Review and Meta-Analysis of the Risk of Increasing Adiposity on BE
Review and Meta-Analysis of the Risk of Increasing Adiposity on BE
Objectives: Esophageal adenocarcinoma and its precursor lesion, Barrett's esophagus, are increasing in incidence in western populations.Gastroesophageal reflux disease (GERD) and high body mass index (BMI)are known risk factors, but it is unclear whether BMI mediates its riskon Barrett's esophagus independently. This systematic review and meta-analysis investigated whether increasing BMI is associated with Barrett's esophagus as compared to general population and GERD controls.
Methods: Search strategies were conducted in MEDLINE (U.S. National Library of Medicine, Bethesda, MD) (1966-2005) and EMBASE (Reed Elsevier PLC,Amsterdam, The Netherlands) (1980-2005). Studies to be included were required to present "current" BMI data for consecutively recruited Barrett's esophagus patients and appropriate comparison arms with a minimum number of 30 subjects in each.
Results: The literature search produced 5,501 hits from which 295 papers were extracted. Only 10 studies met the criteria for inclusion. The Statistics/Data Analysis(STATA) program was used to conduct random effects meta-analyses. Nine studies comparing the BMI of the Barrett's esophagus and GERD groups produced a pooled odds ratio (OR) of 0.99 per kg/m (95% confidence interval [CI] 0.97-1.01, I= 52%), while the pooled estimate of three studies comparing Barrett's esophagus with general population controls was 1.02 per kg/m (95% CI 1.01-1.04, I = 0%).
Conclusions:Increasing adiposity is only an indirect risk factor of Barrett's esophagus through the precursor lesion of GERD. Hence, BMI status has no predictive value with respect to GERD patients and their risk of progression to Barrett's esophagus.
Barrett's esophagus is a metaplastic lesion usually confined to the lower region of the esophagus, which substantially increases the risk of developing esophageal adenocarcinoma. Estimates of risk of progression tomalignancy are approximately 0.5-1% per annum (1, 2). The strongest associated risk factor of this precancerous condition is gastroesophageal reflux disease (GERD) (3).Frequent exposure to caustic refluxate erodes the regular squamousepithelium, which maysubsequently be replaced with the gobletcell-containing metaplasia termed Barrett's esophagus (4).
The increasing incidence of esophageal adenocarcinoma in white populations is well documented (5). Recent evidence also suggests that the incidence of Barrett's esophagus is following a similar pattern in these populations (6, 7).In addition, a progressive imbalance in the sex ratio throughout the progression from reflux disease, Barrett's esophagus, and on to esophageal adenocarcinoma has been confirmed (8). Of relevance to these observations is the obesity pandemic (9). In England, the prevalence of obesity has tripled in 20 years and continues to rise (10). Excess adiposity is a known risk factor of much morbidity, including several cancers (11). The prevalence of obesity has increased at similar rates in parts of Europe and the United States (12, 13).
Recent meta-analyses published statistically significant pooled risk estimates for overweight and obese groups for the development of GERD and esophageal adenocarcinoma (14, 15).Previous studies have not been able to investigate the risk of increasing adiposity on Barrett's esophagus due to the paucity of such data and the failure of any to meet the eligibility criterion of having a general population control group.
The present study is aimed to investigate the effect of body mass index (BMI) on risk of Barrett's esophagus by comparison with GERD controls as well as general population controls. Increasing BMI is already known to be a risk factor of GERD (14), which itself is a risk factor of Barrett's esophagus (3).It is unknown whether the increased risk for Barrett's esophagus associated with BMI is mediated by GERD directly or whether there is an elevated risk regardless of reflux. This study aimed to investigate these questions by conducting meta-analyses of the BMI of Barrett's esophagus patients compared with that of both GERD patients and general population controls.
Objectives: Esophageal adenocarcinoma and its precursor lesion, Barrett's esophagus, are increasing in incidence in western populations.Gastroesophageal reflux disease (GERD) and high body mass index (BMI)are known risk factors, but it is unclear whether BMI mediates its riskon Barrett's esophagus independently. This systematic review and meta-analysis investigated whether increasing BMI is associated with Barrett's esophagus as compared to general population and GERD controls.
Methods: Search strategies were conducted in MEDLINE (U.S. National Library of Medicine, Bethesda, MD) (1966-2005) and EMBASE (Reed Elsevier PLC,Amsterdam, The Netherlands) (1980-2005). Studies to be included were required to present "current" BMI data for consecutively recruited Barrett's esophagus patients and appropriate comparison arms with a minimum number of 30 subjects in each.
Results: The literature search produced 5,501 hits from which 295 papers were extracted. Only 10 studies met the criteria for inclusion. The Statistics/Data Analysis(STATA) program was used to conduct random effects meta-analyses. Nine studies comparing the BMI of the Barrett's esophagus and GERD groups produced a pooled odds ratio (OR) of 0.99 per kg/m (95% confidence interval [CI] 0.97-1.01, I= 52%), while the pooled estimate of three studies comparing Barrett's esophagus with general population controls was 1.02 per kg/m (95% CI 1.01-1.04, I = 0%).
Conclusions:Increasing adiposity is only an indirect risk factor of Barrett's esophagus through the precursor lesion of GERD. Hence, BMI status has no predictive value with respect to GERD patients and their risk of progression to Barrett's esophagus.
Barrett's esophagus is a metaplastic lesion usually confined to the lower region of the esophagus, which substantially increases the risk of developing esophageal adenocarcinoma. Estimates of risk of progression tomalignancy are approximately 0.5-1% per annum (1, 2). The strongest associated risk factor of this precancerous condition is gastroesophageal reflux disease (GERD) (3).Frequent exposure to caustic refluxate erodes the regular squamousepithelium, which maysubsequently be replaced with the gobletcell-containing metaplasia termed Barrett's esophagus (4).
The increasing incidence of esophageal adenocarcinoma in white populations is well documented (5). Recent evidence also suggests that the incidence of Barrett's esophagus is following a similar pattern in these populations (6, 7).In addition, a progressive imbalance in the sex ratio throughout the progression from reflux disease, Barrett's esophagus, and on to esophageal adenocarcinoma has been confirmed (8). Of relevance to these observations is the obesity pandemic (9). In England, the prevalence of obesity has tripled in 20 years and continues to rise (10). Excess adiposity is a known risk factor of much morbidity, including several cancers (11). The prevalence of obesity has increased at similar rates in parts of Europe and the United States (12, 13).
Recent meta-analyses published statistically significant pooled risk estimates for overweight and obese groups for the development of GERD and esophageal adenocarcinoma (14, 15).Previous studies have not been able to investigate the risk of increasing adiposity on Barrett's esophagus due to the paucity of such data and the failure of any to meet the eligibility criterion of having a general population control group.
The present study is aimed to investigate the effect of body mass index (BMI) on risk of Barrett's esophagus by comparison with GERD controls as well as general population controls. Increasing BMI is already known to be a risk factor of GERD (14), which itself is a risk factor of Barrett's esophagus (3).It is unknown whether the increased risk for Barrett's esophagus associated with BMI is mediated by GERD directly or whether there is an elevated risk regardless of reflux. This study aimed to investigate these questions by conducting meta-analyses of the BMI of Barrett's esophagus patients compared with that of both GERD patients and general population controls.
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