Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus

Eric M. Nelsen, Yujiro Kirihara, Naoki Takahashi, Qian D Shi, Jason T. Lewis, Vikneswaran Namasivayam, Navtej Singh Buttar, Kelly T. Dunagan, Prasad G Iyer

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background & Aims: Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma. This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods: We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histologic score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation, and dysplasia. Results: All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. The GEJ fat area (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.3-27.7; P = .02), visceral fat area (OR, 4.9; 95% CI, 1.0-22.8; P = .04), and abdominal circumference (OR, 9.1; 95% CI, 1.4-57.2; P = 0.02) were associated with BE, independent of body mass index (BMI). The subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared with those without, P = .02) and high-grade dysplasia (compared with those without, P = .01), independent of BMI. Conclusions: GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and high-grade dysplasia in BE subjects, independent of BMI. Visceral fat therefore might promote esophageal metaplasia and dysplasia.

Original languageEnglish (US)
Pages (from-to)728-734
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume10
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Body Fat Distribution
Barrett Esophagus
Inflammation
Esophagogastric Junction
Intra-Abdominal Fat
Fats
Body Mass Index
Odds Ratio
Confidence Intervals
Esophagitis
Subcutaneous Fat
Metaplasia
Waist Circumference
Radiology
Endoscopy
Adipose Tissue
Adenocarcinoma
Logistic Models
Tomography

Keywords

  • CT imaging
  • Esophageal carcinoma
  • Obesity
  • Risk factor

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus. / Nelsen, Eric M.; Kirihara, Yujiro; Takahashi, Naoki; Shi, Qian D; Lewis, Jason T.; Namasivayam, Vikneswaran; Buttar, Navtej Singh; Dunagan, Kelly T.; Iyer, Prasad G.

In: Clinical Gastroenterology and Hepatology, Vol. 10, No. 7, 07.2012, p. 728-734.

Research output: Contribution to journalArticle

Nelsen, Eric M. ; Kirihara, Yujiro ; Takahashi, Naoki ; Shi, Qian D ; Lewis, Jason T. ; Namasivayam, Vikneswaran ; Buttar, Navtej Singh ; Dunagan, Kelly T. ; Iyer, Prasad G. / Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus. In: Clinical Gastroenterology and Hepatology. 2012 ; Vol. 10, No. 7. pp. 728-734.
@article{2991409683544b0f9916bc039f27c6fa,
title = "Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus",
abstract = "Background & Aims: Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma. This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods: We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histologic score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation, and dysplasia. Results: All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. The GEJ fat area (odds ratio [OR], 6.0; 95{\%} confidence interval [CI], 1.3-27.7; P = .02), visceral fat area (OR, 4.9; 95{\%} CI, 1.0-22.8; P = .04), and abdominal circumference (OR, 9.1; 95{\%} CI, 1.4-57.2; P = 0.02) were associated with BE, independent of body mass index (BMI). The subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared with those without, P = .02) and high-grade dysplasia (compared with those without, P = .01), independent of BMI. Conclusions: GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and high-grade dysplasia in BE subjects, independent of BMI. Visceral fat therefore might promote esophageal metaplasia and dysplasia.",
keywords = "CT imaging, Esophageal carcinoma, Obesity, Risk factor",
author = "Nelsen, {Eric M.} and Yujiro Kirihara and Naoki Takahashi and Shi, {Qian D} and Lewis, {Jason T.} and Vikneswaran Namasivayam and Buttar, {Navtej Singh} and Dunagan, {Kelly T.} and Iyer, {Prasad G}",
year = "2012",
month = "7",
doi = "10.1016/j.cgh.2012.03.007",
language = "English (US)",
volume = "10",
pages = "728--734",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Distribution of Body Fat and Its Influence on Esophageal Inflammation and Dysplasia in Patients With Barrett's Esophagus

AU - Nelsen, Eric M.

AU - Kirihara, Yujiro

AU - Takahashi, Naoki

AU - Shi, Qian D

AU - Lewis, Jason T.

AU - Namasivayam, Vikneswaran

AU - Buttar, Navtej Singh

AU - Dunagan, Kelly T.

AU - Iyer, Prasad G

PY - 2012/7

Y1 - 2012/7

N2 - Background & Aims: Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma. This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods: We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histologic score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation, and dysplasia. Results: All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. The GEJ fat area (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.3-27.7; P = .02), visceral fat area (OR, 4.9; 95% CI, 1.0-22.8; P = .04), and abdominal circumference (OR, 9.1; 95% CI, 1.4-57.2; P = 0.02) were associated with BE, independent of body mass index (BMI). The subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared with those without, P = .02) and high-grade dysplasia (compared with those without, P = .01), independent of BMI. Conclusions: GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and high-grade dysplasia in BE subjects, independent of BMI. Visceral fat therefore might promote esophageal metaplasia and dysplasia.

AB - Background & Aims: Increased waist circumference and visceral fat are associated with increased risk of Barrett's esophagus (BE) and esophageal adenocarcinoma. This association might be mediated by mechanical and endocrine mechanisms. We investigated the distribution of fat in subjects with BE and its association with esophageal inflammation and dysplasia. Methods: We collected data from 50 BE cases and 50 controls (matched for age and sex, identified from a radiology trauma database) seen at the Mayo Clinic in 2009. Abdominal (subcutaneous and visceral) and gastroesophageal junction (GEJ) fat area was measured using computed tomography with standard techniques. Esophageal inflammation (based on a histologic score) and dysplasia grade were assessed from esophageal biopsies of BE cases by a gastrointestinal pathologist. Conditional logistic regression was used to assess the association of body fat depot area with BE status, esophageal inflammation, and dysplasia. Results: All BE subjects had controlled reflux symptoms without esophagitis, based on endoscopy. The GEJ fat area (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.3-27.7; P = .02), visceral fat area (OR, 4.9; 95% CI, 1.0-22.8; P = .04), and abdominal circumference (OR, 9.1; 95% CI, 1.4-57.2; P = 0.02) were associated with BE, independent of body mass index (BMI). The subcutaneous fat area was not associated with BE. Visceral and GEJ fat were significantly greater in BE subjects with esophageal inflammation (compared with those without, P = .02) and high-grade dysplasia (compared with those without, P = .01), independent of BMI. Conclusions: GEJ and visceral fat are associated with BE, and with increased esophageal inflammation and high-grade dysplasia in BE subjects, independent of BMI. Visceral fat therefore might promote esophageal metaplasia and dysplasia.

KW - CT imaging

KW - Esophageal carcinoma

KW - Obesity

KW - Risk factor

UR - http://www.scopus.com/inward/record.url?scp=84862691710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862691710&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2012.03.007

DO - 10.1016/j.cgh.2012.03.007

M3 - Article

C2 - 22433923

AN - SCOPUS:84862691710

VL - 10

SP - 728

EP - 734

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 7

ER -