Energy Intake, Body Mass Index, Physical Activity, and the Colorectal Adenoma-Carcinoma Sequence

Abstract

Little is known about the precise relationship between energy intake, overweight, sedentary lifestyle, and steps in the colorectal adenoma-carcinoma pathway. We studied these parameters within a case-control study. Patients with adenomas < 10 mm (n = 154) or > 10 mm (n = 208) were compared with polyp-free controls (n = 426) for determining factors associated with adenoma formation, i.e., observed for small and large adenomas, or with adenoma growth only. Colorectal cancer cases (n = 171) were compared with population controls (n = 309) to determine factors specific to the final stage, cancer. Exercise reduced the risk of cancer [odds ratio (OR) = 0.3, 95% confidence interval (CI) = 0.2-0.5 for high vs. low physical activity] but had little influence on adenomas. High energy intake increased the risk of cancer [OR for 5th vs. 1st quintile (OR5) = 1.6, 95% CI = 0.9-2.9, p = 0.02], but not of adenomas. High body mass index (BMI) significantly increased the risk of large adenomas (OR5 = 2.1, 95% CI = 1.2-3.5, p = 0.02 and OR5 = 1.7, 95% CI = 1.0-3.1, p = 0.25) for large and small adenomas vs. polyp-free controls. Neither height nor weight nor BMI influenced the risk of cancer. Results were unmodified when controlling for dietary risk factors and family history. Energy intake, a sedentary lifestyle, and high BMI were independently associated with a high risk of cancer itself or large adenomas, which indicates an effect on promotion of colorectal tumors. These findings suggest that preventive advice regarding these factors should be provided, even late in life, to decrease the risk of colorectal cancer.

Association Between Body Size and Colorectal Adenoma Recurrence

“…Our results are in agreement with epidemiological studies showing a relationship between body mass index and risk for colorectal adenomas [9][10][11][12][13][14][15][16][17][18] . Further support for this association was provided in a small study by Almendingen et al 42 , who reported a direct relationship between obesity and the growth rate of adenomas.…”

“…In several studies of colorectal adenomas reported to date, high BMI has been shown to be associated with the development of advanced, larger adenomas of the colon 9,11,15,16 . Unlike the results for any adenoma recurrence, an association between body size and large or advanced adenoma recurrence has been demonstrated in both women and men in the literature, generally in mixed populations 9,15,16 . The current results do not show such an association, possibly because heavier women in our population showed a modest, nonsignificant trend for protection from advanced recurrence with increasing body size.…”

“…The evidence for obesity as a common risk factor in a number of human diseases, including colorectal cancer, has led to the hypothesis that the metabolic changes associated with chronic overeating and sedentary behaviors have a role in development of many pathologies 8 . The majority of epidemiologic studies support a role for obesity as a risk factor for colorectal adenomas [9][10][11][12][13][14][15][16][17][18] , cancers 12,[19][20][21][22][23][24][25][26][27][28][29][30] ; and colon cancer mortality 31,32 . These observations suggest a continuous action of the adverse effects of obesity along the adenoma to carcinoma continuum, starting early in colon tumorigenesis.…”

Physical Inactivity, Water Intake and Constipation as Risk Factors for Colorectal Cancer among Adults in Jordan

“…Physical activity has been shown consistently to reduce CRC incidence (Peters et al, 1989;Kune et al, 1990;Lee et al, 1991). Many studies demonstrated very obvious protective effect of physical activity on the risk of CRC, the risk reduction in such studies were found to be 40-70% (Marchand et al, 1997;Steindorf et al, 2000;Boutron-Ruault et al, 2001). Friedenreich and Orenstein (2002) reviewed the results of more than 50 studies that conducted to assess the association between CRC and physical activity and they demonstrated that physical activity was capable of reducing the risk of colon and CRC up to 70% (averaged 40-50%).…”

5,10-Methylenetetrahydrofolate Reductase Polymorphisms and Colon Cancer Risk: a Meta-analysis

“…Furthermore, the incidence rates vary approximately 20-fold around the world and the highest rates are seen largely in developing countries (Potter et al, 1993). Epidemiological studies have indicated that diets with a high intake of vegetables, fruit and dietary fiber are associated with an decreased colon cancer risk (Boutron-Ruault et al, 2001;Giovannucci, 2001). It is well known that vegetables, particularly green, leafy vegetables, are a major source of folate.…”