Objective: Barrett's esophagus is associated with abdominal obesity. Adiponectin is a peptide that is secreted from adipocytes and circulates in three multimeric forms: low molecular weight (LMW), middle molecular weight (MMW), and high molecular weight (HMW). The anti-inflammatory effects of adiponectin are specific to individual multimers, with LMW being most anti-inflammatory. We postulated that circulating levels of adiponectin and its multimers would be associated with the risk of Barrett's esophagus.
Design: Cross-sectional study.
Setting: Outpatient clinic in North Carolina, U.S.A.
Patients: Cases of Barrett's esophagus and controls undergoing upper endoscopy for gastroesophageal reflux disease (GERD).
Main outcome measures: Adjusted odds ratios of plasma adiponectin levels and its multimers for Barrett's esophagus.
Results: There were 112 cases of Barrett's esophagus and 199 GERD controls. Total adiponectin was not associated with Barrett's esophagus (3rd tertile vs. 1st tertile adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] = 0.44, 1.78). High levels of LMW adiponectin were associated with a decreased risk of Barrett's esophagus (3rd tertile vs. 1st tertile aOR = 0.33; 95% CI = 0.16, 0.69), and a high LMW/total ratio appeared particularly inversely associated with Barrett's esophagus (3rd tertile vs. 1st tertile aOR = 0.27; 95% CI = 0.13, 0.58).
Conclusions: High levels of LMW adiponectin are associated with a decreased risk of Barrett's esophagus among patients with GERD. Further human studies are required to confirm these findings, and in vitro studies are needed to understand if there is a mechanism whereby adiponectin may affect Barrett's metaplasia.