Presence Of Colorectal Adenomas Research Articles

Research Progress of Intestinal Microecology in the Pathogenesis of Colorectal Adenoma and Carcinogenesis.

Colorectal adenoma is a precancerous lesion that may progress to colorectal cancer. Patients with colorectal adenoma had a 4-fold higher risk of developing colorectal malignancy than the rest of the population, with approximately 80% of colorectal cancer originating from colorectal adenoma. Therefore, preventing the occurrence and progression of colorectal adenoma is crucial in reducing the risk for colorectal cancer. The human intestinal microecology is a complex system consisting of numerous microbial communities with a sophisticated structure. Interactions among intestinal microorganisms play crucial roles in maintaining normal intestinal structure, digestion, absorption, metabolism, and other functions. The colorectal system is the largest microbial bank or fermentation system in the human body. Studies suggest that intestinal microecological imbalance, one of the most important environmental factors, may play an essential role in the occurrence and development of colorectal adenoma and colorectal cancer. Based on the complexity of studying the gut microbiota ecosystem, its specific role in the occurrence and development of colorectal adenoma is yet to be elucidated. In addition, further studies are expected to provide new insights regarding the prevention and treatment of colorectal adenoma. This article reviews the relationship and mechanism of the diversity of the gut microbiota, the relevant inflammatory response, immune regulation, and metabolic changes in the presence of colorectal adenomas.

Abstract 3905: A prospective pilot study of desorption electrospray ionisation mass spectrometry (DESI-MS) for the early detection of colorectal adenoma

Abstract Background: Colorectal adenoma detection using non-invasive faecal-based biomarkers is not yet feasible. Our primary aim was to identify differential metabolomic signatures of colorectal adenomas in faecal samples using a Liquid Chromatography Mass Spectrometry (LCMS) assay. The secondary aim was to translate this assay to an Ambient Mass ionization-based technique, DESI, for high throughput, point of care diagnostics. Methods: Patients were prospectively recruited from the colorectal cancer clinic at Imperial College NHS Trust, UK. Patients provided fresh stool samples, prior to taking bowel preparation for colonoscopy. Specimens were collected in Fecotainer (AT Medical BV) and cooled before immediate manual homogenization, aliquoting and storage at -80oC. LCMS untargeted metabolomics was performed using Reversed Phase chromatography (Acquity UPLC, Xevo G2-XS QToF, Waters) in both ElectroSpray Ionization (ESI) modes. Deactivated faecal samples applied to swabs were analysed using DESI-MS (Xevo G2-XS QToF). Multivariate Statistical Analysis was performed using Python. Logistic regression (LR) classification with Leave One patient Out Cross Validation (LOOCV) was applied. Recursive Feature Elimination and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms were used for feature elimination. Results: 36 subjects (17 females, mean age 63.5, range 42-85) were included: 17 controls, 8 adenoma, and 11 cancer patients. Principal Component Analysis of LCMS data from both ESI modes separated the three groups. LR with LOOCV for the adenoma group showed 97% sensitivity and 100% specificity. Receiver Operator Characteristic curve based on a multivariate model of the top 5 significant features showed a diagnostic ability of binary classifiers of adenoma vs cancer 0.997 (Area under the curve (AUC), 95% CI=0.944-1), adenoma v healthy 0.981 (AUC, 95% CI=0.984-1), and healthy v cancer & adenoma 0.995 (AUC, 95% CI=0.931-1). LR with LOOCV after LASSO on the DESI-MS data revealed sensitivity, 84%, and specificity, 95%, for the adenoma group. Specifically, these data suggest increased abundances of N-acyl amino acids, polyunsaturated chain fatty acids (n-3 PUFAs), in the adenoma group. Both species participate in arachidonic and linoleic acid pathways, where upregulation causes prostaglandin overproduction. Glycerophosphoserines, important in cell apoptosis, were significantly increased in cancer vs adenoma/controls (p < 0.01). Conclusion: DESI-MS analysis of faecal samples can detect the presence of colorectal adenomas and distinguish them from cancer. A prospective trial is now under way to validate these findings. Citation Format: Maria Sani, Lauren Ford, Daniel Simon, Yuchen Xiang, James McKenzie, Stefania Manetta Stavrakaki, Petra Paizs, Tausif Huq, Jim Higginson, James Alexander, Zoltan Takats, James Kinross. A prospective pilot study of desorption electrospray ionisation mass spectrometry (DESI-MS) for the early detection of colorectal adenoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3905.

