Association between Body Mass and Adenocarcinoma of the Esophagus and Gastric Cardia

Association between Body Mass and Adenocarcinoma of the Esophagus and Gastric Cardia

Jesper Lagergren, MD, PhD;
Reinhold Bergström, PhD; and
Olof Nyrén, MD, PhD

From Karolinska Institutet, Stockholm, Sweden; and Uppsala University, Uppsala, Sweden.

Abstract

Background: The incidence of esophageal and gastric cardia adenocarcinoma is, for unknown reasons, increasing dramatically. A weak and inconsistent association between body mass index (BMI) and adenocarcinoma of the esophagus and gastric cardia has been reported.

Objective: To reexamine the association between BMI and development of adenocarcinoma of the esophagus and gastric cardia.

Design: Nationwide, population-based case–control study.

Setting: Sweden, 1995 through 1997.

Patients: Patients younger than 80 years of age who had recently received a diagnosis were eligible. Comprehensive organization ensured rapid case ascertainment. Controls were randomly selected from the continuously updated population register. Interviews were conducted with 189 patients with adenocarcinoma of the esophagus and 262 patients with adenocarcinoma of the gastric cardia; for comparison, 167 patients with incident esophageal squamous-cell carcinoma and 820 controls were also interviewed.

Measurements: Odds ratios were determined from BMI and cancer case–control status. Odds ratios estimated the relative risk for the two adenocarcinomas studied and were calculated by multivariate logistic regression with adjustment for potential confounding factors.

Results: A strong dose-dependent relation existed between BMI and esophageal adenocarcinoma. The adjusted odds ratio was 7.6 (95% CI, 3.8 to 15.2) among persons in the highest BMI quartile compared with persons in the lowest. Obese persons (persons with a BMI > 30 kg/m²) had an odds ratio of 16.2 (CI, 6.3 to 41.4) compared with the leanest persons (persons with a BMI < 22 kg/m²). The odds ratio for patients with cardia adenocarcinoma was 2.3 (CI, 1.5 to 3.6) in those in the highest BMI quartile compared with those in the lowest BMI quartile and 4.3 (CI, 2.1 to 8.7) among obese persons. Esophageal squamous-cell carcinoma was not associated with BMI.

Conclusions: The association between BMI and esophageal adenocarcinoma is strong and is not explained by bias or confounding. The carcinogenic mechanism, however, remains to be clarified. The increasing prevalence of obesity in western countries could be important in understanding the increasing occurrence of this tumor.

