiteman, D. C.; Sadeghi, S.; Pandeya, N.; Smithers, B. M.; Gotley, D. C.; Bain, C. J.; Webb, P. M.; Green, A. C.
February 2008
Gut;Feb2008, Vol. 57 Issue 2, p173
Academic Journal
Objective: To measure the relative risks of adenocarcinomas of the oesophagus and gastro-oesophageal junction associated with measures of obesity, and their interactions with age, sex, gastro-oesophageal reflux symptoms and smoking. Design and setting: Population-based case-control study in Australia. Patients: Patients with adenocarcinomas of the oesophagus (n = 367) or gastro-oesophageal junction In = 4261 were compared with control participants (n = 1580) sampled from a population register. Main outcome measure: Relative risk of adenocarcinoma of the oesophagus or gastro-oesophageal junction. Results: Risks of oesophageal adenocarcinoma increased monotonically with body mass index (BMI) (Ptrend <0.001). Highest risks were seen for BMI ⩾40 kg/m² (odds ratio (OR) = 6.1, 95% Cl 2.7 to 13.61 compared with "healthy" BMI (18.5-24.9 kg/m²). Adjustment for gastro-oesophageal reflux and other factors modestly attenuated risks. Risks associated with obesity were substantially higher among men (OR = 2.6, 95% CI 1.8 to 3.91 than women (OR = 1.4, 95% Cl 0.5 to 3.5), and among those aged <50 years (OR = 7.5, 95% Cl 1.7 to 33.01 than those aged ⩾50 years (OR = 2.2, 95% Cl 1.5 to 3.1). Obese people with frequent symptoms of gastro- oesophageal reflux had significantly higher risks (OR = 16.5, 95% Cl 8.9 to 30.61 than people with obesity but no reflux (OR = 2.2, 95% Cl 1.1 to 4.3) or reflux but no obesity (OR = 5.6, 95% 2.8 to 11.3), consistent with a synergistic interaction between these factors. Similar associations, but of smaller magnitude, were seen for gastro-oesophageal junction adenocarcinomas. Conclusions: Obesity increases the risk of oesophageal adenocarcinoma independently of other factors, particularly among men. From a clinical perspective, these data suggest that patients with obesity and frequent symptoms of gastro-oesophageal reflux are at especially increased risk of adenocarcinoma.


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