Associations between body mass index and gastroesophageal cancer incidence and mortality: novel insights from a nationwide registry-based cohort study

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The association between body mass index (BMI) and cancers of the esophagus and the stomach remains complex and requires further exploration. This study aimed to investigate this association, including early-onset (< 50 years) cancer and cancer related mortality. A nationwide registry-based cohort study was performed by linking data from multiple national registries in Norway. The cohort included 1,723,692 individuals, with 22,473 gastroesophageal cancer cases identified over 55,701,169 person-years of follow-up. In men, a 5 kg/m2 increase in BMI was associated with an increased risk of esophageal (HR 1.34, 95%CI 1.22-1.48) and cardia adenocarcinoma (HR 1.36, 95% CI, 1.22-1.50). This finding extended to individuals with high BMI in early life (16-29 years) for esophageal adenocarcinoma. The highest risk per 5 kg/m2 increase in BMI was observed for early-onset esophageal (HR 2.49, 95%CI 1.23-5.02) and cardia adenocarcinoma (HR 2.26, 95%CI 1.19-4.27). Among women, increased BMI was associated with a higher risk of both esophageal (HR 1.28, 95%CI 1.13-1.44) and gastric adenocarcinoma (HR 1.04, 95%CI 1.01-1.07). Women with elevated BMI in early life also demonstrated increased risk for these cancers. In both sexes, a 5 kg/m2 increase in BMI was inversely associated with squamous cell carcinoma of the esophagus. No association was observed between BMI and risk of cancer-related mortality. This study highlights an elevated risk of gastroesophageal adenocarcinomas with increasing BMI, with notable sex, age, and site-specific variations. The findings also point to a heightened risk of early-onset esophageal and cardia adenocarcinoma in men with high BMI.

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