Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium
- Ai Kubo1,
- Michael Blaise Cook2,
- Nicholas J Shaheen3,
- Thomas L Vaughan4,
- David C Whiteman5,
- Liam Murray6,
- Douglas A Corley1
- 1Division of Research, Northern California Kaiser Permanente, Oakland, California, USA
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, Maryland, USA
- 3Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
- 4Department of Epidemiology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- 5Department of Population and Cancer Studies, Queensland Institute of Medical Research, Brisbane, Queensland, USA
- 6School of Medicine, Belfast, Ireland
- Correspondence to Dr Ai Kubo, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA;
- Received 17 September 2012
- Revised 5 November 2012
- Accepted 7 December 2012
- Published Online First 26 January 2013
Objective Barrett's oesophagus is a precursor lesion of oesophageal adenocarcinoma, a cancer that, in the USA, has increased in incidence over 600% during the past 40 years. Barrett's oesophagus and oesophageal adenocarcinoma are much more common among men than among women; this finding is unexplained and most earlier studies lacked sufficient numbers of women to evaluate sex-specific risk factors. We leveraged the power of an international consortium to assess sex-specific relationships between body mass index (BMI), abdominal circumference and Barrett's oesophagus.
Design Four case–control studies provided a total of 1102 cases (316 women, 786 men) and 1400 population controls (436 women, 964 men) for analysis. Study-specific estimates, generated using individual participant data, were combined using random effects meta-analysis.
Results Waist circumference was significantly associated with Barrett's oesophagus, even after adjustment for BMI; persons in the highest versus the lowest quartiles of waist circumference had approximately 125% and 275% increases in the odds of Barrett's oesophagus among men and women, respectively (OR 2.24, 95% CI 1.08 to 4.65, I2=57; OR 3.75, 95% CI 1.47 to 9.56, I2=0). In contrast, there was no evidence of a significant association between BMI and the risk of Barrett's oesophagus, with or without adjustment for waist circumference.
Conclusions Waist circumference, independent of BMI, was found to be a risk factor for Barrett's oesophagus among both men and women. Future studies examining the biological mechanisms of this association will extend our knowledge regarding the pathogenesis of Barrett's oesophagus.