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Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus
  1. D C Whiteman1,
  2. S Sadeghi1,2,
  3. N Pandeya1,2,
  4. B M Smithers3,
  5. D C Gotley3,
  6. C J Bain2,
  7. P M Webb1,
  8. A C Green1,
  9. for the Australian Cancer Study
  1. 1
    Queensland Institute of Medical Research, Brisbane, Australia
  2. 2
    School of Population Health, University of Queensland, Brisbane, Australia
  3. 3
    School of Medicine, University of Queensland, Brisbane, Australia
  1. Dr D C Whiteman, Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Queensland 4029, Australia; david.whiteman{at}


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 (n = 1580) sampled from a population register.

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

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

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  • The Australian Cancer Study: Oesophageal Cancer

  • Investigators : David C Whiteman MBBS, PhD; Penelope M Webb MA, D Phil; Adele C Green MBBS, PhD; Nicholas K Hayward PhD; Peter G Parsons PhD; David M Purdie PhD

  • Clinical collaborators: B Mark Smithers FRACS; David Gotley FRACS, PhD; Andrew Clouston FRCAP, PhD; Ian Brown FRCAP

  • Project manager: Suzanne Moore RN, MPH

  • Database: Karen Harrap BIT; Troy Sadkowski BIT

  • Research nurses: Suzanne O’Brien RN, MPH; Ellen Minehan RN; Deborah Roffe RN; Sue O’Keefe RN; Suzanne Lipshut RN; Gabby Connor RN; Hayley Berry RN; Frances Walker RN; Teresa Barnes RN; Janine Thomas RN; Linda Terry RN, MPH; Michael Connard BSc; Leanne Bowes BSc; MaryRose Malt RN; Jo White RN

  • Competing interests: None.

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