Explanations for increasing rates of oesophageal adenocarcinoma (OAC) remain unclear, though the concurrent increase in the prevalence of obesity may be a partial explanation. Although obesity has emerged as a leading candidate risk factor for OAC, few studies have examined body fat distribution. Therefore, we evaluated the relation between overall (BMI) and abdominal (waist-to-hip ratio (WHR)) obesity with OAC (n=253) and gastric cardia adenocarcinoma (n=191) in 218 850 men and women of the NIH-AARP Diet and Health Study cohort. We used Cox proportional hazards regression to estimate HR and 95% CIs, with control for many potential confounders. Comparing the highest to the referent category, we observed that BMI and WHR were both positively associated with OAC [HR (95% CI); 2.11 (1.08 to 4.09) and 1.76 (1.22 to 2.54), respectively]. A positive association was also found for BMI and gastric cardia adenocarcinoma [HR (95% CI); 3.67 (2.00 to 6.71)], but not for WHR [HR (95% CI); 1.34 (0.91 to 1.97)]. Mutually adjusting models for BMI and WHR attenuated, but did not eliminate the associations for both BMI and WHR with OAC [highest vs referent category; HR (95% CI); 1.77 (0.90 to 3.49) and 1.44 (0.98 to 2.10), respectively]. Mutual adjustment had only minor influence on the BMI risk estimates for gastric cardia adenocarcinoma [HR (95% CI); 3.28 (1.76 to 6.11)], whereas WHR estimates were attenuated [HR (95% CI); 1.06 (0.71 to 1.58)]. Overall obesity and abdominal obesity were both related to a higher risk of OAC, but only overall obesity showed an association with gastric cardia adenocarcinoma.
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