@article{3077934,
    title = "Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: Results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort",
    author = "Sanikini, H. and Muller, D.C. and Sophiea, M. and Rinaldi, S. and Agudo, A. and Duell, E.J. and Weiderpass, E. and Overvad, K. and Tjønneland, A. and Halkjær, J. and Boutron-Ruault, M.-C. and Carbonnel, F. and Cervenka, I. and Boeing, H. and Kaaks, R. and Kühn, T. and Trichopoulou, A. and Martimianaki, G. and Karakatsani, A. and Pala, V. and Palli, D. and Mattiello, A. and Tumino, R. and Sacerdote, C. and Skeie, G. and Rylander, C. and Chirlaque López, M.-D. and Sánchez, M.-J. and Ardanaz, E. and Regnér, S. and Stocks, T. and Bueno-de-Mesquita, B. and Vermeulen, R.C.H. and Aune, D. and Tong, T.Y.N. and Kliemann, N. and Murphy, N. and Chadeau-Hyam, M. and Gunter, M.J. and Cross, A.J.",
    journal = "International Journal  of Cancer",
    year = "2020",
    volume = "146",
    number = "4",
    pages = "929-942",
    publisher = "Wiley-Liss, Inc.",
    issn = "0020-7136",
    doi = "10.1002/ijc.32386",
    keywords = "abdominal obesity;  adult;  age;  alcohol consumption;  anthropometry;  Article;  body mass;  breast feeding;  cancer risk;  controlled study;  dietary intake;  disease association;  esophageal adenocarcinoma;  esophageal squamous cell carcinoma;  female;  high risk patient;  hip circumference;  human;  major clinical study;  male;  menarche;  ovariectomy;  physical activity;  postmenopause;  premenopause;  prevalence;  priority journal;  reproductive health;  smoking;  stomach cancer;  waist circumference;  waist hip ratio;  waist to height ratio;  anthropometry;  body fat distribution;  classification;  cohort analysis;  esophagus tumor;  Europe;  middle aged;  proportional hazards model;  prospective study;  reproductive history;  risk factor;  stomach tumor, Anthropometry;  Body Fat Distribution;  Cohort Studies;  Esophageal Neoplasms;  Europe;  Female;  Humans;  Male;  Middle Aged;  Proportional Hazards Models;  Prospective Studies;  Reproductive History;  Risk Factors;  Stomach Neoplasms",
    abstract = "Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5–25 kg/m2: HR = 1.94, 95% CI: 1.25–3.03) and women (HR = 2.66, 95% CI: 1.15–6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99–6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52–4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35–14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76–18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14–0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32–0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04–3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers. © 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC"
}