Metabolic Health Does Not Protect Against Erosive Esophagitis in Adults With Obesity

The risk of developing erosive esophagitis is higher in metabolically healthy adults with overweight and obesity than in metabolically healthy adults of normal weight, according to a study published in Clinical and Translational Gastroenterology.

“In a large cohort of strictly defined metabolically healthy men and women, the ‘metabolically healthy obese’ (MHO) phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease,” wrote corresponding author Hyuk Lee, MD, PhD, and study coauthors from Sungkyunkwan University School of Medicine, Seoul, Korea.

Researchers investigated the association between body mass index (BMI) and the development of erosive esophagitis in 14,725 adults without erosive esophagitis or metabolic abnormalities at baseline. Participants underwent health checkups, including screening endoscopies, over a median 5 years of follow-up. The overall incidence rate of erosive esophagitis among participants was 22.9 per 1000 person-years.

Adjusted hazard ratios for incident erosive esophagitis were 1.29 for adults with obesity and 1.12 for adults with overweight compared with normal weight adults, according to the study. Increasing baseline BMI was associated with erosive esophagitis overall and erosive esophagitis of Los Angeles grade B or higher.

Waist circumference categories were also associated with erosive esophagitis development, the study found. Adjusted hazard ratios for developing erosive esophagitis were 1.24 in the highest tertile of waist circumference and 1.15 in the middle tertile compared with the lowest tertile.

The link between BMI and the risk of erosive esophagitis was observed even in adults without central obesity, researchers reported.

“Thus, our findings indicate that metabolically healthy obesity is not a harmless condition and it can induce the development of erosive esophagitis,” the authors wrote.

Reference:
Kim TJ, Lee H, Baek SY, et al. Metabolically healthy obesity and the risk of erosive esophagitis: a cohort study. Clin Transl Gastroenterol. 2019;10(9):e00077. doi:10.14309/ctg.0000000000000077