Ai Kubo

Body Mass Index and Adenocarcinomas of the Esophagus or Gastric Cardia: A Systematic Review and Meta-analysis

Background: The incidence of esophageal adenocarcinoma has increased markedly in recent decades in many countries. Obesity is a potential risk factor, although the results of individual studies differ. We did a systematic review and statistical synthesis of studies that evaluated the association between body mass index (BMI) and the risk of esophageal adenocarcinoma or the adjacent gastric cardia adenocarcinoma. Methods: We identified potential studies using Medline, the Web of Science database, a manual review of the literature and expert bibliographies. Studies were included if they reported (a) a measure of body mass; (b) the occurrence of esophageal or cardia adenocarcinoma diagnosis; and (c) a relative risk or odds ratio (OR) with confidence intervals (CI) or provided sufficient data to permit their calculation. Results: We identified 14 studies (2 cohort, 12 case-control; 2,488 esophageal and 2,509 cardia adenocarcinomas). A high BMI (>25) was associated with an increased risk of esophageal adenocarcinoma (males, OR, 2.2; 95% CI, 1.7-2.7; females, OR, 2.0; 95% CI, 1.4-2.9). Higher levels of BMI were associated with increased risk (overweight males, OR, 1.8; 95% CI, 1.5-2.2; obese males, OR, 2.4; 95% CI, 1.9-3.2). The overall associations with cardia cancer were heterogeneous, although stratification by study location provided homogeneous results for populations from the United States or Europe. A high BMI was weakly associated with the risk of cardia adenocarcinoma (OR, 1.5; 95% CI, 1.3-1.8; Pheterogeneity = 0.38). Conclusions: Pooled results from observational studies support a positive association between high BMI and the risk for esophageal and possibly for cardia adenocarcinoma. (Cancer Epidemiol Biomarkers Prev 2006;15(5):872–8)

Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis.

BACKGROUND:Gastroesophageal reflux disease (GERD) is a common cause of morbidity and health-care utilization in many countries. Obesity is a potentially modifiable risk factor, but existing studies have conflicting results, possibly due to differences in study design, definitions, or populations.METHODS:We performed a systematic review and meta-analysis of studies identified using MEDLINE, the Web of Science electronic database, manual literature review, and a review of expert bibliographies. Studies were included if they: (1) evaluated obesity, body mass index (BMI), or another measure of body size; (2) included data on reflux symptoms, esophagitis, or a GERD-related hospitalization; and (3) reported a relative risk or odds ratio (OR) with confidence intervals or provided sufficient data to permit their calculation.RESULTS:We identified 20 studies that included 18,346 patients with GERD. Studies from the United States demonstrated an association between increasing BMI and the presence of GERD (95% confidence interval [CI] = 1.36–1.80, overweight, OR = 1.57, P value homogeneity = 0.51, 95% CI = 1.89–2.45, obese, OR = 2.15, P = 0.10). Studies from Europe provided heterogeneous results despite stratification for several factors; individual studies demonstrated both positive associations and no association.CONCLUSIONS:This analysis demonstrates a positive association between increasing BMI and the presence of GERD within the United States; this relationship became apparent only after stratification by country and level of BMI. These results support the evaluation of weight reduction as a potential therapy for GERD. Further studies are needed to evaluate potential mechanisms and any differences in this relationship among different study populations.

Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms

Objective: To evaluate the associations between abdominal obesity and gastro-oesophageal reflux disease (GORD), and their interactions with ethnicity and gender. Design: A cross-sectional study. Participants completed detailed symptom questionnaires and underwent a standardised examination, including anthropometric measurements. Setting: A large integrated healthcare system. Patients: 80 110 members of the Kaiser Permanente multiphasic health check-up cohort. Main outcome measures: Gastro-oesophageal reflux-type symptoms. Results: Recent reflux-type symptoms were present in 11% of the population. The multivariate OR for symptoms with an abdominal diameter (adjusted for body mass index (BMI)) of ⩾26 vs <16.3 cm was 1.85 (95% CI 1.55 to 2.21) for the white population, 0.95 (95% CI 0.61 to 1.48) for the black population and 0.64 (95% CI 0.18 to 2.30) for Asians. The mean abdominal diameter was greater in men (22.0 cm, 95% CI 21.9 to 22.0) than in women (20.1 cm, 95% CI 20.0 to 20.1, p<0.01), but the risk of symptoms for any given diameter did not differ markedly by gender. The association between increasing BMI and symptoms was also much stronger among the white population than among the black population. The association between BMI and reflux-type symptoms was partially mediated through abdominal diameter. Conclusions: There was a consistent association between abdominal diameter (independent of BMI) and reflux-type symptoms in the white population, but no consistent associations in the black population or Asians. The BMI association was also strongest among the white population. These findings, combined with the increased prevalence of abdominal obesity in male subjects, suggest that an increased obesity may disproportionately increase GORD-type symptoms in the white population and in male subjects.

