Visceral adipose tissue: the link with esophageal adenocarcinoma

Abstract

Objective. There is strong evidence for an association between obesity and esophageal adenocarcinoma (EAC). This study investigated the association between directly measured visceral adipose tissue and the risk of EAC. Methods. In a case–control setting, we measured visceral adipose tissue in patients with EAC and healthy controls. Visceral adipose tissue was determined by abdominal CT. Exclusion criteria were uninterpretable CT scans and severe comorbidity. Controls were healthy volunteers undergoing screening CT colonography. Cross-sectional areas of visceral and subcutaneous adipose tissues were measured in cm² at L3/L4. Values of adipose tissue of EAC patients were extrapolated to stage 0 and compared to controls. The association between visceral adipose tissue and EAC was calculated with least-squares regression, adjusted for age, sex and TNM stage. Results. We included 175 EAC patients and 251 controls. While body mass index was similar in EAC patients (26.1 kg/m²) and controls (26.2 kg/m²), visceral adipose tissue was significantly higher in EAC patients at stage 0 than in controls (276 vs. 231 cm²; p = 0.015). Regarding subcutaneous adipose tissue, there was no difference. Conclusions. Patients with EAC have significantly higher visceral adipose tissue than healthy controls. Visceral adipose tissue is a risk factor in the development of EAC and seems to be more important than obesity alone.

Key Words::

• CT imaging
• esophageal adenocarcinoma
• risk factor
• visceral adipose tissue

Declaration of interest: None declared. All authors stated no financial relationship to disclose.

Author's contributions

Renate Massl: drafting of the manuscript. Mark van Blankenstein; Suzanne Jeurnink: study concept and design; Margriet C. de Haan, Jaap Stoker: material support; John J. Hermans, Marcel Koek, Wiro J. Niessen: technical support; Ewout W. Steyerberg, C. Looman: statistical analysis; Ernst J. Kuipers: study supervision; All authors: critical revision of the manuscript for important intellectual content. The final approval of the version has to be published yet.