Abstract
Background and aimObesity is a risk factor for both Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). However, it is unclear whether obesity drives the malignant progression of BE. We aimed to assess whether obesity is associated with high-grade dysplasia (HGD) or cancer in patients with BE. MethodsWe searched MEDLINE and EMBASE from inception through April 2024 for studies reporting the effect of body mass index (BMI) on the progression of non-dysplastic BE or low-grade dysplasia (LGD) to HGD or EAC. A two-stage dose response meta-analysis was performed to estimate the dose-response relationship between BMI with malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered (PROSPERO ID CRD42017051046). ResultsTwenty studies reported data on 38565 patients (74.4% male) in total, of whom 1684 patients were diagnosed with HGD/cancer. Nineteen studies were considered moderate to high quality. Eight cohort studies reported data on 6647 male patients with baseline NDBE/LGD, of whom 555 progressed to HGD/EAC (pooled annual rate of progression 0.02%; 95% CI 0.01%-0.03%) and 1992 female patients with baseline NDBE/LGD with 110 progressors (pooled annual rate of progression 0.01%; 95% CI 0.01%-0.02%). There was no significant difference in pooled annual rate of progression between males and females (p=0.15). Each 5kg/m2 increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted OR 1.06; 95% CI 1.02-1.10; p<0.001; I2=0%). ConclusionOur meta-analysis provides some evidence that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. This finding requires confirmation in future high-quality cohort studies. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BE.
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