Abdominal Obesity and the Risk of Esophageal and Gastric Cardia Carcinomas

Background: Esophageal adenocarcinoma is rapidly increasing in incidence. Body mass index (BMI) is a risk factor, but its distribution does not reflect the demographic distribution of the cancer (which is highest among White men). Abdominal obesity patterns may explain this discordance, but no studies exist to date. Methods: Nested case-control study within 206,974 members of the Kaiser Permanente multiphasic health checkup cohort; subjects received detailed questionnaires, a standardized examination including BMI and anthropometric measurements, and follow-up of esophageal and cardia cancers using registry data. Results: 101 incident esophageal adenocarcinomas, 105 cardia adenocarcinomas, and 144 esophageal squamous cell carcinomas were detected (BMI data available for all cases; abdominal measurements for a subset). Increasing abdominal diameter was strongly associated with an increased risk of esophageal adenocarcinoma [odds ratio (OR), 3.47; 95% confidence interval (95% CI), 1.29-9.33; abdominal diameter, ≥25 versus <20 cm]. Adjustment for BMI did not diminish this association (BMI-adjusted OR, 4.78; 95% CI, 1.14-20.11). The association was also not diminished by adjustment for gastroesophageal reflux-type symptoms, although reflux-type symptoms were separately associated with both abdominal diameter and cancer risk. Abdominal diameter was not associated with the risk of cardia adenocarcinomas (OR, 1.28; 95% CI, 0.38-4.25; diameter, ≥25 versus <20 cm) or esophageal squamous cell carcinomas (OR, 0.78; 95% CI, 0.32-1.92). Conclusions: Increasing abdominal diameter was associated with an increased risk of esophageal adenocarcinoma, independent of BMI. Cancer risk was not substantially mediated through gastroesophageal reflux-type symptoms, although symptoms may imperfectly measure reflux severity. Given abdominal obesity is more common among males, these findings suggest that increases in obesity may disproportionately increase the risk of esophageal adenocarcinoma in males. (Cancer Epidemiol Biomarkers Prev 2008;17(2):352–8)

Race, ethnicity, sex and temporal differences in Barrett’s oesophagus diagnosis: a large community-based study, 1994–2006

Objective: To evaluate the demographics and incidence of Barrett’s oesophagus diagnosis using community-based data. Design: Observational study. Setting: Kaiser Permanente, Northern California healthcare membership, 1994–2006. Patients: Members with an electronic diagnosis of Barrett’s oesophagus. Main outcome measures: Incidence and prevalence of a new Barrett’s oesophagus diagnosis by race, sex, age and calendar year. Results: 4205 persons met the study definition for a diagnosis of Barrett’s oesophagus. The annual incidence in 2006 was highest among non-Hispanic whites (39/100 000 race-specific member-years, 95% confidence interval (95% CI) 35 to 43), with lower rates among Hispanics (22/100 000, 95% CI 16 to 29), Asians (16/100 000, 95% CI 11 to 22), and blacks (6/100 000, 95% CI 2 to 12). The annual incidence was higher among men than women (31 vs 17/100 000, respectively, year 2006; p<0.01). The incidence increased with age from 2 per 100 000 for persons aged 21–30 years, to a peak of 31 per 100 000 member-years for persons aged 61–70 years (year 2006). There was no increase in the incidence of new diagnoses until the last two observation years, which coincided with changes in data collection methods and may be due to bias. The overall prevalence among active members increased almost linearly to 131/100 000 member-years by 2006. Conclusions: The demographic distributions of Barrett’s oesophagus differ markedly by race, age and sex and were comparable to those for oesophageal adenocarcinoma. Thus, demographic disparities in oesophageal adenocarcinoma risk may arise partly from the risk of having Barrett’s oesophagus, rather than from differing risks of progression from Barrett’s oesophagus to cancer. There has been an almost linear increase in the prevalence of diagnosed disease.

