Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study

Abstract

Background: In the last decades, the incidence of oesophageal and gastric cardia adenocarcinoma has increased rapidly in the Western world. We investigated the association between body mass index (BMI), height and risk of oesophageal and gastric cardia adenocarcinoma. Methods: The Netherlands Cohort Study was initiated in 1986. All participants (n = 120 852), aged 55-69 years, completed a self administered questionnaire. Cases were identified through annual record linkage with the Netherlands Cancer Registry. After 13.3 years of follow-up, excluding the first follow-up year, complete data from 4552 subcohort members, 133 oesophageal and 163 gastric cardia adenocarcinomas were available for case-cohort analyses. Incidence rate ratios (RRs) and corresponding 95% confidence intervals were estimated using Cox proportional hazard models. Results: The RRs (95% CI) of oesophageal adenocarcinoma were 1.40 (0.95 to 2.04) and 3.96 (2.27 to 6.88) for overweight (BMI 25.0-29.9 kg/m 2 ) and obese subjects (BMI >30.0 kg/m 2 ), respectively, compared to subjects with normal weight (BMI 20.0-24.9 kg/m 2 ). For gastric cardia adenocarcinoma, these RRs were 1.32 (0.94 to 1.85) and 2.73 (1.56 to 4.79). Also change in BMI during adulthood was positively associated with the risk of oesophageal and gastric cardia adenocarcinoma (p trend 0.001 and 0.02, respectively), while no association was found with BMI in early adulthood (p trend 0.17 and 0.17, respectively). None of the tumour types investigated was significantly associated with height. Conclusions: These results confirm higher risks of oesophageal and gastric cardia adenocarcinoma with increasing BMI. This implies that the increasing prevalence of obesity may be one of the explanations for the rising incidence of oesophageal and gastric cardia adenocarcinoma in the Western world.

Gastric Cardia Cancer: How Much Is It from Fat?

“…A Netherlands-based study showed that the relative risk (RR) for GCA in overweight (BMI 25-29.9 kg/m 2 ) and obese (BMI C 30 kg/m 2 ) subjects was 1.32 (95 % CI 0.94-1.85) and 2.73 (95 % CI 1.56-4.79), respectively, as compared to normal weight subjects (BMI 20-24.9 kg/m 2 ). This study also showed that an increase in BMI in adulthood since age 20 was associated with significantly increased risk of ECA and GCA (P trend 0.001 and 0.02, respectively) [16]. A US-population-based cohort study of half a billion people from 1995-1996 to 2003 was consistent with the earlier case-control studies and reported a hazard ratio (HR) of 2.46 (95 % CI 1.6-3.8) for GCA with BMI C 35 kg/m 2 as compared to BMI of 18.5-25 kg/m 2 .…”

“…It has also been shown that not only does obesity increase the risk of cancer, the increase in BMI with age in adulthood is associated with increase in incidence of GCA and ECA [16]. Hence it would be interesting to see if weight reduction leads to a decrease in incidence of GAC or EAC.…”

Adenocarcinoma of the esophagogastric junction: Do we see more or less?

“…15 This conclusion was further supported by a meta-analysis. 16 The complex interaction of all these changing factors in different countries might be the underlying causes of the changing pattern of EGJ adenocarcinoma.…”

Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: A population-based study in the Netherlands

“…18,19 The rise in cardia carcinoma still cannot be explained, although obesity seems to be of influence. 20 In the Netherlands and some countries, however, previous studies showed no increase in the incidence of cardia cancer. 21,22 Our results confirm this, although in the most recent period a small proportional rise was seen in cardia carcinoma.…”