Abstract
BackgroundThe risk of colorectal adenoma (CRA), an important precursor of colorectal cancer, is largely unknown among obese individuals without obesity-related metabolic abnormalities, a condition described as metabolically-healthy obese (MHO). The aim of this study was to examine the association among metabolic status, the different categories of body mass index (BMI), and CRA in a large cohort of adults.MethodsWe analyzed the association among metabolic status, BMI categories and CRA in asymptomatic adults who underwent a first-time colonoscopy as part of the comprehensive health check-up program at the Health Promotion Center of Samsung Medical Center, from January 2005 to December 2012. Being metabolically healthy was defined as lacking any metabolic syndrome components and having a homeostasis model assessment of insulin resistance <2.5.ResultsThe prevalence of “any,” “multiple,” and “high-risk” CRA was 25.6%, 8.3%, and 4.4% among 9,182 metabolically-healthy participants, and 35.9%, 12.5%, and 7.0% among 17,407 metabolically-unhealthy participants, respectively. Increased BMI showed a significant dose-dependent relationship with the prevalence of “any,” “multiple,” and “high-risk” CRA, in both metabolically-healthy and unhealthy participants. In multivariable-adjusted models that accounted for potential confounders including age, sex, smoking, alcohol, first-degree family history of colorectal cancer, and aspirin use, the odds ratio (OR) for any CRA comparing MHO with metabolically-healthy normal-weight (MHNW) participants was 1.25 (95% confidence interval (CI), 1.09–1.43). Further adjustment for metabolic components associated with obesity did not significantly change the association. Similarly, the ORs for multiple CRAs and high risk CRA were higher in MHO participants than MHNW participants [ORs (95% CI), 1.63 (1.31–2.04) and 1.53 (1.14–2.04), respectively].ConclusionsThe MHO phenotype was closely associated with higher prevalence of CRA, including high-risk adenoma. This finding supports the conclusion that MHO increases the risk of colorectal cancer.
Highlights
Colorectal cancer (CRC) is a major public health problem, currently being the third mostcommonly diagnosed cancer, and the fourth highest cause of cancer mortality worldwide [1]
In multivariable-adjusted models that accounted for potential confounders including age, sex, smoking, alcohol, first-degree family history of colorectal cancer, and aspirin use, the odds ratio (OR) for any colorectal adenoma (CRA) comparing metabolically-healthy obese (MHO) with metabolically-healthy normal-weight (MHNW) participants was 1.25 (95% confidence interval (CI), 1.09–1.43)
The ORs for multiple CRAs and high risk CRA were higher in MHO participants than MHNW participants [ORs, 1.63 (1.31–2.04) and 1.53 (1.14–2.04), respectively]
Summary
Colorectal cancer (CRC) is a major public health problem, currently being the third mostcommonly diagnosed cancer, and the fourth highest cause of cancer mortality worldwide [1]. Epidemiological evidence, including meta-analysis comprised of approximately 9,000,000 participants from different countries, strongly support a positive association between obesity and CRC [4]. A number of studies have demonstrated the positive association between body mass index (BMI) and colorectal adenoma (CRA), an important precursor to the subsequent development of CRC [6]. An increased understanding of CRA and its related conditions can be useful in determining the benefits of early CRC screening. The risk of colorectal adenoma (CRA), an important precursor of colorectal cancer, is largely unknown among obese individuals without obesity-related metabolic abnormalities, a condition described as metabolically-healthy obese (MHO). The aim of this study was to examine the association among metabolic status, the different categories of body mass index (BMI), and CRA in a large cohort of adults
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