General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition

Abstract

General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.

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Affiliated Institutions

• Harvard University US
• Academy of Athens GR
• Cancer Research UK Oxford Centre GB
• Gobierno del Principado de Asturias ES
• Umeå University SE
• University of Cambridge GB
• Fondazione IRCCS Istituto Nazionale dei Tumori IT
• Centre international de recherche sur le cancer FR
• Centre de recherche en Epidémiologie et Santé des Populations FR
• Aarhus University DK
• Hellenic Health Foundation GR
• Basque Government ES
• Instituto de Investigación Biosanitaria de Granada ES
• Cancer Registry of Norway
• Danish Cancer Society DK
• Federico II University Hospital IT
• Azienda Usl 8 Arezzo IT
• Lund University SE
• University of Oxford GB
• Institut Català d'Oncologia ES
• Institut d'Investigació Biomédica de Bellvitge ES
• Karolinska Institutet SE
• Andalusian School of Public Health ES
• Biogipuzkoa Health Research Institute ES
• German Cancer Research Center DE
• Inserm FR
• Laboratoire d'études sur les monothéismes FR
• Skåne University Hospital SE
• Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública ES
• Italian institute for Genomic Medicine IT
• UiT The Arctic University of Norway
• Imperial College London GB
• MRC Epidemiology Unit GB
• University Medical Center Utrecht NL
• German Institute of Human Nutrition DE
• Folkhälsans Forskningscentrum FI
• National Institute for Public Health and the Environment NL
• Heidelberg University DE
• National and Kapodistrian University of Athens GR
• Piedmont Reference Center for Epidemiology and Cancer Prevention IT
• University of Malaya MY

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