Body Mass Index, Smoking, and Alcohol and Risks of Barrett’s Esophagus and Esophageal Adenocarcinoma: A UK Prospective Cohort Study

Abstract

BackgroundThe timing of the risk factors cigarette smoking, alcohol and obesity in the development of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) is unclear.AimsTo investigate these exposures in the aetiology of BE and EAC in the same population.MethodsThe cohort included 24,068 men and women, aged 39–79 years, recruited between 1993 and 1997 into the prospective EPIC-Norfolk Study who provided information on anthropometry, smoking and alcohol intake. The cohort was monitored until December 2008 and incident cases identified.ResultsOne hundred and four participants were diagnosed with BE and 66 with EAC. A body mass index (BMI) above 23 kg/m2 was associated with a greater risk of BE [BMI ≥23 vs. 18.5 to <23, hazard ratio (HR) 3.73, 95 % CI 1.37–10.16], and within a normal BMI, the risk was greater in the higher category (HR 3.76, 95 % CI 1.30–10.85, BMI 23–25 vs. 18.5 to >23 kg/m2). Neither smoking nor alcohol intake were associated with risk for BE. For EAC, all BMI categories were associated with risk, although statistically significant for only the highest (BMI >35 vs. BMI 18.5 to <23, HR 4.95, 95 % CI 1.11–22.17). The risk was greater in the higher category of a normal BMI (HR 2.73, 95 % CI 0.93–8.00, p = 0.07, BMI 23–25 vs. 18.5 to >23 kg/m2). There was an inverse association with ≥7 units alcohol/week (HR 0.51, 95 % CI 0.29–0.88) and with wine (HR 0.49, 95 % CI 0.23–1.04, p = 0.06, drinkers vs. non-drinkers).ConclusionsObesity may be involved early in carcinogenesis and the association with EAC and wine should be explored. The data have implications for aetiological investigations and prevention strategies.

Predictors of Progression to High-Grade Dysplasia or Adenocarcinoma in Barrett’s Esophagus

“…An observational study from England showed a significant increase in esophageal adenocarcinoma with a BMI >35 (HR 4.95), but only an upward trend at lower BMIs. 70 This corresponds to earlier data suggesting the largest risk was in patients with BMI > 35. 68 It would appear that male pattern central obesity is the key component of this risk, with a 2013 meta-analysis reporting an odds ratio of 2.51 (95% CI 1.56–4.04) for developing esophageal adenocarcinoma in patients with central adiposity.…”

Serum SH3BP5-specific Antibody Level is a Biomarker of Atherosclerosis

“…This result may be explained by the fact that many types of cancers are attributable to obesity, the complications of which include DM, CVD, CKD, and stroke [44,45]. Furthermore, adiponectin which are negatively correlated with obesity and atherosclerosis [46] was negatively associated with the onset of KRAS-mutant colorectal cancer atherosclerosis [47].…”

Alcohol and the Risk of Barrett's Esophagus: A Pooled Analysis from the International BEACON Consortium

“…Previous studies have reported associations between alcohol and risk of Barrett’s esophagus, however results have been conflicting (12–20). One possible explanation for the conflicting findings may be that individual studies have inadequate power to assess this association and are prone to type II error.…”

“…Despite previous investigation, it remains unclear whether alcohol consumption is truly associated with risk of Barrett’s esophagus, and whether patients’ alcohol histories may help improve risk stratification for Barrett’s esophagus. Results from previous studies of alcohol and Barrett’s esophagus are conflicting, with some studies reporting positive associations with moderate to heavy total and/or beverage-specific consumption (12–15), and others reporting inverse associations (16–20). However, many of these studies used different exposure categorizations, did not evaluate alcohol subtypes, or had limited power to evaluate interactions between alcohol and other risk factors.…”