S726 Weighing the Risk: A Retrospective Analysis of Obesity and Gastric Intestinal Metaplasia

Introduction: Gastric cancer remains a global health concern, although less prevalent in North America. Gastric intestinal metaplasia (GIM), a recognized precancerous lesion in Correa’s cascade, continues to raise concern due to its associated risk factors. Obesity may contribute to GIM development, although its role regarding GIM subtypes and related comorbidities remains unclear. We aim to (1) assess the association between body mass index (BMI) and odds of developing GIM, (2) determine the prevalence of complete versus incomplete GIM, (3) evaluate the relationship between obesity related comorbidities and GIM, and (4) explore associations between nonsteroidal anti-inflammatory drug (NSAID)/proton pump (PPI) inhibitor usage and GIM. Methods: A retrospective study was performed using the HCA Gulf Coast Division electronic database from October 2021 to July 2024. Adults ≥25 years with biopsy-confirmed GIM were identified using International Classification of Diseases, Tenth Revision codes. BMI was stratified into standard categories; GIM subtypes were classified histologically. Logistic regression calculated odds ratios (ORs) for GIM and comorbidities. Waist-to-hip ratio (WHR) assessed visceral adiposity. Results: Total of 7,637 patients were included. Median age was 64 years; 55.8% were women. GIM was most prevalent in the overweight BMI (31.8%), followed by normal BMI (23.4%) and moderate obesity BMI (21.7%). Compared to normal BMI, moderate obesity BMI had strong associations with type 2 diabetes (OR = 6.51, 95% confidence interval [CI]: 3.63-7.51, P < 0.05), while overweight BMI was linked to hypertension (OR = 1.55, 95% CI: 1.42-1.62, P < 0.05), coronary artery disease (OR = 1.53, 95% CI: 1.31-1.77, P < 0.05), dyslipidemia (OR = 1.45, 95% CI: 1.22-2.71, P < 0.01), and gastroesophageal reflux disease, (OR = 1.98, 95% CI: 1.85-2.12, P < 0.05). Incomplete GIM was present in 56.1% of cases (35.9% type II; 20.2% type III), with complete GIM in 40.6%. WHR >0.9 was found in 40.2% of women and 42.9% of men. PPI use was common (46%), especially omeprazole (56.6%); NSAID use was lower (24.2%). Conclusion: A non-linear relationship was seen between BMI and GIM, with higher prevalence in overweight and moderately obese individuals. Visceral adiposity, reflected by WHR, may better predict GIM risk than BMI alone. Incomplete GIM was common, and gastroesophageal reflux disease, metabolic comorbidities, and PPI use were positively associated. These findings support a multifactorial pathogenesis and suggest incorporating fat distribution and comorbidity burden into future screening.