Impact of Body Mass Index on the Risk of Colorectal Adenoma in a Metabolically Healthy Population

Abstract

Metabolically healthy obese (MHO) states exist that seem to be protected from cardiovascular risks. Although obesity is a risk factor for colorectal adenoma (CRA), there has yet to be any study of the risks of CRA in MHO individuals. In this study, we compared CRA prevalence in MHO individuals versus metabolically healthy individuals who were normal in weight. This cross-sectional study involved 18,085 Korean adults (39.1 AE 6.7 years) who had a health checkup including a colonoscopy. High-risk CRA was defined as any adenoma over 1 cm, 3 or more adenomas, adenoma with a villous component, or high-grade dysplasia. Multinomial logistic regression models were used to measure the associations between body mass index (BMI) and the risk of low-risk and highrisk CRA. Low-risk and high-risk CRA were present in 9.3% and 1.4% of the study population, respectively. After adjusting for age, sex, smoking, drinking, exercise, family history of colorectal cancer, education, and use of analgesic and aspirin, compared with normal healthy individuals, the prevalence of low-risk and high-risk CRA was increased in MHO individuals [OR ¼ 1.44; 95% confidence interval (CI), 1.23-1.69 and OR ¼ 1.62; 95% CI, 1.09-2.41, respectively]. In fully adjusted models, the prevalence of low-risk and high-risk CRA was associated with increasing categories of BMI in a dose-response manner (P for trend < 0.001 and 0.01, respectively). Thus, excess body weight, even in the absence of a metabolic unhealthy state, was found to be positively associated with increased presence of CRAs. Cancer Res; 73(13); 4020-7. Ó2013 AACR.

The Metabolic Syndrome Is Associated with an Increased Risk of Colorectal Polyps Independent of Plasma Homocysteine

“…Several mechanisms have been proposed regarding the effect of the metabolic syndrome on the risk of colorectal adenomas, including obesity [41], oxidative stress [42], inflammation [43], and insulin resistance [44,45]. In support of results reported in previous studies [13,14,15,16,17,18], the present study showed that the metabolic syndrome itself and its individual components (i.e. higher WC, SBP, DBP, serum glucose and triglyceride levels, and lower HDL concentration) significantly increased the risk of colorectal polyps.…”

“…The metabolic syndrome, a cluster of central obesity, hypertension, dyslipidemia, and impaired glucose tolerance, has more recently been associated with the recurrence of colorectal adenomas [8] and has been considered an independent risk factor for colorectal cancer [9,10,11,12] and polyps [13,14,15]. Not only the metabolic syndrome itself but also its individual components, such as overweight status and dyslipidemia, were associated with the risk of colorectal polyps [16,17,18]. Although the exact pathogenetic involvement of the metabolic syndrome in the development of colorectal polyps is unknown, the metabolic syndrome may play a role in this development.…”

Colonic Mucosal Fatty Acid Synthase as an Early Biomarker for Colorectal Neoplasia: Modulation by Obesity and Gender

“…[13, 33, 34]. While this is the first report (to our knowledge) to demonstrate overexpression of FASN in the uninvolved mucosa, its expression has been reported to be elevated in aberrant crypt foci [35, 36], adenomas [37] and carcinomas [25]. The biological consequences of FASN include increased endothelial activity (important given that increased micro-circulation is one of the earliest events in colorectal carcinogenesis) as well as proliferation [38].…”

Associations between amount of smoking and alcohol intake and risk of colorectal neoplasm

“…In our study, approximately 60% of the participants were employees of various companies and local governmental organizations, or their spouses, and the remaining participants registered individually for the program. 22 In most Korean companies, the mandatory retirement age is approximately 55 years. As part of their welfare policy, companies often subsidize comprehensive health examinations including colonoscopy, regardless of current guidelines.…”