AUTHOR=Elliott Jessie A. , Reynolds John V. 

TITLE=Visceral Obesity, Metabolic Syndrome, and Esophageal Adenocarcinoma

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.627270

DOI=10.3389/fonc.2021.627270

ISSN=2234-943X

ABSTRACT=<p>Esophageal adenocarcinoma (EAC) represents an exemplar of obesity-associated carcinogenesis, with a progressive increase in EAC risk with increased body mass index. In this context, there is increased focus on visceral adipose tissue and associated metabolic dysfunction, including hypertension, diabetes mellitus and hyperlipidemia, or combinations of these in the metabolic syndrome. Visceral obesity (VO) may promote EAC <italic>via</italic> both directly impacting on gastro-esophageal reflux disease and Barrett's esophagus, as well as <italic>via</italic> reflux-independent effects, involving adipokines, growth factors, insulin resistance, and the microbiome. In this review these pathways are explored, including the impact of VO on the tumor microenvironment, and on cancer outcomes. The current evidence-based literature regarding the role of dietary, lifestyle, pharmacologic and surgical interventions to modulate the risk of EAC is explored.</p>