Associations between Body Mass Index and Chronic Atrophic Gastritis and Intestinal Metaplasia

Nari Kim; Chang-Ho Youn; A-Sol Kim; Hae-Jin Ko; Hyo-Min Kim; Hana Moon; Sujung Park

doi:10.4166/kjg.2017.70.2.81

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Kim, Youn, Kim, Ko, Kim, Moon, and Park: Associations between Body Mass Index and Chronic Atrophic Gastritis and Intestinal Metaplasia

Original Article

Korean J Gastroenterol 2017;70(2):81-88.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.2.81

Associations between Body Mass Index and Chronic Atrophic Gastritis and Intestinal Metaplasia

Nari Kim, Chang-Ho Youn, A-Sol Kim, Hae-Jin Ko, Hyo-Min Kim¹, Hana Moon, Sujung Park

¹Department of Family Medicine, Kyungpook National University School of Medicine, Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea

Correspondence to: Chang-Ho Youn, Department of Family Medicine, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5791, Fax: +82-53-200-5480, E-mail: ychfm@knu.ac.kr

Received 17 January 2017 Accepted 5 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Chronic atrophic gastritis (AG) and intestinal metaplasia (IM) of the stomach are premalignant lesions. The present study aimed to examine the associations between obesity and these lesions.

Methods

A total of 2,997 patients, who underwent gastroscopy, participated in this study, excluding those who had been diagnosed with gastric cancer. Participants were divided into four groups based on their body mass index (BMI). The risk of AG and IM with increasing BMI was analyzed in men and women, separately.

Results

The association between BMI and AG was not significant. After adjusting for age, smoking, alcohol, and AG, the odds ratios for IM in the overweight, obesity, and severe obesity groups were 2.25 (95% confidence interval [CI], 1.50–3.37), 2.32 (95% CI, 1.58–3.42), and 4.86 (95% CI, 2.04–11.5) in men, and 2.66 (95% CI, 1.29–5.47), 4.46 (95% CI, 2.28–8.75), and 9.57 (95% CI, 3.26–28.12) in women, compared with the normal BMI group.

Conclusions

Gastric IM was significantly associated with increased BMI.

Keywords: Body mass index, Atrophic gastritis, Metaplasia

References

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Fig. 1.

Adjusted mean BMI of patients with AG (A) and IM (B). Values are presented as adjusted mean±standard error. ^* p-values are from ANCOVA test after adjusting for age, smoking, alcohol intake, and IM. ^† p-values are from ANCOVA test after adjusting for age, smoking, alcohol intake, and AG. BMI, body mass index, AG, atrophic gastritis, IM, intestinal metaplasia, ANCOVA, analysis of covariance.

Table 1.

Baseline Characteristics of Study Subjects

Characteristics	Total (n=2,997)	Male (n=1,857)	Female (n=1,140)
Mean age, years	49.9±12.5	49.5±12.3	50.4±12.9
Systolic BP, mmHg	123.4±16.8	125.1±15.5	120.6±18.2
Diastolic BP, mmHg	73.5±11.7	75.8±11.4	69.8±11.3
Height, cm	165.4±8.6	170.3±11.4	157.4±5.9
Weight, kg	65.9±11.3	71.2±9.6	57.1±8.0
BMI, kg/m²	24.0±2.9	24.5±2.7	23.1±3.1
Waist circumference, cm	79.1±8.9	82.2±7.6	74.1±8.5
Smoking status
Non-smoker	2,355 (78.6)	1,417 (76.3)	938 (82.3)
Smoker	642 (21.4)	440 (23.7)	202 (17.7)
Drinking status
Non-alcoholics	685 (22.9)	340 (18.3)	345 (30.3)
Social alcoholics	1,888 (63.0)	1,215 (65.4)	673 (59.0)
Heavy alcoholics	424 (14.1)	302 (16.3)	122 (10.7)
BMI groups, kg/m²
<23	1,115 (37.2)	530 (28.6)	585 (51.3)
≥23 and <25	829 (27.7)	553 (29.8)	276 (24.2)
≥25 and <30	976 (32.6)	725 (39.0)	251 (22.0)
≥30	77 (2.6)	49 (2.6)	28 (2.5)
Atrophic gastritis
No	827 (27.6)	500 (26.9)	327 (28.7)
Yes	2,170 (72.4)	1,357 (73.1)	813 (71.3)
Intestinal metaplasia
No	2,661 (88.8)	1,597 (86.0)	1,064 (93.3)
Yes	336 (11.2)	260 (14.0)	76 (6.7)
Reflux esophagitis
No	1,756 (58.6)	1,026 (55.3)	730 (64.0)
Yes	1,241 (41.4)	831 (44.7)	410 (36.0)
Erosive gastritis
No	2,560 (85.4)	1,551 (83.5)	1,009 (88.5)
Yes	437 (14.6)	306 (16.5)	131 (11.5)
Gastric ulcer
No	2,959 (98.7)	1,829 (98.5)	1,130 (99.1)
Yes	38 (1.3)	28 (1.5)	10 (0.9)
Duodenal ulcer
No	2,874 (95.9)	1,757 (94.6)	1,117 (98.0)
Yes	123 (4.1)	100 (5.4)	23 (2.0)

Values are presented as mean±standard deviation or number (%).

