Mie Thu Ko, Tom Thomas, Emily Holden, Ian L P Beales, Leo Alexandre
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引用次数: 0
Abstract
Background and aim: Obesity is a risk factor for both Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). However, it is unclear whether obesity drives the malignant progression of BE. We aimed to assess whether obesity is associated with high-grade dysplasia (HGD) or cancer in patients with BE.
Methods: We searched MEDLINE and EMBASE from inception through April 2024 for studies reporting the effect of body mass index (BMI) on the progression of non-dysplastic BE or low-grade dysplasia (LGD) to HGD or EAC. A two-stage dose response meta-analysis was performed to estimate the dose-response relationship between BMI with malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered (PROSPERO ID CRD42017051046).
Results: Twenty studies reported data on 38565 patients (74.4% male) in total, of whom 1684 patients were diagnosed with HGD/cancer. Nineteen studies were considered moderate to high quality. Eight cohort studies reported data on 6647 male patients with baseline NDBE/LGD, of whom 555 progressed to HGD/EAC (pooled annual rate of progression 0.02%; 95% CI 0.01%-0.03%) and 1992 female patients with baseline NDBE/LGD with 110 progressors (pooled annual rate of progression 0.01%; 95% CI 0.01%-0.02%). There was no significant difference in pooled annual rate of progression between males and females (p=0.15). Each 5kg/m2 increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted OR 1.06; 95% CI 1.02-1.10; p<0.001; I2=0%).
Conclusion: Our meta-analysis provides some evidence that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. This finding requires confirmation in future high-quality cohort studies. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BE.
期刊介绍：
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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