Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus
Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus
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DOI：
10.1136/gut.2007.131375
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发表时间：
2008-02-01
期刊：
影响因子：
24.5
通讯作者：
Green, A. C.
中科院分区：
文献类型：
--
作者：
Whiteman, D. C.;Sadeghi, S.;Green, A. C.
目的：测量食道和胃-食管交界处腺癌与肥胖相关的相对风险，以及它们与年龄、性别、胃-食管反流症状和吸烟的相互作用。设计和背景：澳大利亚基于人群的病例对照研究。患者：食道腺癌患者（n = 367）或胃-食管交界处患者（n = 426）与从人群登记中抽样的对照参与者（n = 1580）进行比较。主要结局指标：食道或胃-食道交界处腺癌的相对危险度。结果：食管癌的发生风险随着体重指数（BMI）的增加而单调增加（p（趋势）< 0.001）。与“健康”BMI （18.5-24.9 kg/m(2)）相比，BMI bb0 = 40 kg/m(2)的风险最高（比值比(OR) = 6.1, 95% Cl = 2.7至13.6）。调整胃食管反流和其他因素可适度降低风险。与肥胖相关的风险在男性（OR = 2.6, 95% Cl 1.8至3.9）中明显高于女性（OR = 1.4, 95% Cl 0.5至3.5），在年龄为50岁的人群中（OR = 2.2, 95% Cl 1.5至3.1）。经常出现胃食管反流症状的肥胖者的风险（OR = 16.5, 95% Cl 8.9至30.6）明显高于肥胖但没有反流（OR = 2.2, 95% Cl 1.1至4.3）或反流但没有肥胖（OR = 5.6, 95% Cl 2.8至11.3）的人，这与这些因素之间的协同作用是一致的。胃-食管交界处腺癌也有类似的关联，但程度较小。结论：肥胖增加食管癌的风险独立于其他因素，尤其是男性。从临床角度来看，这些数据表明，肥胖和胃食管反流症状频繁的患者发生腺癌的风险特别高。
Objective: To measure the relative risks of adenocarcinomas of the oesophagus and gastro-oesophageal junction associated with measures of obesity, and their interactions with age, sex, gastro-oesophageal reflux symptoms and smoking.Design and setting: Population-based case-control study in Australia.Patients: Patients with adenocarcinomas of the oesophagus (n = 367) or gastro-oesophageal junction (n = 426) were compared with control participants (n = 1580) sampled from a population register.Main outcome measure: Relative risk of adenocarcinoma of the oesophagus or gastro-oesophageal junction.Results: Risks of oesophageal adenocarcinoma increased monotonically with body mass index (BMI) (p(trend) < 0.001). Highest risks were seen for BMI >= 40 kg/m(2) (odds ratio (OR) = 6.1, 95% Cl 2.7 to 13.6) compared with "healthy'' BMI (18.5-24.9 kg/m(2)). Adjustment for gastro-oesophageal reflux and other factors modestly attenuated risks. Risks associated with obesity were substantially higher among men (OR = 2.6, 95% Cl 1.8 to 3.9) than women (OR = 1.4, 95% Cl 0.5 to 3.5), and among those aged = 50 years (OR = 2.2, 95% Cl 1.5 to 3.1). Obese people with frequent symptoms of gastro-oesophageal reflux had significantly higher risks (OR = 16.5, 95% Cl 8.9 to 30.6) than people with obesity but no reflux (OR = 2.2, 95% Cl 1.1 to 4.3) or reflux but no obesity (OR = 5.6, 95% 2.8 to 11.3), consistent with a synergistic interaction between these factors. Similar associations, but of smaller magnitude, were seen for gastro-oesophageal junction adenocarcinomas.Conclusions: Obesity increases the risk of oesophageal adenocarcinoma independently of other factors, particularly among men. From a clinical perspective, these data suggest that patients with obesity and frequent symptoms of gastro-oesophageal reflux are at especially increased risk of adenocarcinoma.