Helicobacter Pylori Infection and the Risk of Barrett's Oesophagus: A Community-Based Study

Objective: Gastric colonisation with the Helicobacter pylori bacterium is a proposed protective factor against oesophageal adenocarcinoma, but its point of action is unknown. Its associations with Barrett’s oesophagus, a metaplastic change that is a probable early event in the carcinogenesis of oesophageal adenocarcinoma, were evaluated Methods: A case–control study was carried out in the Kaiser Permanente Northern California population, a large health services delivery organisation. Persons with a new Barrett’s oesophagus diagnosis (cases) were matched to subjects with gastro-oesophageal reflux disease (GORD) without Barrett’s oesophagus and to population controls. Subjects completed direct in-person interviews and antibody testing for H pylori and its CagA (cytotoxin-associated gene product A) protein. Results: Serological data were available on 318 Barrett’s oesophagus cases, 312 GORD patients and 299 population controls. Patients with Barrett’s oesophagus were substantially less likely to have antibodies for H pylori (OR = 0.42, 95% CI 0.26 to 0.70) than population controls; this inverse association was stronger among those with lower body mass indexes (BMIs <25, OR = 0.03, 95% CI 0.00 to 0.20) and those with CagA+ strains (OR = 0.08, 95% CI 0.02 to 0.35). The associations were diminished after adjustment for GORD symptoms. The H pylori status was not an independent risk factor for Barrett’s oesophagus compared with the GORD controls. Conclusions: Helicobacter pylori infection and CagA+ status were inversely associated with a new diagnosis of Barrett’s oesophagus. The findings are consistent with the hypothesis that H pylori colonisation protects against Barrett’s oesophagus and that the association may be at least partially mediated through GORD.

Alcohol types and sociodemographic characteristics as risk factors for Barrett's esophagus.

BACKGROUND & AIMS Little is known about the effects of alcohol use and sociodemographics on the risk of Barretts esophagus, a precursor to esophageal adenocarcinoma. We evaluated the association between alcohol use, alcohol type, sociodemographic profiles, other lifestyle factors, and the risk of Barretts esophagus. METHODS With the use of a case-control study within the Kaiser Permanente Northern California membership, patients with a new diagnosis of Barretts esophagus (n = 320) diagnosed between 2002 and 2005 were matched to persons with gastroesophageal reflux disease (GERD; n = 316) and to population controls (n = 317). We collected information using validated questionnaires during direct in-person interviews. Analyses used multivariate unconditional logistic regression. RESULTS Total alcohol use was not significantly associated with the risk of Barretts esophagus, although stratification by beverage type showed an inverse association for wine drinkers compared with nondrinkers (>/=7 drinks of wine per week vs none: odds ratio, 0.44; 95% confidence interval, 0.20-0.99; multivariate analysis). Among population controls, those who preferred wine were more likely to have college degrees and regularly take vitamin supplements than those who preferred beer or liquor, although adjustment for these factors or GERD symptoms did not eliminate the inverse association between wine consumption and Barretts esophagus. Education status was significantly inversely associated with the risk of Barretts esophagus. CONCLUSIONS There are associations between alcohol types, socioeconomic status, and the risk of Barretts esophagus. Although choice of alcoholic beverages was associated with several factors, multiple adjustments (including for GERD) did not eliminate the association between alcohol and Barretts esophagus. Further research to evaluate the associations among socioeconomic status, GERD, and Barretts esophagus is warranted.

Pilot Survey of HIV Risk and Contextual Problems and Issues In Mexican/Latino Migrant Day Laborers

A preliminary survey was conducted with 102 migrant day laborers (MDLs) to assess HIV risk and related contextual problems and issues. These men were primarily Mexican, of low SES background, low in acculturation to the United States, and their income ranged from

Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium

100 and

Dietary Antioxidants, Fruits, and Vegetables and the Risk of Barrett's Esophagus

400 a week, 40% of which is sent back home. The psychosocial context of HIV risk included concerns expressed about lack of money and employment, followed by racism, social isolation, sadness and loneliness. High rates of alcohol use and binge drinking that co-occur with sexual activities were reported. While only 7% of MDLs reported illegal injection drug use, needles were frequently shared without bleach cleaning. Men generally did not carry condoms and knowledge of proper condom use was poor. For the most common form of sex reported, vaginal sex, condom use was infrequent. However, men did report confidence in being able to insist on condom use in challenging sexual situations, and they also reported fairly frequent pro-condom attitudes and behaviors within their social circles. Slightly over half of the men reported sexual activity with female partners, during the past 2 months. These female partners were almost evenly divided into regular sex partners, including spouses, and riskier partners such as one time only sex partners, prostitutes, and multiple sex partners. Results also indicated encouraging efforts by MDLs to reduce risk with risky partners (e.g., more condom use).