Prediagnostic adult body mass index change and esophageal adenocarcinoma survival

Elizabeth A. Loehrer, Edward L. Giovannucci, Rebecca A. Betensky, Andrea Shafer, David C. Christiani

Research output: Contribution to journalArticlepeer-review


Background: We examined whether body mass index (BMI) changes in adulthood, prior to disease onset, are associated with overall survival among esophageal adenocarcinoma patients. Methods: We included 285 histologically confirmed patients with a complete baseline BMI questionnaire. Using extended Cox regression models, we obtained adjusted hazard ratios (HRs) for the associations between overall survival and BMI at diagnosis, BMI 6 months before diagnosis, self-reported average adult BMI, and ΔBMI (BMI 6 months before diagnosis minus average adult BMI), categorized into tertiles <0 kg/m2 (BMI loss), ≥0 and <1.25 kg/m2 (stable BMI), and ≥1.25 kg/m2 (BMI gain). We also assessed interaction between ΔBMI and average adult BMI (≥ kg/m2 versus <27.5 kg/m2) with overall survival. Results: Body mass index at diagnosis >25 and <35 kg/m2 was associated with better overall survival. Compared to patients with stable BMI in adulthood, patients who gained BMI throughout adulthood had 1.68 times the all-cause hazard of death (95% CI: 1.17-2.43; P <.01), independent of diagnosis BMI and percent weight loss 6 months before diagnosis. Compared to patients with average adult BMI < 27.5 who maintained stable adult BMI, patients with average adult BMI ≥ 27.5 kg/m2 who gained BMI had the worst survival (HR = 3.05; 95% CI 1.62-5.72; P <.01). Conclusion: Body mass index gain in adulthood is associated with poor overall survival, and maintaining a normal body weight throughout adulthood is associated with the best overall survival among esophageal adenocarcinoma patients, independent of BMI at diagnosis.

Original languageEnglish (US)
Pages (from-to)3613-3622
Number of pages10
JournalCancer Medicine
Issue number10
StatePublished - May 1 2020


  • adenocarcinoma
  • body mass index
  • body weight changes
  • esophageal neoplasms
  • survival analysis
  • Body Mass Index
  • Prognosis
  • Humans
  • Middle Aged
  • Risk Factors
  • Proportional Hazards Models
  • Obesity/epidemiology
  • Overweight/epidemiology
  • Adenocarcinoma/epidemiology
  • Male
  • Survival Rate
  • Esophageal Neoplasms/epidemiology
  • Female
  • Aged
  • Body-Weight Trajectory

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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