• Barrett's esophagus;
  • case–control;
  • risk factors;
  • obesity


Esophageal adenocarcinoma arises from Barrett's esophagus (BE). Both occur predominantly in males. The role of abdominal obesity in this sex distribution is uncertain. Our study aimed to determine whether there is an association between abdominal obesity and risk of BE and if present was it modified by sex. A structured interview and anthropometric measures were conducted within a population-based case–control study. We recruited 237 BE cases (70% male) and 247 population controls, frequency matched by age and sex. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression analysis. In the overall group and males, all measures of abdominal obesity [waist circumference (WC), waist–hip ratio (WHR), sagittal abdominal diameter (SAD) and waist–height ratio (WHtR)] were strongly associated with risk of BE (Overall: WC OR 2.2 95% CI 1.4–3.5, WHR 1.8 95% CI 1.2–2.9, SAD 2.3 95% CI 1.4–3.7, WHtR 1.9 95% CI 1.2–3.0, males WC 2.5 95% CI 1.4–4.3, WHR 2.4 95% CI 1.3–4.2, SAD 2.5 95% CI 1.4–4.3, WHtR 1.9 95% CI 1.1–3.4). These associations were minimally attenuated by adjusting for ever-symptoms of gastroesophageal reflux (GER). These findings suggest in males, non-GER factors related to abdominal obesity may be important in the development of BE. In females, there was modest association between measures of abdominal obesity and risk of BE but these were all abolished after adjusting for ever-symptoms of GER. The power to detect differences between sexes in the risk of BE associated with abdominal obesity was limited by the number of females in the study.