A prospective study of BMI and risk of oesophageal and gastric adenocarcinoma
Introduction
In 1991, Blot et al. noted a precipitous increase in the incidence of oesophageal adenocarcinoma (EADC) in the United States.1 Later updates from SEER2 and from other cancer registries suggest that EADC rates have increased in many parts of the Western world.3 Unfortunately, most patients with oesophageal cancer do not come to medical attention until the tumour has reached an advanced stage and therapy with curative intent is impossible.4
Gastric cardia adenocarcinoma incidence rates are also increasing in the United States (US),1 however the trend is not as sharp as with EADC. It is possible that some of this increase may be due to better subsite classification for gastric tumours rather than a true increase in incidence rates.5 Furthermore, most EADC and all gastric cardia adenocarcinomas occur near the gastro-oesophageal junction and may overgrow the junction, so pinpointing the site of tumour origin may not be possible. No current pathological, immunohistochemical or molecular techniques can accurately separate these two tumours, so misclassification does occur6 and some authors have suggested that the clinical, epidemiological, pathological and molecular features are similar enough that they may represent a single disease.7
Previous research on the association between BMI and EADC and gastric cardia adenocarcinoma has relied almost exclusively on case–control studies,8, 9, 10, 11, 12, 13 because the low incidence rates have precluded accruing sufficient case numbers in most cohorts. To our knowledge, only three prospective studies have examined the association.14, 15, 16 Two of these studies could not control for important potential confounders,14 such as cigarette smoking, and the other two had incomplete information on confounders.15, 16 All these studies have also relied primarily on categorical analyses of BMI and estimated the risks associated with being overweight or obese.12
Here, we prospectively examine the association between BMI and EADC, gastric cardia adenocarcinoma, and gastric non-cardia adenocarcinoma using the NIH-AARP Diet and Health Study cohort that has extensive information on potential confounders.
Section snippets
Study population
The establishment and recruitment procedures of the NIH-AARP Diet and Health study have been described.17 Briefly, between 1995 and 1996, a questionnaire eliciting information on demographic characteristics, dietary intake and health-related behaviours was mailed to 3.5 million AARP members. These members resided in six US states (California, Florida, Louisiana, New Jersey, North Carolina and Pennsylvania) and two metropolitan areas (Atlanta, Georgia and Detroit, Michigan) and were between 50
Results
Table 1 presents the cohort characteristics by BMI category. Less than 1% of the cohort had a BMI <18.5, and 35% of the cohort had a normal BMI between 18.5 and 25 at the time of the baseline interview. 43% of the cohort was overweight, 16% was obese and 6% were extremely obese, with a BMI over 35. Subjects with higher BMI were younger and had fewer years of education, smoked less, drank less alcohol and had less physical activity.
Table 2 presents both age and sex, and multivariate-adjusted
Discussion
We found a strong monotonically increasing association between BMI and the risk of oesophageal adenocarcinoma; compared to subjects with a normal BMI of 18.5–25, we saw significantly and progressively increased risk for subjects in BMI categories of 25–<30, 30–<35 and ⩾35. For gastric cardia adenocarcinoma, compared to our referent group, there was no increased risk for subjects with a BMI of 25–<30, but risk was significantly increased in subjects with BMIs of 30–<35 and for those with a BMI
Conflict of interest statement
None declared.
Acknowledgements
This research was supported in part by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health. Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University. Cancer incidence data from California were collected by the California Department of Health Services, Cancer Surveillance
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