Gastrointestinal disease | Obesity as a risk factor | Physiological mechanism by which obesity is associated with gastrointestinal disease | |
Risk expressed as OR or RR | 95% CI | ||
Oesophagus | |||
Gastro-oesophageal reflux disease | OR, 1.94 | 1.46–2.57 | ↑ intra-abdominal pressure, ↓ Oesophageal pressure. |
↑ Oestrogen | |||
Erosive oesophagitis | OR, 1.87 | 1.51–2.31 | Abdominal adiposity |
Barrett’s oesophagus | OR, 4.0 | 1.4–11.1 | Abdominal adiposity, |
↓ Adiponectin, ↑Leptin | |||
Oesophageal adenocarcinoma | Men: OR, 2.4 | 1.9–3.2 | Abdominal adiposity, ↓ Adiponectin, |
Women: OR, 2.1 | 1.4–3.2 | ↑ Leptin, Insulin-like growth factor | |
RR, 4.8 | 3.0–7.7 | ||
Stomach | |||
Gastritis | OR, 2.23 | 1.59–3.11 | ↓ Adiponectin |
Gastric cancer | OR, 1.55 | 1.31–1.84 | Proinflammatory, adipokines, Insulin-like growth factor |
RR (Cardia), 1.8 | 1.3–2.5 | ||
Hepatobiliary | |||
Non-alcoholic fatty liver disease | RR, 4.6 | 2.5–11.0 | Abdominal obesity, ↑ serum free fatty acids, ↑ hepatic triglycerides, hepatic de novo lipogenesis |
Liver cirrhosis | RR, 4.1 | 1.4–11.4 | Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, proinflammatory |
Hepatocellular carcinoma | RR, 1.8 | 1.6–2.1 | Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, proinflammatory |
Gallstone disease (gallstones, cholecystitis) | Men: RR 2.51 | 2.16–2.91 | Abdominal obesity, ↑ Insulin, ↑ leptin, ↑ lipids, insulin resistance, dysmotility |
Women: RR, 2.32 | 1.17–4.57 | ||
Gallbladder cancer | RR, 1.3 | 1.2–1.4 | ↑ risk of gallstones, chronic inflammation |
Pancreas | |||
Acute pancreatitis | RR, 2.20 | 1.82–2.66 | Hyperlipidaemia, chronic inflammation |
Pancreatic cancer | Men: RR, 1.10 | 1.04–1.22 | Insulin-like growth factor binding protein-1 |
Women: RR, 1.13 | 1.05–1.18 | ||
RR, 1.5 | 1.2–1.8 | ||
Intestinal | |||
Diarrhoea | OR, 2.7 | 1.10–6.8 | ↑ Bile acids, accelerated colonic transit, |
Diverticular disease | RR, 1.78 | 1.08–2.94 | Chronic inflammation, alteration in gut microbiota |
Polyps | OR, 1.44 | 1.23–1.70 | Chronic inflammation |
Colorectal cancer | Men: RR, 1.95 | 1.59–2.39 | Chronic inflammation, ↑ adipokines, bile acids, insulin resistance, gut microbiota |
Women: RR, 1.15 | 1.06–1.24 | ||
RR, 1.3 | 1.3–1.4 |
Adapted from Camilleri et al. 7
CI, confidence interval; OR, odds ratio; RR, relative risk.