Patients with a high ratio of visceral abdominal fat to subcutaneous fat are more likely to develop Barrett’s esophagus, according to recent results.
In a case-control study, researchers evaluated 173 patients aged 40 to 80 years with Barrett’s esophagus (BE) along with 343 controls without BE who underwent colonoscopy and 172 who received endoscopy. All participants received esophagastroduoendoscopy, and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) surface areas were measured. Participants also responded to a survey on their GERD symptoms and use of alcohol, tobacco, proton pump inhibitors (PPI), nonsteroidal anti-inflammatory drugs, aspirin and H2 receptor antagonists.
Patients with BE had a larger median VAT surface area than controls who received colonoscopy (P=.006) and a borderline-significant larger surface area than controls who underwent endoscopy (P=.06). No significant difference was observed between groups regarding SAT surface area.
The median VAT to SAT ratio was greater among participants with BE than colonoscopy (P=.007) and endoscopy controls (P=.12). Investigators observed an association between a higher VAT/SAT ratio and BE risk after adjustment for confounders (aOR=1.47; 95% CI, 0.88-2.45 for the highest tertile vs. lowest). This association was especially pronounced among white males (aOR=2.12; 95% CI, 1.15-3.9 for highest tertile) and those with a BE segment of 3 cm or longer (aOR=1.93; 95% CI, 0.92-4.09).
Further adjustment for use of PPI and the presence of GERD symptoms attenuated the association between VAT/SAT ratio and risk for BE within the overall cohort, but not among white males (aOR=1.96; 95% CI, 0.97-3.97 for the highest tertile vs. lowest).
“This is the first large study to evaluate the distribution of abdominal fat compartments between BE cases and appropriate controls,” the researchers wrote. “We found that visceral abdominal obesity measured as the ratio of VAT to SAT surface areas on mid-abdomen CT scan imaging was associated with a significantly increased risk of having BE. The association between BE and abdominal obesity was specific to visceral but not subcutaneous fat. The mechanisms for this association need to be further examined.”