Colorectal adenomas and MAFLD: a cross-sectional study in a hispanic screening cohort

Aims: Prior evidence demonstrates an association between non-alcoholic fatty liver disease (NAFLD) and colorectal adenomas (CRA) risk. However, information using the new definition of the disease [i.e., metabolic dysfunction-associated fatty liver disease (MAFLD)] is scarce. We aimed to assess the relationship between MAFLD and CRA risk. Methods: We conducted a cross-sectional study including patients from three university centers in Chile who underwent a colonoscopy for colorectal cancer screening and abdominal imaging study. We obtained sociodemographic and clinical data, and we performed univariate and multivariable regression analyses. Results: In total, 895 patients were included; 42% were male, the mean age was 59.9 ± 9.3 years, and 37.8% (338) had CRA. Patients harboring polyps were predominantly males (48.2% vs. 38.2%, P = 0.002), older (61.6 ± 8.7 years vs. 58.9 ± 9.5 years, P < 0.001), and exhibited a higher body weight than controls [75 (66-88) kg vs. 72 (63-82.3) kg, P = 0.002]. Fifty-six percent of patients showed hepatic steatosis in imaging studies and 54.4% met MAFLD diagnostic criteria. The adenoma detection rate was higher in the MAFLD group compared to controls (46.4% vs. 27.5%, P < 0.001). In the multivariable analysis, MAFLD was significantly associated with the presence of CRA (odds ratio = 2.32; 95%CI: 1.68-3.19, P < 0.0001). There were no statistically significant differences of histopathological characteristics of the adenomas according to the presence of MAFLD. Conclusion: The present study shows that, in Chilean Hispanic subjects, MAFLD is associated with an increased risk of CRA. This information may be useful to design specific screening colonoscopy recommendations in MAFLD patients.

ARE OBESITY AND ADENOMA DEVELOPMENT ASSOCIATED AS COLORECTAL CANCER PRECURSORS?

ABSTRACT Background:One of the most important concerns on health is the increased rates of obesity in population and the speed in which this number is increasing. This number translates a serious public health problem, since it also increases the risk of several other diseases associated with obesity resulting in significant morbidity and mortality. Among them, it seems to be connected to several neoplasms, such as colorectal carcinoma. Aim:To evaluate the impact of obesity as a risk factor for colorectal carcinoma through the detection of adenoma, and to discuss the mechanisms that could establish a link between obesity and neoplasm. Methods:Patients who underwent colonoscopy were included. Personal and anthropometric data, clinical history, and results of the tests were analyzed in order to verify the correlation of BMI and the presence of adenomatous polyps. Results:A total of 142 patients were studied, which a mean age of 62 years. Of the patients, 74 (52.1%) were men and 68 (47.9%) were. Obesity was identified in 16.2% of the patients. Polyps were found in 61 (42.9%), mostly smaller than 1 cm. Obese individuals were 1.56 times more likely to present colorectal adenoma than patients with normal weight. Conclusion:This study, although showing the greater presence of colorectal adenomas in obese individuals, did not show a significant difference in the occurrence of pre-malignant lesions.

Association between High Levels of Circulating Chemerin and Colorectal Adenoma in Men

Background: Obesity and metabolic syndrome are considered the risk factors of colorectal adenoma (CRA) and colorectal cancer (CRC). Chemerin is a novel adipocytokine associated with the development of gastric cancer, esophageal cancer, hepatocellular carcinoma, and CRC. However, the relationship between chemerin levels and CRA remains unclear. Objective: This study is aimed at investigating the ­association between serum chemerin levels and the development of CRA. Methods: We conducted a total colonoscopy-based cross-sectional case-control study of 80 male patients with CRA and 80 male age-matched control individuals without CRA, according to their endoscopic findings. Serum chemerin concentrations were measured using a sandwich enzyme-linked immunosorbent assay kit, and the OR of CRA was calculated via logistic regression analysis. Results: The mean serum chemerin level of the CRA group was significantly higher than that of the control group (7.9 ± 0.41 vs. 5.16 ± 0.34 ng/mL, p < 0.001). Serum chemerin level was positively correlated to the development of CRA (r = 0.34). Multivariate logistic regression analysis revealed that a high chemerin level was independently associated with the development of CRA (OR 2.82, 95% CI 1.39–5.72). Conclusions: Our findings indicated that increased serum chemerin levels are positively associated with the presence of CRA in men. Chemerin may play an important role in the development of CRA.

