Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Cancer Epidemiol Biomarkers Prev. 2019 Apr;28(4):789-797. doi: 10.1158/1055-9965.EPI-18-0733. Epub 2019 Jan 30.
We examined the association between body mass index (BMI) and development of endoscopic intestinal metaplasia.
This retrospective cohort study included 142,832 Korean adults free of endoscopic intestinal metaplasia and atrophic gastritis 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 HR with 95% confidence interval (CI) for incident intestinal metaplasia.
In more than 444,719.1 person-years of follow-up, 2,281 participants developed endoscopic intestinal metaplasia (incidence rate, 5.1 per 1,000 person-years). Increased BMI categories were associated with increased risk of new-onset intestinal metaplasia 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 infection, the multivariable adjusted HRs (95% CIs) for incident intestinal metaplasia comparing BMIs of <18.5, 23-24.9, 25.0-29.9, and >30 kg/m with a BMI of 18.5-22.9 kg/m 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 atrophic gastritis also increased as the baseline BMI category increased.
In a large cohort of Korean men and women, obesity was independently associated with increased incidence of endoscopic atrophic gastritis and intestinal metaplasia.
Excessive adiposity appears to play a role in development of stomach precursor lesions of stomach cancer, requiring further studies to determine whether strategies to reduce obesity will also help reduce precancerous lesions and, in turn, gastric cancer.
我们研究了体重指数（BMI）与内镜肠上皮化生发展之间的关系。
这项回顾性队列研究纳入了 142832 名韩国成年人，他们在基线和随后的随访中均未接受内镜肠上皮化生和萎缩性胃炎检查，并随访了长达 5 年。使用参数比例风险模型来估计发生肠上皮化生的调整后 HR 及其 95%置信区间（CI）。
在超过 444719.1 人年的随访中，有 2281 名参与者发生了内镜肠上皮化生（发生率为 5.1/1000 人年）。BMI 类别增加与新发生的肠上皮化生风险呈剂量反应关系。在调整年龄、性别、中心、筛查检查年份、吸烟状况、饮酒、运动、总热量摄入、糖尿病和高血压病史以及感染史后，与 BMI 为 18.5-22.9kg/m2 的参与者相比，BMI<18.5kg/m2、23-24.9kg/m2、25.0-29.9kg/m2 和>30kg/m2 的参与者发生肠上皮化生的多变量调整 HR（95%CI）分别为 0.84（0.64-1.09）、1.03（0.93-1.16）、1.07（0.96-1.20）和 1.48（1.20-1.83）。这些关联在有临床意义的亚组中没有差异。随着基线 BMI 类别的增加，内镜萎缩性胃炎的风险也随之增加。
在一项大型的韩国男女队列中，肥胖与内镜萎缩性胃炎和肠上皮化生的发生率增加独立相关。
过度肥胖似乎与胃癌前病变的发展有关，需要进一步的研究来确定减少肥胖的策略是否也有助于减少癌前病变，进而降低胃癌的风险。
