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Gut 56:1503-1511 doi:10.1136/gut.2006.116665
  • Oesophagus

Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study

  1. Audrey H H Merry1,
  2. Leo J Schouten1,
  3. R Alexandra Goldbohm2,
  4. Piet A van den Brandt3
  1. 1
    Department of Epidemiology, NUTRIM, Maastricht University, Maastricht, Netherlands
  2. 2
    Department of Food and Chemical Risk Analysis, TNO Quality of Life, Zeist, Netherlands
  3. 3
    Department of Epidemiology, NUTRIM, Maastricht University, Maastricht, Netherlands
  1. Audrey H H Merry, Maastricht University, PO Box 616, 6200 MD, Maastricht, Netherlands; audrey.merry{at}epid.unimaas.nl
  • Revised 23 February 2007
  • Accepted 27 February 2007
  • Published Online First 2 March 2007

Abstract

Background: In the last decades, the incidence of oesophageal and gastric cardia adenocarcinoma has increased rapidly in the Western world. We investigated the association between body mass index (BMI), height and risk of oesophageal and gastric cardia adenocarcinoma.

Methods: The Netherlands Cohort Study was initiated in 1986. All participants (n = 120 852), aged 55–69 years, completed a self administered questionnaire. Cases were identified through annual record linkage with the Netherlands Cancer Registry. After 13.3 years of follow-up, excluding the first follow-up year, complete data from 4552 subcohort members, 133 oesophageal and 163 gastric cardia adenocarcinomas were available for case-cohort analyses. Incidence rate ratios (RRs) and corresponding 95% confidence intervals were estimated using Cox proportional hazard models.

Results: The RRs (95% CI) of oesophageal adenocarcinoma were 1.40 (0.95 to 2.04) and 3.96 (2.27 to 6.88) for overweight (BMI 25.0–29.9 kg/m2) and obese subjects (BMI ⩾30.0 kg/m2), respectively, compared to subjects with normal weight (BMI 20.0–24.9 kg/m2). For gastric cardia adenocarcinoma, these RRs were 1.32 (0.94 to 1.85) and 2.73 (1.56 to 4.79). Also change in BMI during adulthood was positively associated with the risk of oesophageal and gastric cardia adenocarcinoma (p trend 0.001 and 0.02, respectively), while no association was found with BMI in early adulthood (p trend 0.17 and 0.17, respectively). None of the tumour types investigated was significantly associated with height.

Conclusions: These results confirm higher risks of oesophageal and gastric cardia adenocarcinoma with increasing BMI. This implies that the increasing prevalence of obesity may be one of the explanations for the rising incidence of oesophageal and gastric cardia adenocarcinoma in the Western world.

Footnotes

  • Grant support: This study was financially supported by the Dutch Cancer Society (UM 2006-3562).

  • Competing interests: None.

  • Abbreviations:
    BMI
    body mass index
    LOS
    lower oesophageal sphincter
    NOS
    not otherwise specified
    RR
    rate ratios