Abdominal diameter index is a stronger predictor of prevalent Barrett's esophagus than BMI or waist-to-hip ratio

Abstract

Abdominal obesity is associated with gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE). Increased body mass index (BMI) and waist-to-hip ratio (WHR) have been associated with BE. Abdominal diameter index (ADI, sagittal abdominal diameter divided by thigh circumference) was previously shown to be a more accurate predictor of incident cardiovascular disease compared to other measurements. Our aim is to examine whether abdominal diameter index was a more accurate predictor of prevalent BE compared to other anthropometric measurements. We conducted a case-control study of patients presenting to our institution. Our study population was consecutive Caucasian men with a known history of BE, and we recruited control patients who had GERD without BE. Both groups completed a questionnaire about demographics, smoking, and medications and underwent a series of anthropometric body measurements using standardized measuring tools. BMI, waist-to-hip ratio, and abdominal diameter index were calculated. Thirty-one BE patients and 27 control patients were recruited. The BE cohort were older and had a higher rate of hiatal hernia. The mean abdominal diameter index for patients with BE was 0.65 ± 0.07 and without BE was 0.60 ± 0.07 (p = 0.01). The predictive value of abdominal diameter index was analyzed using a receiver-operator characteristic (ROC) curve and was a more powerful predictor of BE than waist-to-hip ratio or BMI (AUROC = 0.70 vs. 0.60 vs. 0.52, respectively). Using a cut-point abdominal diameter index value of 0.60, abdominal diameter index had a sensitivity of 77.4% and a specificity of 63.0% for the presence of BE. When controlling for age, smoking status, and BMI, an abdominal diameter index ≥0.60 was a significant independent risk factor for BE (OR = 5.7, 95% CI = 1.29-25.4). In this pilot study, the abdominal diameter index appears to be a more powerful predictor of the presence of BE than BMI and waist-to-hip ratio and remained the only significant predictor of BE in multivariate analysis. We propose further validation of abdominal diameter index before inclusion in future prediction tools for BE.

Epidemiologic Risk Factors in a Comparison of a Barrett Esophagus Registry (BarrettNET) and a Case–Control Population in Germany

“…However, our study showed no association between a higher BMI and the diagnosis of Barrett's esophagus, in correlation with our recent findings from the mouse model that Western diet is not only inducing obesity but also changing the gut microbiota and induces an accelerated inflammatory condition in the esophagus (34). Recently, the waist to hip ratio has been found to be more strongly associated with the risks of Barrett's esophagus and esophageal adenocarcinoma than BMI (35). However, waist and hip measurements were not assessed in this study.…”

The Medical Management of Gastroesophageal Reflux Disease: A Narrative Review

“… 7 , 10 More recent data suggests that the waist-to-hip ratio and abdominal diameter correlate better with esophageal acid exposure and risk of Barrett’s esophagus than BMI does. 11 , 12 This evidence is further supported by the fact that patients who achieve weight loss report a decrease in GERD symptoms. 9 …”

Obesity and Asthma: Key Clinical Questions

“…As an example, it is known that the mechanical effect of obesity on lung function is strongly associated with the central distribution of body fat. This fact is well known in cardiovascular diseases and was recently discussed in other types of disorders such as Barrett esophagus [10] and insulin resistance [11]. Barret esophagus was also associated with a subphenotype of asthma and obesity.…”