Relationship between Barrett's esophagus and colonic diseases: a role for colonoscopy in Barrett's surveillance.

Given that risk factors for Barrett's carcinogenesis are predictive, appropriate management and surveillance of Barrett's esophagus (BE) may be provided. The presence of colorectal neoplasms (CRNs) is a possible predictor of the development of BE and the progression to esophageal adenocarcinoma (EAC). We evaluated the relationship between BE or EAC and colonic diseases, including neoplasms and diverticulosis. Patients (N = 5606) who underwent both colonoscopy and esophagogastroduodenoscopy between January 2016 and December 2017 at three institutions were enrolled. The relationships between the presence of colonic diseases and BE or EAC and other clinical or endoscopic predictors of the presence of BE were investigated retrospectively. The prevalence of BE ≥ 1cm and ≥ 3cm in length was 13.0% and 0.52%, respectively. BE was closely related with the presence of colorectal adenoma (48.4% vs. 37.2% in non-BE; P < 0.001), adenocarcinoma (16.6% vs. 8.4%, P < 0.001) and colonic diverticulosis (CD) (34.1% vs. 29.3%, P < 0.001). In patients with long-segment BE, CRNs (79.3%, P < 0.001) and CD (48.2%, P = 0.038) were more common. EAC patients also had a statistically significantly higher incidence of CRNs than non-BE patients (87.5% vs. 45.6%, P = 0.027). Diverticulosis at the distal colon correlated significantly with EAC and BE (50.0%, P = 0.010 and 15.4%, P = 0.024, vs. 12.0% in non-BE). Multivariate analysis showed that CRNs (t = 8.55, P < 0.001), reflux esophagitis (t = 5.26, P < 0.001) and hiatal hernia (t = 11.68, P < 0.001) were predictors of BE. The presence of CRNs was strongly associated with BE and EAC. Therefore, colonoscopy may be useful for establishing a strategy for the surveillance of BE.

Abdominal fat distribution measured using computed tomography is associated with an increased risk of colorectal adenoma in men.

A few studies have shown inconsistent results regarding the association between the visceral fat proportion and colorectal adenomas. We aimed to investigate the association between abdominal fat distribution measured by computed tomography (CT) and colon adenoma.A total of 336 participants underwent physical examination, blood tests, colonoscopy, and abdominal computed tomography at Chung-Ang University Hospital. The associations between the obesity indicies (body mass index, visceral fat area (VFA), subcutaneous fat area (SFA), VFA-to-SFA ratio (VFA/SFA), and colorectal adenomas were evaluated.Of 309 subjects, 119 patients (38.5%) had colorectal adenoma. Mean age and fasting plasma glucose were higher in the patients with colorectal adenoma (P < .05, respectively). The mean VFA (153.3 cm2 vs 131.4 cm2, P < .01) and VFA/SFA (1.07 vs 0.92, P < .05) were higher in the adenoma group than in the nonadenoma group. Males had higher mean VFA and VFA/SFA (P < .001). The mean VFA, SFA, and VFA/SFA were not associated with the location, size, number, and advancement of colorectal adenoma. In multivariate analysis, colorectal adenoma was significantly associated with VFA rather than VFA/SFA. In addition, colorectal adenoma was significantly associated with VFA rather than VFA/SFA in the men. The VFA, SFA, and VFA/SFA were not associated with colorectal adenoma in the women.The VFA measured by using a CT scan was positively associated with the presence of colorectal adenoma, especially in men. Furthermore, average risk men with large visceral fat volume should be examined carefully in screening colonoscopy.

Glucose metabolism of visceral adipose tissue measured by 18F-FDG PET/CT is related to the presence of colonic adenoma.

