Ann Thorac Surg 2009;88:1728. doi:10.1016/j.athoracsur.2009.04.142
© 2009 The Society of Thoracic Surgeons
Correspondence
On the Association Between Body Mass Index and Barrett's Esophagus
Michael B. Cook, PhDa,
Darren C. Greenwood, PhDb,
Laura J. Hardie, PhDc,
David Forman, PhDd,
Christopher P. Wild, PhDe
a Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, EPS 5012, Rockville, MD 20852-7234
b Division of Biostatistics, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, LS2 9JT United Kingdom
c Molecular Epidemiology Unit, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, LS2 9JT United Kingdom
d Cancer Epidemiology Group, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, LS2 9JT United Kingdom
e International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon CEDEX 08, 69372 France
(Email: cookmich{at}mail.nih.gov; d.c.greenwood{at}leeds.ac.uk; laura.j.hardie{at}leeds.ac.uk; d.forman{at}leeds.ac.uk; director{at}iarc.fr).
To the Editor:
We read with interest the recent systematic review and meta-analysis of the association between body mass index (BMI) and Barrett's esophagus (BE) by Kamat and colleagues [1]. The authors found a positive association between increasing BMI and BE, and then proceeded to state: "Based on the results of eight studies that compared subjects with BE to population or hospital-based controls, there is a statistically significant association between BE and elevated BMI. This is in contrast to findings in a prior meta-analysis by Cook and colleagues [2] that did not find a statistically significant association between increasing adiposity and BE." This is incorrect. We undertook two meta-analyses of BE; one composed of studies with gastroesophageal reflux disease (GERD) controls and the other composed of studies with population-based controls [2]. The meta-analysis of BE compared with GERD controls produced an odds ratio (OR) of 0.99 per kg/m2 (95% confidence interval [CI]: 0.97–1.01; I
2 = 52%), whereas the meta-analysis of BE compared with population-based controls gave a pooled OR of 1.02 per kg/m2 (95% CI: 1.01–1.04; P = 0.002; I
2 = 0%) (Fig 1). This latter result is equivalent to an OR of 1.12 (95% CI: 1.05–1.20) for a 5-unit increase in BMI, which is similar, albeit slightly lower, than that reported by Kamat and colleagues [1]. The lack of association between BMI and BE when compared with GERD controls led us to speculate that the association between BMI and BE may be largely mediated by GERD. Further analyses, possibly from consortial efforts, may elucidate this relationship further.
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Fig 1. Forest plot of random effects meta-analysis of the association between body mass index (per kg/m2) and Barrett's esophagus when compared to general population controls.
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References
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- Kamat P, Wen S, Morris J, Anandasabapathy S. Exploring the association between elevated body mass index and barrett's esophagus: a systematic review and meta-analysis Ann Thorac Surg 2009;87:655-662.[Abstract/Free Full Text]
- Cook MB, Greenwood DC, Hardie LJ, Wild CP, Forman D. A systematic review and meta-analysis of the risk of increasing adiposity on barrett's esophagus Am J Gastroenterol 2008;103:292-300.[Medline]
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