Body Mass Index and Risk of Intestinal Metaplasia: A Cohort Study

Abstract

Background: We examined the association between body mass index (BMI) and development of endoscopic intestinal metaplasia.Methods: This retrospective cohort study included 142,832 Korean adults free of endoscopic intestinal metaplasia and atrophic gastritis who underwent upper endoscopy at baseline and subsequent visits and were followed for up to 5 years. A parametric proportional hazards model was used to estimate the adjusted HR with 95% confidence interval (CI) for incident intestinal metaplasia.Results: In more than 444,719.1 person-years of follow-up, 2,281 participants developed endoscopic intestinal metaplasia (incidence rate, 5.1 per 1,000 person-years). Increased BMI categories were associated with increased risk of new-onset intestinal metaplasia in a dose-response manner. After adjustment for age, sex, center, year of screening exam, smoking status, alcohol intake, exercise, total calorie intake, history of diabetes and hypertension, and history of Helicobacter pylori infection, the multivariable adjusted HRs (95% CIs) for incident intestinal metaplasia comparing BMIs of <18.5, 23-24.9, 25.0-29.9, and >30 kg/m 2 with a BMI of 18.5-22.9 kg/m 2 were 0.84 (0.64-1.09), 1.03 (0.93-1.16), 1.07 (0.96-1.20), and 1.48 (1.20-1.83), respectively. These associations did not differ by clinically relevant subgroups. Risk of endoscopic atrophic gastritis also increased as the baseline BMI category increased.Conclusions: In a large cohort of Korean men and women, obesity was independently associated with increased incidence of endoscopic atrophic gastritis and intestinal metaplasia.Impact: Excessive adiposity appears to play a role in development of stomach precursor lesions of stomach cancer, requiring further studies to determine whether strategies to reduce obesity will also help reduce precancerous lesions and, in turn, gastric cancer. d Median (interquartile range). e Among 123,194 participants without missing value on hsCRP. f Among 112,418 participants with plausible estimated energy intake levels (within three standard deviations from the log-transformed mean energy intake).Kim et al.

Dose‐dependent association of proton pump inhibitors use with gastric intestinal metaplasia among Helicobacter pylori‐positive patients

“…A recent large Korean study reported that obesity was independently associated with an increased incidence of GIM. 21 In our study, the univariate analysis did show an association between increasing BMI and a diagnosis of GIM. However, after adjusting for multiple variables, this association was no longer observed, and a negative association was observed for the obese (as defined by either the WHO classification and by quintiles).…”

“…17 However, understanding the association of PPI use with the development of GIM is complex, as histological examination is required and other multiple risk factors are associated with the diagnosis of GIM, such as H. pylori infection, increasing age, cigarette smoking, autoimmune gastropathy, alcohol consumption, bile reflux, a diet low in fruits and vegetables, obesity, high body mass index (BMI) and high salt intake. 2,[18][19][20][21] Hence, to clarify further the association between PPI use and the development of GIM, we conducted a retrospective endoscopic pathology-based study to assess whether PPI use is associated with the diagnosis of GIM while controlling for quantitative PPI use, H. pylori infection and multiple other risk factors.…”

“…However, understanding the association of PPI use with the development of GIM is complex, as histological examination is required and other multiple risk factors are associated with the diagnosis of GIM, such as H. pylori infection, increasing age, cigarette smoking, autoimmune gastropathy, alcohol consumption, bile reflux, a diet low in fruits and vegetables, obesity, high body mass index (BMI) and high salt intake 2 ,. 18–21 …”

Esophagogastric premalignant conditions. A literature review

“…Another factor that has been extensively examined in several observational studies is obesity, although results are mostly inconclusive [21][22]. Recently, a large cohort analysis by Kim et al [24] showed that obesity was associated with a higher incidence of AG and IM, with risk increasing as BMI category increased. In addition, the Korean study demonstrated that the positive association between BMI and IM was more evident in individuals younger than 40 years old, suggesting that accumulative exposure to other environmental factors may play a role in the prevalence of gastric cancer and its precancerous lesions with more advancing age.…”

Diabetes mellitus is associated with an increased risk of gastric cancer: a cohort study

“…Gastric cancer was defined as gastric adenocarcinoma or signet ring cell carcinoma. Atrophic gastritis was defined as mucosal thinning with pale and shiny surface and visible submucosal vessels and intestinal metaplasia was defined as nodular elevated whitish plaques in the antrum or corpus [27,28]. H. pylori infection status was evaluated histologically only when indicated such as in the case of peptic ulcer disease, at the discretion of the endoscopist based on Korean guidelines [29].…”