作者：Laurie Barclay, MD
出處：WebMD醫學新聞
April 23, 2009 — 根據一項線上發表於3月30日腸胃醫學期刊的前瞻性世代研究結果，巴瑞特氏食道症與女性肥胖有關，但與過重無關。
麻州波士頓醫學中心的Brian C. Jacobson醫師與其同事表示，身體質量過高與胃食道逆流疾病的症狀有關，且斷面性研究結果顯示，身體質量指數（BMI）與巴瑞特氏食道症之間是有關的。我們想要前瞻性地檢驗BMI與其他身體指標對女性巴瑞特氏食道症風險的影響。
這是護理人員健康研究的一部份，收納15,861位沒有癌症病史，且於1986年到2004年之間接受上消化道內視鏡的女性。主要的試驗終點是巴瑞特氏食道症，以病理學確認的特異腸道組織變形定義，共有261位女性罹患這樣的疾病。以兩年一次的問卷調查提供有關體重的自我通報記錄。在1976年，這些女性被要求報告她們的身高，然後於1986年時提報腰圍與臀圍。
相較於那些BMI介於20~49 kg/m2的女性，BMI維持在25~29 kg/m2的女性，發生巴瑞特氏食道症的多變項勝算比（OR）為0.92（95%信賴區間[CI]0.66-1.27）；那些BMI超過30 kg/m2的女性，其多變項OR為1.52（95% CI為1.02-2.28）；BMI低於20 kg/m2女性的多變項OR為0.92（95% CI為0.65-1.31）。相對的，腰臀圍比值、腰圍、以及身高顯然與巴瑞特氏食道症無關。
控制了胃食道逆流疾病（GERD）的症狀後，結果是相似的，如同在整個護理人員健康研究群眾中（共93,609位）一樣，無論是否有接受內視鏡的病史。
研究作者表示，肥胖但沒有過重，顯然會增加巴瑞特氏食道症的風險；這樣的風險顯然無法單以身體脂肪分布來解釋。
這項研究的限制包括自我通報身高、體重、腰圍、臀圍的可靠度；僅在1986年時取得一次腰圍與臀圍的比值，之後並未再更新；以及缺乏病理樣本統一檢驗與判讀、潛在性地造成分類錯誤的誤差。
研究作者們的結論是，這些發現與主要是男性的研究結果不同，在那些研究軀幹肥胖可能更能解是這些風險的上升。當男性與女性的身體脂肪分布偏好模式不同時（例如軀幹與周邊），這可能可以解釋男性對女性在發生巴瑞特氏食道症上優越性的傾斜原因。需要更進一步的研究來確定明顯減重是否可以降低巴瑞特氏食道症的風險。
國家癌症機構與國家糖尿病及消化及腎臟疾病機構贊助這項研究。共同作者Andrew T. Chen醫師是Damon Runyon癌症研究基金會臨床研究者獎項得主。該研究作者表示沒有相關資金上的往來。
Barrett's Esophagus Linked to Obesity, but Not Overweight, in Women
By Laurie Barclay, MD
Medscape Medical News
April 23, 2009 — Barrett's esophagus is linked to obesity, but not overweight, in women, according to the results of a prospective cohort study reported in the March 30 Online First issue of Gut.
"Excess body mass is associated with symptoms of gastroesophageal reflux disease, and cross-sectional studies suggest an association between body mass index (BMI) and Barrett's oesophagus," write Brian C. Jacobson, MD, MPH, from Boston Medical Center in Boston, Massachusetts, and colleagues. "We sought to prospectively examine the influence of BMI and other anthropomorphic measures on the risk for Barrett's oesophagus among women."
As part of the Nurses' Health Study, 15,861 women without a history of cancer underwent upper gastrointestinal tract endoscopy for any reason between 1986 and 2004. The primary study endpoint of Barrett's esophagus, defined as pathologically confirmed specialized intestinal metaplasia within the esophagus, occurred in 261 women. Biennial questionnaires provided self-reported data on weight. In 1976, women were asked to report their height and in 1986, to report their waist and hip circumference.
Compared with women in whom BMI was 20 to 24.9 kg/m2, those with a BMI of 25 to 29.9 kg/m2 had a multivariate odds ratio (OR) for Barrett's esophagus of 0.92 (95% confidence interval [CI], 0.66 - 1.27); those with a BMI of more than 30 kg/m2 had a multivariate OR of 1.52 (95% CI, 1.02 - 2.28); and those with a BMI less than 20 kg/m2 had a multivariate OR of 0.92 (95% CI, 0.65 - 1.31). In contrast, waist-to-hip ratio, waist circumference, and height did not appear to be associated with Barrett's esophagus.
Controlling for symptoms of gastroesophageal reflux disease (GERD) yielded similar findings, as did analysis of the entire Nurses' Health Study cohort (n = 93,609), regardless of a history of endoscopy.
"Obese, but not overweight, women appear to be at increased risk for Barrett's oesophagus," the study authors write. "This risk did not appear to be explained solely by body fat distribution."
Limitations of this study include reliance on self-reported measures of height, weight, and waist and hip circumference; waist and hip measurements done only in 1986 and not updated; and lack of central review of pathology specimens, potentially resulting in misclassification bias.
"These findings differ from observations among predominantly male cohorts wherein central adiposity may account for much of the risk," the study authors conclude. "As the predominant pattern of body fat distribution differs between men and women, (i.e. central versus peripheral, respectively) this may account for the skewed male to female preponderance of Barrett's oesophagus. Further studies are needed to determine if significant weight loss can decrease the risk for Barrett's oesophagus."
The National Cancer Institute and the National Institutes of Diabetes and Digestive and Kidney Diseases supported this study. Coauthor Andrew T. Chan, MD, MPH, is a recipient of the Damon Runyon Cancer Research Foundation Clinical Investigator Award. The study authors have disclosed no relevant financial relationships.
Gut. Published online March 30, 2009. |
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