Multifaceted association of overweight and metabolically unhealthy with the risk of Barrett's esophagus in the UK Biobank cohort

Abstract

The association of overweight/obesity and metabolically unhealthy (MU) with the risk of developing Barrett's esophagus (BE) remains uncertain. We evaluated whether MU and overweight/obesity are associated with increased BE incidence and whether they have a synergistic impact on BE development. We analyzed the body mass index (BMI) and metabolic indicators at baseline of 402,510 individuals from the UK Biobank with no history of BE. Overweight/obesity and MU were defined as BMI ≥ 25.0 kg/m² and presence of ≥ 1 MU indicators, respectively. Accordingly, the participants were categorized into four groups: (1) metabolically healthy non-overweight/obesity (MHNO), (2) metabolically unhealthy non-overweight/obesity (MUNO), (3) metabolically healthy overweight/obesity (MHO), and (4) metabolically unhealthy overweight/obesity (MUO). During a median follow-up of 13.5 years, 6195 (1.5%) individuals were newly diagnosed with BE. Among them, 39,281 (9.8%), 92,000 (22.9%), 25,297 (6.3%), and 245,932 (61.1%) individuals were classified as MHNO, MUNO, MHO, and MUO, respectively. In Cox regression analyses, both MU and overweight/obesity were independently associated with BE incidence. Moreover, BE incidence was significantly higher in the MUNO, MHO, and MUO groups, compared to the MHNO group. MU and overweight/obesity are independent risk factors for BE and have a synergistic effect on BE development.

Keywords: Barrett’s esophagus; Metabolically unhealthy; Overweight/obesity.

Fig. 1

Flow diagram of the study subjects.

Fig. 2

Hazard ratios for the occurrence of Barrett’s esophagus according to according to body mass index and number of metabolic factors. In adjusted model, covariates including age, sex, race, smoking, alcohol habits, and history of gastroesphageal reflux disease. No, number; CI, confidence interval.

Fig. 3

Cumulative incidence rate for Barrett’s esophagus according to metabolic phenotypes. MHNO, metabolically healthy non-overweight/obesity; MUNO, metabolically unhealthy non-overweight/obesity; MHO, metabolically healthy overweight/obesity; MUO, metabolically unhealthy overweight/obesity.