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A prospective cohort study of obesity and risk of oesophageal and gastric adenocarcinoma in the NIH–AARP Diet and Health Study
  1. Mark G O'Doherty1,2,
  2. Neal D Freedman2,
  3. Albert R Hollenbeck3,
  4. Arthur Schatzkin2,
  5. Christian C Abnet2
  1. 1Cancer Epidemiology Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, UK
  2. 2Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
  3. 3AARP, Washington, DC, USA
  1. Correspondence to Dr Mark G O'Doherty, Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, ICS-B Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK; m.odoherty{at}


Objective The incidence of oesophageal adenocarcinoma (EAC) has increased rapidly over the past 40 years and accumulating evidence suggests that obesity, as measured by body mass index (BMI), is a major risk factor. It remains unclear whether abdominal obesity is associated with EAC and gastric adenocarcinoma.

Design Cox proportional hazards regression was used to examine associations between overall and abdominal obesity with EAC and gastric adenocarcinoma among 218 854 participants in the prospective NIH–AARP cohort.

Results 253 incident EAC, 191 gastric cardia adenocarcinomas and 125 gastric non-cardia adenocarcinomas accrued to the cohort. Overall obesity (BMI) was positively associated with EAC and gastric cardia adenocarcinoma risk (highest (≥35 kg/m2) vs referent (18.5–<25 kg/m2); HR 2.11, 95% CI 1.09 to 4.09 and HR 3.67, 95% CI 2.00 to 6.71, respectively). Waist circumference was also positively associated with EAC and gastric cardia adenocarcinoma risk (highest vs referent; HR 2.01, 95% CI 1.35 to 3.00 and HR 2.22, 95% CI 1.43 to 3.47, respectively), whereas waist-to-hip ratio (WHR) was positively associated with EAC risk only (highest vs referent; HR 1.81, 95% CI 1.24 to 2.64) and persisted in patients with normal BMI (18.5–<25 kg/m2). Mutual adjustment of WHR and BMI attenuated both, but did not eliminate the positive associations for either with risk of EAC. In contrast, the majority of the anthropometric variables were not associated with adenocarcinomas of the gastric non-cardia.

Conclusion Overall obesity was associated with a higher risk of EAC and gastric cardia adenocarcinoma, whereas abdominal obesity was found to be associated with increased EAC risk; even in people with normal BMI.

  • Adenocarcinoma
  • alcohol
  • cancer epidemiology
  • diet
  • dietary factors
  • epidemiology
  • gastric adenocarcinoma
  • gastric cancer
  • gastrointestinal cancer
  • hepatocellular carcinoma
  • micronutrients
  • molecular epidemiology
  • nutrition
  • obesity
  • oesophageal cancer
  • tumour markers

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  • Funding This research was supported (in part) by the All-Ireland National Cancer Institute Cancer Consortium Joint Research Project in Cancer, supported by the Health and Social Care Research and Development Office (Belfast, Northern Ireland) and the Intramural Research Program of the National Institutes of Health, National Cancer Institute (Bethesda, Maryland, USA).

  • Competing interests None.

  • Ethics approval The NIH–AARP Diet and Health Study was approved by the Special Studies Institutional Review Board of the US National Cancer Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement To gain access to the NIH–AARP data the correct procedures and proposal application should be followed. Instructions are accessible via the website:

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