BP, blood pressure; BMI, body mass index.

Table 2.

Univariate Analysis of the Risk Factors for AG

Characteristics	Male (n=1,857)			Female (n=1,140)
	Non-AG (n=500)	AG (n=1,357)	p-value ^a	Non-AG (n=327)	AG (n=813)	p-value ^a
Mean age, years	42.7±12.1	52.1±11.4	<0.001	43.6±12.5	53.1±12.0	<0.001
Systolic BP, mmHg	125.3±14.0	125.1±16.1	0.755	115.5±16.1	122.7±18.6	<0.001
Diastolic BP, mmHg	75.6±11.3	75.9±11.4	0.669	68.1±10.5	70.5±11.5	0.001
Height, cm	172.4±5.8	169.6±5.8	<0.001	159.3±5.4	156.6±5.9	<0.001
Weight, kg	73.3±9.6	70.4±9.5	<0.001	57.1±7.8	57.2±8.0	0.850
Waist circumference, cm	82.4±7.6	82.2±7.6	0.557	71.9±8.2	75.0±8.4	<0.001
BMI, kg/m²	24.6±2.6	24.5±2.7	0.290	22.5±2.9	23.3±3.1	<0.001
Smoking status
Non-smoker	391 (27.6)	1,026 (72.4)	0.244	271 (28.9)	667 (71.1)	0.739
Current smoker	109 (24.8)	331 (75.2)		56 (27.7)	146 (72.3)
Drinking status
Non-alcoholics	106 (31.2)	234 (68.8)	0.120	107 (31.0)	238 (69.0)	0.176
Social alcoholics	320 (26.3)	895 (73.7)		193 (28.7)	480 (71.3)
Heavy alcoholics BMI groups, kg/m²	74 (24.5)	228 (75.5)		27 (22.1)	95 (77.9)
<23	142 (26.8)	388 (73.2)	0.250	195 (33.3)	390 (66.7)	0.001
≥23 and <25	137 (24.8)	416 (75.2)		75 (27.2)	201 (72.8)
≥25 and <30	211 (29.1)	514 (70.9)		54 (21.5)	197 (78.5)
≥30	10 (20.4)	39 (79.6)		3 (10.7)	25 (89.3)
Intestinal metaplasia
No	486 (30.4)	1,111 (69.6)	<0.001	323 (30.4)	741 (69.6)	<0.001
Yes	14 (5.4)	246 (94.6)		4 (9.2)	72 (90.8)

Values are presented as mean±standard deviation, or number (%).

AG, atrophic gastritis; BP, blood pressure; BMI, body mass index.

^a p-values were calculated by chi-square test for discrete outcomes and independent t-test for continuous outcomes.

Table 3.

Univariate Analysis of the Risk Factors for IM

Characteristics	Male (n=1,857)			Female (n=1,140)
	Non-IM (n=1,597)	IM (n=260)	p-value ^a	Non-IM (n=1,064)	IM (n=76)	p-value ^a
Mean age, years	48.2±12.1	57.9±10.1	<0.001	49.6±12.7	61.1±10.0	<0.001
Systolic BP, mmHg	125.0±15.4	125.8±16.2	0.439	119.8±17.7	132.1±21.0	<0.001
Diastolic BP, mmHg	75.9±11.5	75.4±11.0	0.561	69.6±11.1	73.1±12.5	0.008
Height, cm	170.6±5.9	168.3±6.1	<0.001	157.6±5.8	154.1±5.9	<0.001
Weight, kg	71.2±9.7	71.0±9.1	0.772	57.0±7.9	59.9±8.8	0.002
Waist circumference, cm	82.3±7.6	81.9±7.7	0.434	73.8±8.5	77.5±7.8	<0.001
BMI, kg/m²	24.4±2.7	25.0±2.6	0.001	22.9±3.0	25.2±3.4	<0.001
Smoking status
Non-smoker	1,258 (88.8)	159 (11.2)	<0.001	877 (93.5)	61 (6.5)	0.634
Smoker	339 (77.0)	101 (23.0)		187 (92.6)	15 (7.4)
Drinking status
Non-alcoholics	324 (95.3)	16 (4.7)	<0.001	336 (97.4)	9 (2.6)	<0.001
Social alcoholics	1,050 (86.4)	165 (13.6)		626 (93.0)	47 (7.0)
Heavy alcoholics	223 (73.8)	79 (26.2)		102 (83.6)	20 (16.4)
BMI groups, kg/m²
<23	479 (90.4)	51 (9.6)	0.005	571 (97.6)	14 (2.4)	<0.001
≥23 and <25	466 (84.3)	87 (15.7)		255 (92.4)	21 (7.6)
≥25 and <30	613 (84.6)	112 (15.4)		217 (86.5)	34 (13.5)
≥30	39 (79.6)	10 (20.4)		21 (75.0)	7 (25.0)
Atrophic gastritis
No	486 (97.2)	14 (2.8)	<0.001	323 (98.8)	4 (1.2)	<0.001
Yes	1,111 (81.9)	246 (18.1)		741 (91.1)	72 (8.9)

