Abstract
Background:Overweight in Thailand is not as common as in Western countries. We sought to evaluate overweight as the additional risk factor that can increase the prediction of colorectal neoplasia (CRN) detection in Thais apart from the Asia-Pacific Colorectal Screening (APCS) score.Methods:We prospectively enrolled asymptomatic 338 subjects who underwent screening colonoscopy between November 2016 and September 2017. All risk factors according to APCS, BMI and the presence of metabolic syndrome were collected. Overweight was defined as BMI ≥23 kg/m2. By APCS score, subjects were categorized into 1) high-risk and 2) average-risk. Using the combination of APCS score and overweight, subjects were stratified into 4 groups; high-risk with overweight (G1), average-risk with overweight (G2), high-risk with normal weight (G3) average-risk and with normal weight (G4). Logistic regression analysis was used to estimate the risk of detecting CRN.Results:The prevalence of CRN in the high-risk subjects was higher than that of in the average-risk subjects (49%vs.32%; OR, 2.00; 95%CI, 1.17-3.41). After adjustment for APCS risk factors and metabolic syndrome, overweight significantly increased the risk of detecting CRN (OR, 2.52; 95%CI, 1.57-4.05). Among the 4 groups, the detection rates of CRN were significantly different (G1=64%, G2=40%, G3=32% and G4=21%, p<0.01). The relative risk of detecting CRN increased when G1 (OR 6.49; 95%CI, 2.87-14.67), and G2 (2.42; 1.39-4.21) were compared with G4.Conclusions:In addition to the APCS score, overweight is an independent risk factor for detecting CRN. In Thai population, combining overweight and APCS score may be useful to improve the prediction for CRN.
Highlights
Incidence of colorectal cancer (CRC) has been increasing in Asia and in Thailand (Sung et al, 2005)
CRC, colorectal cancer, Asia-Pacific Colorectal Screening BMI (APCS) score; Asia-Pacific Colorectal Screening score; a Model 1, was the analysis for the association between overweight and metabolic syndrome and the risk of CRN detection after adjustment for the individual traditional CRC risk factors; b Model 2, was the analysis for the association between overweight and metabolic syndrome and the risk of CRN detection after adjustment for the APCS risk stratification; c, Any variables with p < 0.1 in the univariate analysis were included in the multivariate analysis
We demonstrated that apart from the traditional CRC risk factors, overweight is the additional risk factor for CRN detection in asymptomatic subjects
Summary
Incidence of colorectal cancer (CRC) has been increasing in Asia and in Thailand (Sung et al, 2005). The Asia-Pacific Colorectal Screening (APSC) score has been developed across 11 countries in Asia and Pacific region (Yeoh et al, 2011) It has been validated in Asian and Western population (Aniwan et al, 2015; Corte et al, 2016; Aniwan et al, 2017; Quach et al, 2018). Since the original APCS score did not include overweight as a parameter, the potential increase in the prediction of CRN detection by adding overweight as additional factor to the APCS score in Thai population is uncertain To confirm this hypothesis, this study was taken to evaluate the association between the combination of overweight and the APCS score and the detection rate of CRN in asymptomatic Thais who presented for CRC screening
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