Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis
- PMID: 23707461
- PMCID: PMC3873801
- DOI: 10.1016/j.cgh.2013.05.009
Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis
Abstract
Background & aims: Central adiposity has been implicated as a risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), possibly promoting the progression from inflammation to metaplasia and neoplasia. We performed a systematic review and meta-analysis of studies to evaluate the association between central adiposity and erosive esophagitis (EE), BE, and EAC, specifically exploring body mass index (BMI)-independent and gastroesophageal reflux (GERD)-independent effects of central adiposity on the risk of these outcomes.
Methods: We performed a systematic search of multiple databases through March 2013. Studies were included if they reported effect of central adiposity (visceral adipose tissue area, waist-hip ratio, and/or waist circumference) on the risk of EE, BE, and EAC. Summary adjusted odds ratio (aOR) estimates with 95% confidence intervals (CIs), comparing highest category of adiposity with the lowest category of adiposity, were calculated by using random-effects model.
Results: Forty relevant articles were identified. Compared with patients with normal body habitus, patients with central adiposity had a higher risk of EE (19 studies; aOR, 1.87; 95% CI, 1.51-2.31) and BE (17 studies; aOR, 1.98; 95% CI, 1.52-2.57). The association between central adiposity and BE persisted after adjusting for BMI (5 studies; aOR, 1.88; 95% CI, 1.20-2.95). Reflux-independent association of central adiposity and BE was observed in studies that used GERD patients as controls or adjusted for GERD symptoms (11 studies; aOR, 2.04; 95% CI, 1.44-2.90). In 6 studies, central adiposity was associated with higher risk of EAC (aOR, 2.51; 95% CI, 1.54-4.06), compared with normal body habitus.
Conclusions: On the basis of a meta-analysis, central adiposity, independent of BMI, is associated with esophageal inflammation (EE), metaplasia (BE), and neoplasia (EAC). Its effects are mediated by reflux-dependent and reflux-independent mechanisms.
Keywords: BE; BMI; Barrett's Esophagus; Barrett's esophagus; Body Habitus; CI; CT; EAC; EE; Esophageal Cancer; GERD; OR; RR; Visceral Fat; WC; WHR; aOR; adjusted odds ratio; body mass index; computed tomography; confidence interval; erosive esophagitis; esophageal adenocarcinoma; gastroesophageal reflux disease; odds ratio; relative risk; waist circumference; waist-hip ratio.
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Conflicts of interest
The authors disclose no conflicts.
Figures
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Comment in
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Weight Change and Weight Cycling Are Not Associated With Risk of Barrett's Esophagus.Clin Gastroenterol Hepatol. 2016 Dec;14(12):1839-1840. doi: 10.1016/j.cgh.2016.05.031. Epub 2016 Jun 2. Clin Gastroenterol Hepatol. 2016. PMID: 27264394 No abstract available.
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Reply.Clin Gastroenterol Hepatol. 2016 Dec;14(12):1840. doi: 10.1016/j.cgh.2016.07.005. Epub 2016 Jul 12. Clin Gastroenterol Hepatol. 2016. PMID: 27417575 No abstract available.
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