This study investigated the relationships between the area and metabolic activity of adipose tissue and the presence of colorectal adenoma (CRA). Our institutional review board approved the study and waived informed consent. A total of 212 subjects who underwent fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and colonoscopy for routine health check-ups were enrolled. The volumetric parameters of areas of visceral (VATav), subcutaneous (SATav), and total adipose tissue (TATav) and calculated visceral-to-subcutaneous adipose tissue ratio (VSR) and visceral-to-total adipose tissue ratio (VAR) were considered. Metabolic parameters of standardized uptake value (SUV) of visceral (vcSUVmax, vcSUVmean), subcutaneous (scSUVmax, scSUVmean), and calculated visceral-to-subcutaneous adipose tissue ratio (VSRmax, VSRmean) were considered. Anthropometric data of height, weight, body mass index (BMI), waist circumference (WC), body fat mass (BFM), skeletal muscle mass (SMM), and diverse laboratory data were also considered as variables. Sixty-six subjects were placed in the CRA group and 146 subjects in the non-CRA group. The presence of CRA was significantly correlated with older age (P = .001), male sex (P = .041), higher BMI (P = .004), higher WC (P = .001), higher BFM (P = .024), higher VATav (P < .001), higher TATav (P = .004), higher VSR (P < .001), higher VAR (P < .001), lower vcSUVmax (P = .002), lower vcSUVmean (P < .001), and lower VSRmean (P = .002). On multiple regression analysis, vcSUVmax and vcSUVmean were independently associated with the presence of CRA (P = .009 and P = .045). Lower glucose metabolism of visceral adipose tissue was related to the presence of CRA. Our findings identify the value of visceral metabolic dysfunction as a potential surrogate marker of elevated risk for CRA.

Background Colonic 18F-Fluoro-2-Deoxy-D-Glucose Uptake on Positron Emission Tomography Is Associated with the Presence of Colorectal Adenoma.

18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) scan is used to evaluate various kinds of tumors. While most studies on PET findings of the colon focus on the colonic uptake pattern, studies regarding background colonic uptake on PET scan are rare. The purpose of this study was to identify the association between the background colonic uptake and the presence of colorectal adenoma (CRA), which is a frequent precancerous lesion. We retrospectively reviewed the medical records of 241 patients with gynecologic malignancy who had received PET or PET/computed tomography (CT) scan and colonoscopy at the same period as a baseline evaluation. Background colonic 18F-FDG uptake was visually graded and the maximal standardized uptake values (SUVmax) of 7 different bowel segments were averaged. In univariate analysis, older age at diagnosis (≥ 50 years, p = 0.034), overweight (BMI ≥ 23 kg/m², p = 0.010), hypercholesterolemia (≥ 200 mg/dL, p = 0.027), and high grade background colonic uptake (p = 0.009) were positively associated with the prevalence of CRA. By multiple logistic regression, high grade background colonic uptake was independently predictive of CRA (odds ratio = 2.25, p = 0.021). The proportion of CRA patients significantly increased as background colonic uptake grade increased from 1 to 4 (trend p = 0.015). Out of the 138 patients who underwent PET/CT, the proportion of CRA patients in the group with high SUVmax (> 2.25) was significantly higher than in the low SUVmax group (27.5% vs. 11.6%, p = 0.031). In conclusion, high grade of background colonic 18F-FDG uptake is significantly associated with the prevalence of CRA.

To assess the association between vertebral marrow fat content and colorectal adenoma in postmenopausal women using magnetic resonance spectroscopy.

Although lower bone mineral density (BMD) is considered to have an increased risk for colorectal adenoma, no association between marrow fat content and colorectal adenoma has been elucidated yet. To evaluate the relationship between marrow fat fraction (MFF) and the presence of colorectal adenoma in postmenopausal women using magnetic resonance spectroscopy (MRS). We performed a cross-sectional observational study on 152 postmenopausal patients with colorectal adenoma and 100 matched control subjects who underwent screening colonoscopy, biochemical measurements, dual-energy X-ray absorptiometry, and MRS. Logistic regression models were performed to assess the relationships among BMD, MFF, and colorectal adenoma. With univariate analysis, marrow fat accumulation was higher and BMD values were lower in patients with colorectal adenoma compared with those in controls. After adjustment for potential confounders including demographics, health history, blood lipid levels, indexes of glucose metabolism, and validated measures of diet and physical activity, MFF was significantly positively associated with colorectal adenoma (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.10-2.46; P = 0.008). Vertebral BMD, but not total hip and femoral neck BMD, was inversely related with colorectal adenoma (OR, 0.62; 95% CI, 0.14-0.89; P = 0.027). Additionally, MFF was associated with adenoma number, size, and high-risk adenoma (all P < 0.01). MFF was found to be an independent risk factor of a high-risk colorectal adenoma (OR, 2.08; 95% CI, 1.24-3.60; P = 0.019). Marrow fat accumulation is highly associated with colorectal adenoma, particularly high-risk adenoma, in postmenopausal women.