Article and Author Information

Acknowledgments: The authors thank Leila Nyrén for coordination of the field work, Dr. Anders Lindgren for his review of all histopathologic material, and Dr. Wolfgang Kraaz for expert pathology guidance in the planning of the study and during the field work. They also thank the following physicians for acting as contact persons at the participating departments or providing invaluable input during the planning of this study: Bengt Åberg, Bo Ahlman, Örjan Ahrenstedt, Leif-Åke Åkesson, Stig-Olof Almgren, Per Almqvist, Nils-Axel Alsén, Mathias Ålund, Anders Alwmark, Christer Andersson, Lars Andréasson, Ulf Angerås, Åke Arwidi, Lars Backman, Björn Bäckstrand, Mikael Bech, Jan Bergman, Magnus Berne, Hlödur Bjarnasson, Anders Bjerkhed, Jan-Inge Björnberg, John Blomberg, Bernt Boeryd, Paul Boisen, Lars Boman, Anders Borgström, Mogens Bove, Mats Broberg, Stefan Cajander, Tora Cambell-Chiru, Hans Danielsson, Hilmi DeSai, Jan Dolata, Roger Edin, Kent Edin, Bengt Ekelund, Tom Ekstrand, Per Ekström, Lars-Krister Enander, Lennart Engström, Kerstin Erhart, Lars Eriksson, Thomas Eriksson, Sven-Börje Ewers, Jan Fagerberg, Mats Fagerberg, Anders Falk, Anders Faxén, Mats Fernström, Wolfgang Finkbeiner, Björn Fornander, Nils Forsby, Ulla Friberg, Kjell Furugård, Adel Gad, Ann Gawelin, Ole Grangaard, Lars Granström, Per Gullstrand, Olle Gunder, Peter Gunvén, Gunnar Gustafsson, Gustav Gustavsson, Hans Gustavsson, Sven Gustavsson, Göran Göransson, Mehmet Gözen, Tomas Hagerman, Ulf Haglund, Bengt Hallerbäck, Göran Hambreus, Erik Hammar, Ann Hammarlund, Lars-Erik Hammrström, Göran Hansson, Lennart Hardell, Lennart Hedenborg, Per Herlin, Lars-Erik Holmgren, Ivar Holmgren, Ulf Hyvönen, Hans-Olof Håkansson, Claes Höglund, Hans Högström, Gunnar Isaksson, Elisabeth Jansson, Roland Jansson, Pål-Henry Jeppsson, Karl-Erik Johansson, Sven Johansson, Leif Johansson, Leif Johansson, Göran Karlsson, Antii Kempas, Staffan Kinman, Ingvar Kjartanson, Gerhard Kjellén, Arne Kleberg, Per-Arne Kling, Jan Klos, Wieslava Krauze, Richard Kuylenstierna, Fredrik Kylberg, Anders Kylebäck, Peter Lannes, Lars-Göran Larsson, Sven Larsson, Carl-Erik Leijonmark, Freddi Lewin, Pontus Lidberg, Håkan Liljeholm, Tore Lind, Sten-Åke Lindahl, Jacob Lindhagen, Christer Lindholm, Karin Lindholm, Thomas Linné, Martin Ljungman, Otto Ljungberg, Mikael Ljungdahl, Thomas Lorenz, Bertil Lundberg, Kjell Lundberg, Sven Lundberg, Lars Lundell, Jan Lundgren, Lars Lundgren, Helge Lyckberg, Tord Magnusson, Jan Malina, Lennart Mannerberg, Joachim Mark, Ewa Mårtensson, Janusz Matusik, Lennart Mellbom, Claes Mercke, Anders Moberg, Hans Modig, Eva Munck-Wikland, Ingemar Näslund, Arthur Nathanson, Torben Navne, Anders Nihlberg, Klas Nilsell, Erik Nilsson, Kjell Nilsson, Lars Nilsson, Mats Nilsson, Ola Nilsson, Roland Nilsson, Arne Nordahl, Torgny Nordén, Bo Nordenskjöld, Stefan Öberg, Bengt Ohlander, Hans Öhman, Jan Öhman, Bo Ojen, Bengt Olsson, Håkan Olsson, Olle Olsson, Jan Oscarsson, Åke Öst, Görel Östberg, Jan Ovesen, Roland Pahlitzsch, Carl-Magnus Peterson, Karl-Iver Pettersson, Peter Pitkänen, Göran Rådberg, Ture Rådmark, Stig Ramel, Gunnar Rimsbäck, Björn Risberg, Jörgen Roed, Staffan Rosendahl, Sam Rotstein, Claes Rudberg, Lars Rudberg, Magnus Ruth, Rune Sandbu, Bengt Sandhammar, Ingemar Sandin, Björn Sandmark, José Santos, Runa Schedwin, Eric Secher, Ralf Segersvärd, Håkan Sellström, Charles Silseth, Göran Simert, Björn Sjöström, Johnny Sobin, Stefan Spinnell, Roger Stenling, Rolf Stjernman, Edit Stöckel, Dag Stockeld, Nils Stormby, Kaj Strid, Arild Stubberöd, Erik Svartholm, Conny Svensson, Jan-Olov Svensson, Anders Sylvan, Maria Sylvan, Kalev Teder, Kjell Thor, Lars Thulin, Orjan Tjernström, Torbjörn Tuvesson, Egil Tveit, Tadeusz Tyszkiewicz, Maciej Tytov, Sören Vallgren, Anders Victorin, Gunnar Wagenius, Torkel Wallin, Bruno Walther, Johan Wennerberg, Ingmar Wennström, Jens Wigermark, Olle Wihlborg, Bo Wikström, Erik Wilander, Bo Wilhelmsson, Roger Willén, and Mats Wirén.
Grant Support: By a grant from the National Cancer Institute (R01 CA57947-03), the Swedish Cancer Society, and the Dalarna Research Institute.
Requests for Reprints: Jesper Lagergren, Department of Medical Epidemiology, Karolinska Institutet, Box 281, S-171 77 Stockholm, Sweden; e-mail, Jesper.Lagergren{at}mep.ki.se.
Current Author Addresses: Drs. Lagergren and Nyrén: Department of Medical Epidemiology, Karolinska Institutet, Box 281, S-171 77 Stockholm, Sweden.
Dr. Bergström: Department of Statistics, Uppsala University, Box 513, S-751 20 Uppsala, Sweden.