Anthropometry and Esophageal Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

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Background: Increasing evidence suggests that general obesity [measured by body mass index (BMI)] is positively associated with risk of esophageal adenocarcinoma (EAC). In contrast, previous studies have shown inverse relations with esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether body fat distribution, particularly abdominal obesity, is associated with each type of esophageal cancer. Methods: We applied multivariable adjusted Cox proportional hazards regression to investigate the association between anthropometric measures and risk of EAC and ESCC among 346,554 men and women participating in the European Prospective Investigation into Cancer and Nutrition. All statistical tests were two sided. Results: During 8.9 years of follow-up, we documented 88 incident cases of EAC and 110 cases of ESCC. BMI, waist circumference, and waist-to-hip ratio (WHR) were positively associated with EAC risk [highest versus lowest quintile; relative risk (RR), 2.60; 95% confidence interval (95% CI), 1.23-5.51; P-trend < 0.01; RR, 3.07; 95% CI, 1.35-6.98; P-trend < 0.003; and RR, 2.12; 95% CI, 0.98-4.57; P-trend < 0.004]. In contrast, BMI and waist circumference were inversely related to ESCC risk, whereas WHR showed no association with ESCC. In stratified analyses, BMI and waist circumference were significantly inversely related to ESCC only among smokers but not among nonsmokers. However, when controlled for BMI, we found positive associations for waist circumference and WHR with ESCC, and these associations were observed among smokers and nonsmokers. Conclusion: General and abdominal obesity were associated with higher EAC risk. Further, our study suggests that particularly an abdominal body fat distribution might also be a risk factor for ESCC. (Cancer Epidemiol Biomarkers Prev 2009;18(7):2079-89)


  • Annika Steffen
  • Matthias B. Schulze
  • Tobias Pischon
  • Thomas Dietrich
  • Esther Molina
  • Maria-Dolores Chirlaque
  • Aurelio Barricarte
  • Pilar Amiano
  • J. Ramon Quiros
  • Rosario Tumino
  • Amalia Mattiello
  • Domenico Palli
  • Paolo Vineis
  • Claudia Agnoli
  • Gesthimani Misirli
  • Paolo Boffetta
  • Rudolf Kaaks
  • Sabine Rohrmann
  • H. Bas Bueno-de-Mesquita
  • Petra H. M. Peeters
  • Anne M. May
  • Elizabeth A. Spencer
  • Naomi E. Allen
  • Sheila Bingham
  • Anne Tjonneland
  • Jytte Halkjaer
  • Kim Overvad
  • Jakob Stegger
  • Bjorn Lindkvist
  • Goran Hallmanns
  • Roger Stenling
  • Eiliv Lund
  • Elio Riboli
  • Carlos A. Gonzalez
  • Heiner Boeing
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)2079-2089
JournalCancer Epidemiology Biomarkers & Prevention
Issue number7
Publication statusPublished - 2009
Publication categoryResearch