Abstract
Adiposity has been recognized as a risk factor for colorectal adenoma, but the influence of weight gain, adipose tissue distribution, and possible differences between ethnic/racial and gender groups remains unanswered. The aim of this prospective study was to examine the association between adiposity and weight change and colorectal adenoma risk. Over approximately 10-year period, anthropometric measures and other risk factors were measured at three time points in the multicenter multiethnic Insulin Resistance Atherosclerosis Study cohort. Colonoscopies were then conducted on 600 cohort participants regardless of symptoms whose mean age at colonoscopy was 64 years. Multivariate logistic regression analyses were used to assess the association between colorectal adenomas and measures of adiposity and weight change over the approximately 10-year period before colonoscopy. Obesity was positively associated with risk of colorectal adenomas at the time of colonoscopy [adjusted odds ratio (OR(adj)), 2.16; 95% confidence interval (95% CI), 1.13-4.14] and was stronger in women (OR(adj), 4.42; 95% CI, 1.53-12.78) than in men (OR(adj), 1.26; 95% CI, 0.52-3.07). The risk of adenomas increased among participants who gained weight compared with those who maintained weight over the approximately 5 years (OR(adj), 2.30; 95% CI, 1.25-4.22) and approximately 10 years (OR(adj), 2.12; 95% CI, 1.25-3.62). These associations were similar for both advanced and nonadvanced adenomas. These results suggest a positive association between obesity, weight gain, and colorectal adenoma risk. Stronger associations were observed when obesity was measured at the time of colonoscopy, suggesting that obesity may be a promoting factor in the growth of colorectal adenomas.
Highlights
Colon cancer is the second leading cause of cancer deaths in the United States with f146,940 new cancer cases and 56,730 related deaths annually [1]
After adjustment of potential confounders, obesity was positively associated with risk of colorectal adenomas at the time of colonoscopy (ORadj, 2.16; 95% confidence interval (95% CI), 1.13-4.14; Table 2)
Similar trends were observed at f5 years before colonoscopy (ORadj, 1.59; 95% CI, 0.86-2.93) and f10 years before colonoscopy (ORadj, 1.54; 95% CI, 0.87-2.71), but these associations were not statistically significant
Summary
Colon cancer is the second leading cause of cancer deaths in the United States with f146,940 new cancer cases and 56,730 related deaths annually [1]. A substantial literature exists about the association between various body measures and the risk of colorectal adenomas [3] Both body mass index (BMI) and waist-to-hip ratio have been associated with increased risk of adenomas in most [4,5,6,7,8,9,10,11,12,13,14] but not all studies [15,16,17]. Studies that have investigated the association between BMI or visceral adipose tissue and recurrence of colorectal adenomas among people under endoscopic surveillance have reported null findings [18,19,20] This may be due to the relatively short interval between screenings (0-4 years). When adenomas were not resected, but observed over a 3-year period, higher adiposity was associated with adenoma growth [21], suggesting that adiposity may be associated with factors that promote the growth of existing colorectal adenomas
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