Oesophagus

Body mass index and Barrett’s oesophagus in women

B C Jacobson¹, A T Chan², E L Giovannucci³, C S Fuchs⁴

¹ Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
² Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
³ Department of Epidemiology and Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
⁴ Cancer Epidemiology Program, Dana-Farber and Harvard Cancer Center, Boston, Massachusetts, USA

^{Correspondence to} Dr B C Jacobson, Boston University Medical Center, 88 East Concord Street, Room 7721, Boston, MA 02118, USA; brian.jacobson{at}bmc.org

Objective: Excess body mass is associated with symptoms of gastro-oesophageal reflux disease, and cross-sectional studies suggest an association between body mass index (BMI) and Barrett’s oesophagus. The present study sought prospectively to examine the influence of BMI and other anthropomorphic measures on the risk for Barrett’s oesophagus among women.

Methods: This was a prospective study of 15 861 women who participated in the Nurses’ Health Study, without a history of cancer, who underwent upper gastrointestinal endoscopy for any reason between 1986 and 2004. The main outcome measures were 261 cases of pathologically confirmed specialised intestinal metaplasia within the oesophagus (Barrett’s oesophagus). Self-reported data on weight were collected from biennial questionnaires. Self-reported height was collected in 1976, and self-reported waist and hip circumferences were collected in 1986.

Results: Compared with women with a BMI of 20–24.9 kg/m², women with a BMI of 25–29.9 had a multivariate OR for Barrett’s oesophagus of 0.92 (95% CI 0.66 to 1.27), women with a BMI 30 had a multivariate OR of 1.52 (95% CI 1.02 to 2.28) and women with a BMI <20 had a multivariate OR of 0.92 (95% CI 0.65 to 1.31). Results were similar when controlling for symptoms of gastro-oesophageal reflux, and among the entire Nurses’ Health Study cohort (n = 93 609) regardless of a history of endoscopy. In contrast, waist-to-hip ratio, waist circumference and height did not appear to be associated with Barrett’s oesophagus.

Conclusions: Obese, but not overweight, women appear to be at increased risk for Barrett’s oesophagus.

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