Waist-to-Hip Ratio, but Not Body Mass Index, Is Associated With an Increased Risk of Barrett's Esophagus in White Men

doi:10.1016/j.cgh.2012.11.028

Clinical Gastroenterology and Hepatology

Volume 11, Issue 4, April 2013, Pages 373-381.e1

https://doi.org/10.1016/j.cgh.2012.11.028 Get rights and content

Background & Aims

Abdominal obesity increases the risk of gastroesophageal reflux disease (GERD) and also might contribute to the development of Barrett's esophagus (BE), although results are inconsistent. We examined the effects of waist-to-hip ratio (WHR) and body mass index (BMI) on the risk of BE and investigated whether race, GERD symptoms, or hiatus hernia were involved.

Methods

We conducted a case-control study using data from eligible patients who underwent elective esophagogastroduodenoscopy; 237 patients had BE and the other 1021 patients served as endoscopy controls. We also analyzed data and tissue samples from enrolled patients who were eligible for screening colonoscopies at a primary care clinic (colonoscopy controls, n = 479). All patients underwent esophagogastroduodenoscopy, completed a survey, and had anthropometric measurements taken. WHR was categorized as high if it was 0.9 or greater for men or 0.85 or greater for women. Data were analyzed with logistic regression.

Results

There was no association between BMI and BE. However, more patients with BE had a high WHR (92.4%) than endoscopy controls (79.5%) or colonoscopy controls (84.6%) (P < .001 and P = .008, respectively). In adjusted analysis, patients with BE were 2-fold more likely to have a high WHR than endoscopy controls (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.1–3.5), this association was stronger for patients with long-segment BE (OR, 2.81; 95% CI, 1.0–7.9). A high WHR was associated significantly with BE only in whites (OR, 2.5; 95% CI, 1.2–5.4), but not in blacks or Hispanics. GERD symptoms, hiatus hernia, or gastroesophageal valve flap grade could not account for the association.

Conclusions

High WHR, but not BMI, is associated with a significant increase in the risk of BE, especially long-segment BE and in whites. The association is not caused by GERD symptoms or hiatus hernia.

Section snippets

Study Population and Design

We performed a case-control study at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston, TX. To obtain the cases and controls, we first conducted 2 cross-sectional studies in subjects seeking health care at the MEDVAMC. In one cross-sectional study we recruited all eligible patients who were scheduled for an elective esophagogastroduodenoscopy (EGD) at MEDVAMC from February 15, 2008, to July 31, 2011, and for the second cross-sectional study we recruited patients eligible for

Enrollment

Among 1424 primary care patients who met the study criteria and were invited to undergo a screening colonoscopy and participate in our study, 580 subsequently were enrolled in the study (Figure 1). Among 1966 preliminarily eligible patients who presented for a scheduled EGD and were contacted by our study staff, 1735 were verified to fulfill the study inclusion and exclusion criteria, and 1346 were enrolled in the study (Figure 1). For this analysis, we further excluded 7 patients who withdrew

Discussion

Abdominal obesity as measured by high WHR (≥0.9 for males and ≥0.85 for females) is associated with a greater than 85% increase in BE risk. This effect is pronounced for the risk of long-segment but not short-segment BE. The high WHR–BE association seems to be limited only to whites. This association persists while adjusting for the confounding effects of age, sex, cigarette smoking, alcohol drinking, physical activity, and H pylori infection. The estimated effect was not explained by GERD

Acknowledgment

The authors would like to thank David Ramsey, Diana (Mica) Carney, Kristina Carter, Curtis Griffin, Bianca Easterly, Rhiannon Dodge, Dallese Jones, Annette Walder, and participating primary care doctors at the Michael E. DeBakey VA Medical Center (Drs Chen, Darvishi, Firmpong-Badu, Gupta, Hargraves, Hirani, Kadiyala, Koduri, Kolpakchi, and Kullama), without whom this research would not have been possible.

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A total of 3298 participants were included in the final analysis. Asian-specific BMI cut-offs were used to define BMI subgroups: underweight <18.5 kg/m², normal ≥18.5 to <24 kg/m² and overweight or obese ≥24 kg/m². Hazard ratios (HRs) and 95 % confidence intervals (95 %CIs) were estimated using the Cox proportional hazard model.
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Barrett's Esophagus (BE) is a well-recognized pre-malignant condition. Previous data indicate histologically confirmed BE frequency varies by ethnicity in the United States. However, clinical factor assessment to explain this has only occurred in a veteran population to date. The study aim was to determine which clinical factors may be associated with the ethnic variation seen in histologically confirmed BE among a general population.
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: Conflicts of interest The authors disclose no conflicts.

: Funding Supported in part by National Institutes of Health grant National Cancer Institute R01 116845, the Houston VA HSR&D Center of Excellence (HFP90-020), and the Texas Digestive Disease Center National Institutes of Health (DK58338). Also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24-04-107 to H.B.E.-S.). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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Original articleAlimentary tractWaist-to-Hip Ratio, but Not Body Mass Index, Is Associated With an Increased Risk of Barrett's Esophagus in White Men

Background & Aims

Methods

Results

Conclusions

Section snippets

Study Population and Design

Enrollment

Discussion

Acknowledgment

Am J Gastroenterol

Gastroenterology

Ann Thorac Surg

Gastroenterology

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastroenterology

Am J Gastroenterol

Am J Gastroenterol

Clin Gastroenterol Hepatol

Gastroenterology

Gastroenterology

Increasing incidence of Barrett's oesophagus in the general population

Gut

Demographic variations in the rising incidence of esophageal adenocarcinoma in white males

Cancer

Prognostic influence of Barrett's oesophagus and Helicobacter pylori infection on healing of erosive gastro-oesophageal reflux disease (GORD) and symptom resolution in non-erosive GORD: report from the ProGORD study

Gut

Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms

Digestion

Incidence of adenocarcinoma among patients with Barrett's esophagus

N Engl J Med

Original article
Alimentary tract
Waist-to-Hip Ratio, but Not Body Mass Index, Is Associated With an Increased Risk of Barrett's Esophagus in White Men