Abdominal obesity and gastroesophageal cancer risk: systematic review and meta-analysis of prospective studies.

Xuan Du,Bi-Min Shi,Khemayanto Hidayat

doi:10.1042/bsr20160474

Xuan Du, Bi-Min Shi + Show 1 more

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https://doi.org/10.1042/bsr20160474

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Abstract

To systematically and quantitatively review the relation of abdominal obesity, as measured by waist circumference (WC) and waist to hip ratio (WHR), to total gastroesophageal cancer, gastric cancer (GC), and esophageal cancer. PubMed and Web of Science databases were searched for studies assessing the association between abdominal obesity and gastroesophageal cancer (GC and/or esophageal cancer) up to August 2016. A random-effect model was used to calculate the summary relative risks (RRs) and 95% confidence intervals (CIs). Seven prospective cohort studies – one publication included two separate cohorts – from six publications were included in the final analysis. A total of 2130 gastroesophageal cancer cases diagnosed amongst 913182 participants. Higher WC and WHR were significantly associated with increased risk of total gastroesophageal cancer (WC: RR 1.68, 95% CI: 1.38, 2.04; WHR: RR 1.49, 95% CI: 1.19, 1.88), GC (WC: RR 1.48, 95% CI: 1.24, 1.78; WHR: 1.33, 95% CI: 1.04, 1.70), and esophageal cancer (WC: RR 2.06, 95% CI: 1.30, 3.24; WHR: RR 1.99, 95% CI: 1.05, 3.75).Findings from our subgroup analyses showed non-significant positive associations between gastric non-cardia adenocarcinoma (GNCA) and both measures of abdominal adiposity, while gastric cardia adenocarcinoma (GCA) was positively associated with WC but not with WHR. On analysis restricted to studies that adjusted for body mass index (BMI), WC was positively associated with GC and esophageal cancer, whereas WHR was positively associated with risk of GC only. Although limited, the findings from our meta-analysis suggest the potential role of abdominal obesity in the etiology of gastric and esophageal cancers.

Highlights

Esophageal cancer ranks eighth for cancer incidence and sixth for cancer death, while gastric cancer (GC) ranks fourth and second, respectively [1]
Higher waist circumference (WC) and waist to hip ratio (WHR) were significantly associated with increased risk of total gastroesophageal cancer (WC: relative risk (RR) 1.68, 95% confidence interval (CI): 1.38, 2.04; WHR: RR 1.49, 95% CI: 1.19, 1.88), GC (WC: RR 1.48, 95% CI: 1.24, 1.78; WHR: 1.33, 95% CI: 1.04, 1.70), and esophageal cancer (WC: RR 2.06, 95% CI: 1.30, 3.24; WHR: RR 1.99, 95% CI: 1.05, 3.75).Findings from our subgroup analyses showed non-significant positive associations between gastric non-cardia adenocarcinoma (GNCA) and both measures of abdominal adiposity, while gastric cardia adenocarcinoma (GCA) was positively associated with WC but not with WHR
On analysis restricted to studies that adjusted for body mass index (BMI), WC was positively associated with GC and esophageal cancer, whereas WHR was positively associated with risk of GC only

Summary

Introduction

Esophageal cancer ranks eighth for cancer incidence and sixth for cancer death, while gastric cancer (GC) ranks fourth and second, respectively [1]. Obesity may have contributed to the recent rise in gastric cardia carcinoma and esophageal adenocarcinoma (EAC) incidence over the past decades because the prevalence of obesity has increased dramatically at an accelerating and alarming rate during approximately the same time period [8,9]. According to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report from 2016, the association of general obesity, as measured by the body mass index (BMI), with esophageal cancer has been judged convincing by the panel [10], whereas the evidence for an association with GC has remained less conclusive [11]. Neither BMI differentiates between c 2017 The Author(s).

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