Protective role of gluteofemoral obesity in erosive oesophagitis and Barrett's oesophagus.

OBJECTIVE: Abdominal obesity has been associated with erosive oesophagitis (EO) and Barrett's oesophagus (BO). As gluteofemoral obesity protects against diabetes mellitus and cardiovascular disease, we hypothesised that gluteofemoral obesity would be inversely associated with EO and BO. DESIGN: We conducted a cross-sectional study on 822 male colorectal cancer screenees who were recruited to also undergo upper endoscopy. An additional 80 patients with BO clinically detected by upper endoscopy referred for clinical indications were recruited shortly after their diagnoses of BO. Logistic regression was used to estimate the effects of abdominal obesity (waist circumference), gluteofemoral obesity (hip circumference) and waist-to-hip ratio (WHR) on EO and BO (vs neither condition). RESULTS: There were 225 cases of either BO or EO and 675 controls. After adjustment for potential confounders, a positive association was observed between waist circumference and BO and/or EO, which became stronger with further adjustment for hip circumference. In contrast, hip circumference was inversely associated with BO and/or EO. Compared with the lowest quartile of WHR, the adjusted ORs were 1.32 (95% CI 0.747 to 2.33) for the 2nd quartile, 1.54 (95% CI 0.898 to 2.63) for the 3rd quartile, and 2.68 (95% CI 1.57 to 4.55) for the highest quartile. Similar results were obtained for BO and EO treated as separate outcomes. CONCLUSIONS: In a population of older, mostly overweight men, the distribution of obesity is associated with the presence of EO and BO. Abdominal obesity appears to increase the risk of these outcomes, whereas gluteofemoral obesity may be protective.

Prediction of Barrett's esophagus among men.

OBJECTIVES: Risk factors for Barrett's esophagus include gastroesophageal reflux disease (GERD) symptoms, age, abdominal obesity, and tobacco use. We aimed to develop a tool using these factors to predict the presence of Barrett's esophagus. METHODS: Male colorectal cancer (CRC) screenees were recruited to undergo upper endoscopy, identifying newly diagnosed cases of Barrett's esophagus. Logistic regression models predicting Barrett's esophagus using GERD symptoms alone and together with abdominal obesity, tobacco use, and age were compared. RESULTS: Barrett's esophagus was found in 70 (8.5%) of 822 CRC screenees. Mutually adjusting for other covariates, Barrett's esophagus was associated with weekly GERD (odds ratio (OR)=2.33, 95% confidence interval (CI)=1.34, 4.05), age (OR per 10 years=1.53, 95% CI=1.05, 2.25), waist-to-hip ratio (OR per 0.10=1.44, 95% CI=0.898, 2.32) and pack-years of cigarette use (OR per 10 pack-years=1.09, 95% CI=1.04, 1.14). A model including those four factors had a greater area under the receiver operating characteristics curve than did a model based on GERD frequency and duration alone (0.72 vs. 0.61, P<0.001), and it had a net reclassification improvement index of 19-25%. CONCLUSIONS: The prevalence of Barrett's esophagus was substantial in our population of older overweight men. A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barrett's esophagus than did a model based on GERD alone. Following validation of the tool in another population, its use in clinical practice might improve the efficiency of screening for Barrett's esophagus.

Validation of a new physical activity questionnaire for a sedentary population.

BACKGROUND: Many available physical activity questionnaires (PAQs) are limited due to either focus on recreational activities or burdensome length. AIMS: We sought to assess the reliability and validity of a new short PAQ that captures all activity types. METHODS: The 12-item multiple-choice PAQ-M included eight activity domains, providing a total Physical Activity Score (PAS-M) in kcal/kg/week. The new PAQ-M was administered with the previously validated Paffenbarger PAQ to 426 men, ages 50-79, undergoing colon-cancer screening. RESULTS: The PAQ-M had excellent test-retest reliability (intraclass correlation = 0.87). The PAS-M was moderately correlated with the Paffenbarger Physical Activity Score (PAS-P) (r = 0.31) and inversely correlated with BMI (r = -0.14) and waist circumference (r = -0.17). Adenoma prevalence was inversely associated with the PAS-M (3rd vs. 1st tertile adjusted odds ratio, 0.46; 95% confidence interval, 0.26-0.84) but not with the PAS-P. CONCLUSIONS: Our new short physical activity questionnaire has excellent test-retest reliability, and was correlated moderately with a widely used physical activity questionnaire and obesity measures. Furthermore, the new PAQ was a better predictor of adenoma prevalence in the expected direction than the Paffenbarger questionnaire in this largely sedentary population.