Inverse Association Between Gluteofemoral Obesity and Risk of Barrett's Esophagus in a Pooled Analysis

<p>BACKGROUND &amp; AIMS: Gluteofemoral obesity (determined by measurement of subcutaneous fat in hip and thigh regions) could reduce risks of cardiovascular and diabetic disorders associated with abdominal obesity. We evaluated whether gluteofemoral obesity also reduces risk of Barrett's esophagus (BE), a premalignant lesion associated with abdominal obesity.</p><p>METHODS: We collected data from non-Hispanic white participants in 8 studies in the Barrett's and Esophageal Adenocarcinoma Consortium. We compared measures of hip circumference (as a proxy for gluteofemoral obesity) from cases of BE (n=1559) separately with 2 control groups: 2557 population-based controls and 2064 individuals with gastroesophageal reflux disease (GERD controls). Study-specific odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using individual participant data and multivariable logistic regression and combined using random effects meta-analysis.</p><p>RESULTS: We found an inverse relationship between hip circumference and BE (OR per 5 cm increase, 0.88; 95% CI, 0.81-0.96), compared with population-based controls in a multivariable model that included waist circumference. This association was not observed in models that did not include waist circumference. Similar results were observed in analyses stratified by frequency of GERD symptoms. The inverse association with hip circumference was only statistically significant among men (vs population-based controls: OR, 0.85; 95% CI, 0.76-0.96 for men; OR, 0.93; 95% CI, 0.74-1.16 for women). For men, within each category of waist circumference, a larger hip circumference was associated with decreased risk of BE. Increasing waist circumference was associated with increased risk of BE in the mutually adjusted population-based and GERD control models.</p><p>CONCLUSIONS: Although abdominal obesity is associated with increased risk of BE, there is an inverse association between gluteofemoral obesity and BE, particularly among men.</p>

Palliative Medicine:Scoping the level and extent of service provision to people with intellectual disability at end of life Poster Presentation

Background: Concerns exist about the end of life care<br/>that people with intellectual disabilities receive. This population<br/>are seldom referred to palliative care services and<br/>inadequate data sets exist about their place of death.<br/>Aim: To scope the extent of service provision to people<br/>with intellectual disabilities at the end of life by specialist<br/>palliative care and intellectual disability services in one<br/>region of the United Kingdom.<br/>Methods: As part of a larger doctoral study a regional survey<br/>took place of a total sample (n=66) of specialist palliative<br/>care and intellectual disability services using a postal<br/>questionnaire containing forty items. The questionnaire<br/>was informed by the literature and consultation with an<br/>expert reference group. Data were analysed using SPSS to<br/>obtain descriptive statistics.<br/>Results: A total response rate from services of 71.2%<br/>(n=47) was generated. Findings showed a range of experience<br/>among services in providing end of life care to people<br/>with intellectual disabilities in the previous five years, but<br/>general hospitals were reported the most common place of<br/>death. A lack of accessible information on end of life care<br/>for people with learning disabilities was apparent. A few<br/>services (n=14) had a policy to support this population to<br/>make decisions about their care or had used adapted Breaking<br/>Bad News guidelines (n=5) to meet their additional<br/>needs. Both services recognised the value of partnership<br/>working in assessing and meeting the holistic needs of<br/>people with intellectual disabilities at end of life.<br/>Conclusions: A range of experience in caring for people<br/>with intellectual disabilities was present across services,<br/>but more emphasis is required on adapting communication<br/>for this population to facilitate them to participate in their<br/>care. These findings could have international significance<br/>given that studies in other countries have highlighted a<br/>need to widen access to palliative care for this group of<br/>people.