Association of low serum adiponectin levels with erosive esophagitis in men: An analysis of 2405 subjects undergoing physical check-ups

Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Journal of Gastroenterology (Impact Factor: 4.52). 08/2011; 46(12):1361-7. DOI: 10.1007/s00535-011-0453-3
Source: PubMed


Obesity is a risk factor for gastro-esophageal reflux disease (GERD). It is generally considered that intra-abdominal pressure in obese subjects is involved in the pathogenesis of GERD through acid exposure to the esophagus. Recently, visceral fat has been recognized as an endocrine organ that secretes various adipocytokines including adiponectin. The aim of this study was to elucidate the relation between adiponectin and erosive esophagitis.
This was a cross-sectional retrospective observational study: 2405 consecutive subjects who underwent screening esophago-gastro-duodenoscopy with serum adiponectin measurement as part of their physical check-up programs were analyzed. Clinical factors were compared between subjects with and without erosive esophagitis. The association between adiponectin and erosive esophagitis was assessed using a bootstrapping re-sampling method after adjustment for factors that tended to be different in univariate analysis.
Serum adiponectin levels were significantly lower in those with erosive esophagitis (8.17 μg/ml) than in those without (10.1). The erosive esophagitis group had a greater body mass index (BMI) and waist circumference (WC) and a higher prevalence of hiatal hernia. Using the bootstrap method, with a lower adiponectin cut-off value of 3-7 μg/ml, the lower limit of the 95% confidence interval of the adjusted odds ratio consistently exceeded 1 after adjustment for BMI and hiatal hernia in men. When adjusting for WC instead of BMI, the effect of adiponectin was reduced but remained significant at a lower cut-off value (3-3.5 μg/ml).
Low serum adiponectin levels may be associated with an increased risk for erosive esophagitis in men.

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Available from: Yoshihiro Kamada
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    • "The first of these includes the direct mechanical effects of abdominal obesity, resulting in an elevation of the intragastric and gastroesophageal pressure gradient [10], [24], an increase in acid reflux episodes with longer duration [25], and in transient lower esophageal sphincter (LES) relaxation [26], leading to esophageal mucosal local injury. The second process, from mediator-driven view, is based on inflammatory signals that originate from the visceral adipose tissue, including an increase in proinflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α [27], [28] and a decrease in potentially anti-inflammatory adiponectin [29], [30]. Furthermore, one study showed that adipokines, such as leptin, are positively correlated with WC in overweight subjects, while adiponectin is negatively correlated with it [31]. "
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    ABSTRACT: To investigate the relationship between overweight and erosive esophagitis (EE) in a non-obese Taiwanese population. A total of 7,352 subjects (non-obese, 5,826; obese, 1,526) from a health examination center at National Cheng Kung University Hospital were enrolled. Central obesity was defined by a waist circumference (WC) ≥90 cm in male and 80 cm in female. Overweight was defined as body mass index (BMI) of 24-26.9 kg/m(2), and general obesity as BMI ≥27 kg/m(2). The Los Angeles classification was adopted to determine the presence of EE. There were significant differences in the prevalence of central obesity and different BMI status between subjects with and without EE in total and non-obese population. In total population, multivariate analyses revealed central obesity (OR, 1.17, 95% CI, 1.02-1.34, p = 0.021) and being obese (OR, 1.28, 95% CI, 1.07-1.52, p = 0.007)/overweight (OR, 1.25, 95% CI, 1.08-1.45, p = 0.003) had positive associations with EE in different model, respectively. When considering the joint effect of central obesity and BMI status, overweight (OR, 1.22; 95% CI, 1.04-1.44; p = 0.016) remained as an independent associated factor of EE but central obesity (OR, 1.06; 95% CI, 0.89-1.26; p = 0.549)/being obese (OR, 1.22; 95% CI, 0.98-1.53; p = 0.082) did not. As for non-obese group, separate model showed central obesity (OR, 1.19, 95% CI, 1.00-1.40, p = 0.046) and overweight (OR, 1.24; 95% CI, 1.07-1.44, p = 0.005) was positively associated with EE, respectively. However, being overweight (OR, 1.20; 95% CI, 1.02-1.42, p = 0.030) but not central obesity (OR, 1.08; 95% CI, 0.90-1.31; p = 0.398) was positively related to EE with considering the effect of overweight and central obesity simultaneously. Overweight effect on EE was more detrimental than central obesity in non-obese subjects. In addition, male gender, hiatus hernia and alcohol use were also associated with increased risk of EE.
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    • "Observational studies from Asia have reported a consistent association between WC or VAT and RE [32,33]. Two studies of RE in a Japanese population showed that abdominal obesity may be an important risk factor for RE in males, but not in females [34,35], but another report did not show this association [36], which has led to some controversy about the association between obesity and RE. The present study clearly demonstrated that RE was an independent risk factor for ESBE, while obesity was not a risk factor for RE. "
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