Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus

Abstract

Background & Aims Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histological score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation and dysplasia. Results All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. GEJ fat area (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.3–27.7; P=.02), visceral fat area (OR, 4.9; 95% CI, 1.0–22.8; P=.04) and abdominal circumference (OR=9.1; 95% CI, 1.4–57.2; P=0.02) were associated with BE, independent of BMI. Subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared to those without, P=.02) and high-grade dysplasia (HGD) (compared to those without, P=.01), independent of BMI. Conclusions GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and HGD in BE subjects, independent of BMI. Visceral fat might therefore promote esophageal metaplasia and dysplasia.

Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett's oesophagus: a case-control study

“…It is possible that the relative distribution of abdominal fat in these two compartments has a varied effect on the risk of BE 9. Visceral abdominal fat in addition to exerting a mechanical effect on the stomach and oesophagus secrets multiple pro-inflammatory cytokines, and is strongly associated with insulin resistance10 11 thus facilitating the development of BE by additional mechanisms.…”

“…Two small studies have evaluated the effect of visceral abdominal fat measured by imaging on the risk of BE 9 12. For example, we previously reported in a retrospective study of only 36 BE patients and 93 controls who underwent abdominal CT scan for clinical reasons that surface area of visceral abdominal fat was significantly greater in patients with BE than those without BE 13.…”

Adherence to WCRF/AICR lifestyle recommendations for cancer prevention and the risk of Barrett’s esophagus onset and evolution to esophageal adenocarcinoma: results from a pilot study in a high-risk population

“…Due to multicollinearity, waist circumference was preferred to BMI. Waist circumference was preferred because recently published evidence has revealed how waist circumference has a stronger association with BE and EAC in comparison with BMI [8,24,25]. The performance of the model was evaluated using the C-index.…”

Risk factors associated with Barrett’s epithelial dysplasia

“…More recently, several studies have revealed that waist circumference, but not BMI, has a modest independent associations with the incidence BE, dysplasia and adenocarcinoma. Other studies have reported that a higher waist-to-hip ratio is associated with BE when data are adjusted for GERD symptoms and BMI [14,50] . In our multivariate logistic analysis, anthropometric variables were not extracted as risk factors.…”