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

David C. Whiteman ^1*, Shahram Sadeghi ², Nirmala Pandeya ², Bernard Mark Smithers ³, David C Gotley ³, Christopher J Bain ³, Penelope M Webb ¹ and Adele C Green ¹

¹ Queensland Institute of Medical Research, Australia
² University of Queensland, QIMR, Australia
³ University of Queensland, Australia

^* To whom correspondence should be addressed. E-mail: david.whiteman{at}qimr.edu.au.

Accepted 7 August 2007

Abstract

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 (n=426) were compared with control participants sampled from a population register (n=1,580).

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 observed for BMI >40 kg/m2 (OR 6.1, 95%CI 2.7-13.6) 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 males (OR 2.6, 95%CI 1.8-3.9) than females (OR 1.4, 95% CI 0.5-3.5), and among those <50 years (OR 7.5, 95%CI 1.7-33.0) than >50 years (OR 2.2, 95% CI 1.5-3.1). Obese people with frequent symptoms of gastro-oesophageal reflux had significantly higher risks (OR 16.5, 95% CI 8.9-30.6) than people with obesity but no reflux (OR 2.2, 95%CI 1.1-4.3) or reflux but no obesity (OR 5.6, 95% 2.8-11.3), consistent with a synergistic interaction between these factors. Similar associations, but of lower magnitude, were observed for gastro-oesophageal junction adenocarcinomas.

Conclusions: Obesity increases the risk of oesophageal adenocarcinoma independently of other factors, particularly among males. From a clinical perspective, these data suggest that patients with obesity and frequent symptoms of gastro-oesophageal reflux are at especially elevated risk of adenocarcinoma.

Keywords: adenocarcinoma, case-control study, gastro-oesophageal reflux, obesity, oesophagus

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller and Magnus Simren
Gut 2008 57: 1-2. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Steffen, A., Schulze, M. B., Pischon, T., Dietrich, T., Molina, E., Chirlaque, M.-D., Barricarte, A., Amiano, P., Quiros, J. R., Tumino, R., Mattiello, A., Palli, D., Vineis, P., Agnoli, C., Misirli, G., Boffetta, P., Kaaks, R., Rohrmann, S., Bueno-de-Mesquita, H. B., Peeters, P. H.M., May, A. M., Spencer, E. A., Allen, N. E., Bingham, S., Tjonneland, A., Halkjaer, J., Overvad, K., Stegger, J., Manjer, J., Lindkvist, B., Hallmanns, G., Stenling, R., Lund, E., Riboli, E., Gonzalez, C. A., Boeing, H. (2009). Anthropometry and Esophageal Cancer Risk in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol. Biomarkers Prev. 18: 2079-2089 [Abstract] [Full Text]  
• Pandeya, N., Williams, G. M., Sadhegi, S., Green, A. C., Webb, P. M., Whiteman, D. C. (2008). Associations of Duration, Intensity, and Quantity of Smoking with Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus. Am J Epidemiol 168: 105-114 [Abstract] [Full Text]  
• Doecke, J. D., Zhao, Z. Z., Stark, M. S., Green, A. C., Hayward, N. K., Montgomery, G. W., Webb, P. M., Whiteman, D. C., and for the Australian Cancer Study, (2008). Single Nucleotide Polymorphisms in Obesity-Related Genes and the Risk of Esophageal Cancers. Cancer Epidemiol. Biomarkers Prev. 17: 1007-1012 [Abstract] [Full Text]  
• Kendall, B J, Macdonald, G A, Hayward, N K, Prins, J B, Brown, I, Walker, N, Pandeya, N, Green, A C, Webb, P M, Whiteman, D C, for the Study of Digestive Health, (2008). Leptin and the risk of Barrett's oesophagus. Gut 57: 448-454 [Abstract] [Full Text]