Body mass index and risk of intestinal metaplasia: A cohort study
Menée en Corée à partir de données portant sur 142 832 participants ayant subi une endoscopie, cette étude de cohorte rétrospective analyse l'association entre l'indice de masse corporelle et le risque de métaplasie intestinale et d'atrophie gastrique (période de suivi : 444 791 personnes-années ; 2 281 cas)
Background: We examined the association between body mass index (BMI) and development of endoscopic intestinal metaplasia (IM). Methods: This retrospective cohort study included 142,832 Korean adults free of endoscopic IM and atrophic gastritis (AG) who underwent upper endoscopy at baseline and subsequent visits and were followed for up to 5 years. A parametric proportional hazards model was used to estimate the adjusted hazard ratio with 95% confidence interval (CI) for incident IM. Results: Over 444,719.1 person-years of follow-up, 2281 participants developed endoscopic IM (incidence rate, 5.1 per 1,000 person-years). Increased BMI categories were associated with increased risk of new-onset IM in a dose-response manner. After adjustment for age, sex, center, year of screening exam, smoking status, alcohol intake, exercise, total calorie intake, history of diabetes and hypertension, and history of Helicobacter pylori infection, the multivariable adjusted hazard ratios (95% CIs) for incident IM comparing BMIs of <18.5, 23-24.9, 25.0-29.9 and >30 with a BMI of 18.5-22.9 kg/m2 were 0.84 (0.64-1.09), 1.03 (0.93-1.16), 1.07 (0.96-1.20) and 1.48 (1.20-1.83), respectively. These associations did not differ by clinically relevant subgroups. Risk of endoscopic AG also increased as baseline BMI category increased. Conclusions: In a large cohort of Korean men and women, obesity was independently associated with increased incidence of endoscopic AG and IM. Impact: Excessive adiposity appears to play a role in development of stomach precursor lesions of stomach cancer, requiring further studies to determine that whether strategies to reduce obesity will also help reduce precancerous lesions and, in turn, gastric cancer.