Values are presented as mean±standard deviation or number (%).

IM, intestinal metaplasia; BP, blood pressure; BMI, body mass index.

^a p-values were calculated by chi-square test for discrete outcomes and independent t-test for continuous outcomes.

Table 4.

Odds Ratios of AG according to BMI Category

Males
BMI, kg/m²	Non-AG	AG	Unadjusted OR (95% CI)	p-trend ^a	Adjusted OR (95% CI)	p-trend ^a
<23	142 (26.8)	388 (73.2)	1 (reference)	0.543	1 (reference)	0.771
≥23 and <25	137 (24.8)	416 (75.2)	1.11 (0.85–1.46)		1.18 (0.88–1.58)
≥25 and <30	211 (29.1)	514 (70.9)	0.89 (0.69–1.15)		0.94 (0.72–1.24)
≥30	10 (20.4)	39 (79.6)	2.73 (0.69–2.94)		2.58 (1.17–5.69)
Females
BMI, kg/m²	Non-AG	AG	Unadjusted OR (95% CI)	p-trend ^a	Adjusted OR (95% CI)	p-trend ^a
<23	195 (33.3)	390 (66.7)	1 (reference)	<0.001	1 (reference)	0.746
≥23 and <25	75 (27.2)	201 (72.8)	1.34 (0.98–1.84)		0.86 (0.61–1.21)
≥25 and <30	54 (21.5)	197 (78.5)	1.82 (1.29–2.58)		0.97 (0.66–1.42)
≥30	3 (10.7)	25 (89.3)	4.17 (1.24–13.97)		2.72 (0.75–9.83)

Values are presented number (%). Logistic model adjusted for age, smoking, alcohol, and intestinal metaplasia. BMI, body mass index; AG, atrophic gastritis; OR, odds ratio; CI, confidence interval.

^a p for trend were calculated by linear by linear association in which BMI group was put as a continuous variable.

Table 5.

Odds Ratios of IM according to BMI Category

Males
BMI, kg/m²	Non-IM	IM	Unadjusted OR (95% CI)	p-trend ^a	Adjusted OR (95% CI)	p-trend ^a
<23	479 (90.4)	51 (9.6)	1 (reference)	0.002	1 (reference)	<0.001
≥23 and <25	466 (84.3)	87 (15.7)	1.75 (1.21–2.54)		2.25 (1.50–3.37)
≥25 and <30	613 (84.6)	112 (15.4)	1.72 (1.21–2.44)		2.32 (1.58–3.41)
≥30	39 (79.6)	10 (20.4)	2.41 (1.14–5.11)		4.86 (2.04–11.55)
Females
BMI, kg/m²	Non-IM	IM	Unadjusted OR (95% CI)	p-trend ^a	Adjusted OR (95% CI)	p-trend ^a
<23	571 (97.6)	14 (2.4)	1 (reference)	<0.001	1 (reference)	<0.001
≥23 and <25	255 (92.4)	21 (7.6)	3.36 (1.68–6.71)		2.66 (1.29–5.47)
≥25 and <30	217 (86.5)	34 (13.5)	6.39 (3.36–12.14)		4.46 (2.28–8.75)
≥30	21 (75.0)	7 (25.0)	13.60 (4.97–37.19)		9.57 (3.26–28.12)

Values are presented number (%). Logistic model adjusted for age, smoking, alcohol, and atrophic gastritisBMI, body mass index; IM, intestinal metaplasia; OR, odds ratio; CI, confidence interval.

^a p for trend were calculated by linear by linear association in which BMI group was put as a continuous variable.

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