General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition

Annika Steffen*, José Maria Huerta, Elisabete Weiderpass, H. B. Bueno-De-Mesquita, Anne M. May, Peter D. Siersema, Rudolf Kaaks, Jasmine Neamat-Allah, Valeria Pala, Salvatore Panico, Calogero Saieva, Rosario Tumino, Alessio Naccarati, Miren Dorronsoro, Emilio Sánchez-Cantalejo, Eva Ardanaz, J. Ramón Quirós, Bodil Ohlsson, Mattias Johansson, Bengt WallnerKim Overvad, Jytte Halkjær, Anne Tjønneland, Guy Fagherazzi, Antoine Racine, Françoise Clavel-Chapelon, Tim J. Key, Kay Tee Khaw, Nick Wareham, Pagona Lagiou, Christina Bamia, Antonia Trichopoulou, Pietro Ferrari, Heinz Freisling, Yunxia Lu, Elio Riboli, Amanda J. Cross, Carlos A. Gonzalez, Heiner Boeing

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

83 Citations (Scopus)


General obesity, as reflected by BMI, is an established risk factor for esophageal adenocarcinoma (EAC), a suspected risk factor for gastric cardia adenocarcinoma (GCC) and appears unrelated to gastric non-cardia adenocarcinoma (GNCC). How abdominal obesity, as commonly measured by waist circumference (WC), relates to these cancers remains largely unexplored. Using measured anthropometric data from 391,456 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC) study and 11 years of follow-up, we comprehensively assessed the association of anthropometric measures with risk of EAC, GCC and GNCC using multivariable proportional hazards regression. One hundred twenty-four incident EAC, 193 GCC and 224 GNCC were accrued. After mutual adjustment, BMI was unrelated to EAC, while WC showed a strong positive association (highest vs. lowest quintile HR = 1.19; 95% CI, 0.63-2.22 and HR = 3.76; 1.72-8.22, respectively). Hip circumference (HC) was inversely related to EAC after controlling for WC, while WC remained positively associated (HR = 0.35; 0.18-0.68, and HR=4.10; 1.94-8.63, respectively). BMI was not associated with GCC or GNCC. WC was related to higher risks of GCC after adjustment for BMI and more strongly after adjustment for HC (highest vs. lowest quintile HR = 1.91; 1.09-3.37, and HR = 2.23; 1.28-3.90, respectively). Our study demonstrates that abdominal, rather than general, obesity is an indisputable risk factor for EAC and also provides evidence for a protective effect of gluteofemoral (subcutaneous) adipose tissue in EAC. Our study further shows that general obesity is not a risk factor for GCC and GNCC, while the role of abdominal obesity in GCC needs further investigation.

Original languageEnglish
Pages (from-to)646-657
Number of pages12
JournalInternational Journal of Cancer
Issue number3
Publication statusPublished - 1 Aug 2015
Externally publishedYes


  • abdominal obesity
  • body mass index
  • esophageal cancer
  • gastric cancer
  • general obesity
  • waist circumference


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