Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States)

Abstract

Hyperplastic polyps of the colon reveal a geographic distribution similar to that of colorectal cancer and adenomatous polyps. However, unlike adenomas--known precursors of colorectal cancer--little is known about the etiology or clinical significance of the hyperplastic polyp. In this prospective study, we set out to determine the main dietary and other lifestyle factors in the United States that might be associated with this lesion. Hyperplastic polyps of the distal colon and rectum were diagnosed in 219 of 12,922 men of the Health Professionals Follow-up Study having had an endoscopic procedure between 1986 and 1992, and 175 of 15,339 women of the Nurses' Health Study who had undergone an endoscopy for a variety of reasons between 1980 and 1990. After adjusting for age, family history of colon cancer, history of previous endoscopy, and total energy intake using multiple logistic regression, those consuming 30 g or more of alcohol per day were at increased risk relative to nondrinkers among men (relative risk [RR] = 1.69; 95 percent confidence interval [CI] = 1.01-2.80) and women (RR = 1.79, CI = 1.02-3.15). Current smoking also was found to be associated strongly positively with hyperplastic polyps in men (RR = 2.45, CI = 1.59-3.75) and women (RR = 1.96, CI = 1.16-2.86). High intake of folate was associated inversely with risk in both men (RR = 0.74, CI = 0.49-1.11, between high and low intakes of folate) and women (RR = 0.45, CI = 0.28-0.74, between high and low intakes of folate). Among macronutrients, a suggestive increase in risk existed with intake of animal fat, although this was attenuated in the full multivariate model (RR[men] = 1.48, CI = 0.94-2.41, and RR[women] = 1.22, CI = 0.77-1.94) between high and low quantities of animal fat intake. These prospective data provide evidence of associations between low folate intake, alcohol consumption, and current cigarette smoking, and risk of hyperplastic polyps of the distal colon and rectum. These same factors also have been found to be related to adenoma and cancer of the colon. The hyperplastic polyp is an indicator of populations at high risk for colorectal carcinoma, and it also may serve as a marker for factors that influence neoplastic evolution.

Risk factors for self-reported colon polyps

“…The prospective studies of health professionals also suggested an independent risk associated with high alcohol consumption, 5,15 an association that has been demonstrated for adenomatous polyps in some recent case-control studies, [31][32][33][34] but not in others. 26,[35][36][37][38][39][40] Three case-control studies found an association between high alcohol consumption and adenomatous polyps among men, but not among women.…”

“…Adenomatous polyps are considered to be precursor lesions, [2][3][4] while hyperplastic polyps may be markers for populations at high risk of colorectal cancer. 5 Early and repeated screening for colon polyps is generally recommended among adults with a personal or first-degree family history of colorectal neoplasia or inflammatory bowel disease, [6][7][8][9][10] but proposals to screen persons at otherwise "average risk" have been criticized for their financial cost, low patient acceptability, and possible adverse effects. 11 It may be useful, therefore, to investigate other polyp risk factors that could improve the recognition of those average-risk adults who are most likely to benefit from polyp screening.…”

“…(For general reviews, see Neugut et al 12 and Peipins and Sandler. 13 ) Two population-based, prospective cohorts, the Health Professionals Follow-up Study and the Nurses' Health Study, have reported on characteristics associated with adenomatous colon polyps [14][15][16][17][18][19][20][21][22] and hyperplastic colon polyps 5 during an observation period of up to 10 years. These prospective cohorts yielded detailed epidemiologic insights in part because their participants were highly educated health professionals who underwent endoscopic screening.…”

Colorectal Cancer and Alcohol

“…In addition, also the occurrence of hyperplastic polyps is enhanced when more than 30 grams of alcohol per day were consumed. The relative risk for men was 1.8 and for women 2.5 (Kearney et al, 1995). Alcohol affects the adenoma/carcinoma sequence at the different early steps (Boutron et al, 1995).…”

Evidence Regarding the Level of Alcohol Consumption Considered to be Low-Risk for Men and Women

“…Alcohol has been associated with the formation of adenomatous polyps, a pre-cancerous lesion (Kearney et al, 1995), and may play a role in later stages of tumour growth (Boutron-Ruault et al, 1995). One recent line of work in this area regarding biological mechanisms is focused on the role of acetaldehyde (a first metabolite of ethanol) and its production in the gut by intestinal bacteria (Seitz et al, 1998a).…”