Su1057 Sex Hormone Binding Globulin (Shbg) and MRI Fat Quantification As Markers for Non-Alcoholic Steatohepatitis (NASH)

A S L D A b st ra ct s between NAFLD and colorectal adenoma in asymptomatic patients, who underwent screening colonoscopy. Methods: Electronic database including Pubmed and Embase were searched for relevant studies that investigate the Association between Nonalcoholic fatty liver disease and colorectal adenoma. Study designs and locations in addition to characteristics of adenoma were added to subgroup analysis. The random-effects model was used to pool the effect size across studies and calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for infectious complications. Results: Overall Four cross-sectional studies and three cohort studies with a total of14, 095 subjects were included in the final meta-analysis. The association between NAFLD and colorectal adenoma was statistically significant [pooled odds ratio (OR) 1.42, 95% confidence interval (CI): 1.271-1.587]. The association was more significant in Asian population five studies compared to European/North American population two studies. Conclusions: According to our results in asymptomatic patients undergoing screening colonoscopy, NAFLD is significantly associated with the presence of colorectal adenoma. Our results suggest that extra carful screening for colorectal cancer in patients with NAFLD. The majority of subjects were from Asian country; Further studies of western population might be needed to confirm our results.

Lack of significant association between serum inflammatory cytokine profiles and the presence of colorectal adenoma.

BackgroundInflammatory cytokines in the colonic microenvironment have been shown to increase with advance colorectal cancer disease state. However, the contribution of inflammatory cytokines to pre-malignant disease, such as the formation of adenomas, is unclear.MethodsUsing the Milliplex® MAP Human Cytokine/ Chemokine Magnetic Bead Panel Immunoassay, serum cytokine and chemokine profiles were assayed among participants without an adenoma (n = 97) and those with an adenoma (n = 97) enrolled in the NCI-funded Insulin Resistance Atherosclerosis Colon Study. The concentrations of interleukin-10 (IL-10), IL-1β, IL-6, IL-17A, IL-2, IL-4, IL-7, IL-12(p70), interferon-γ (IFN-γ), macrophage chemoattractant protein-1 (MCP-1), regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), granulocyte macrophage colony-stimulating factor (GM-CSF), and macrophage inflammatory protein-1β (MIP-1β) were determined. Multiple logistic regression analyses were used to evaluate the association between adenoma prevalence and cytokine levels.ResultsThe presence of colorectal adenomas was not associated with significant increases in the systemic levels of proinflammatory (TNF-α, IL-6, IL-1β) or T-cell polarizing (IL-12, IL-2, IL-10, IL-4, IL-17, IFN-γ) cytokines. Furthermore, MCP-1 and RANTES levels were equivalent in the serum of study participants with and without adenomas.ConclusionsThese findings suggest colorectal adenoma prevalence may not be associated with significant alterations in systemic inflammation.

Low bone mineral density linked to colorectal adenomas: a cross-sectional study of a racially diverse population.

Epidemiologic studies suggest that lower bone mineral density (BMD) is associated with an increased risk for colorectal adenoma/cancer, especially in postmenopausal women. The aim of this study is to investigate the association between osteopenia and/or osteoporosis and colorectal adenomas in patients from a New York community hospital. We performed a cross-sectional observational study on 200 patients who underwent screening colonoscopies and bone density scan (dual-energy X-ray absorptiometry) at Nassau University Medical Center from November 2009 to March 2011. Among these, 83 patients were identified as osteoporosis (T score of -2.5 or below) and 67 were osteopenia (T score between -1.0 and -2.5). Logistic regression model was performed to assess the association between osteopenia and/or osteoporosis and colorectal adenomas. Among the patients with osteopenia and osteoporosis, the mean ages were 59.1 years [standard deviation (SD) =8.9] and 61.5 (SD =8.9), respectively. There were 94.0%, 85.1% and 74.7% women, respectively, in normal BMD, osteopenia and osteoporosis groups. The prevalence of colorectal adenomas was 17.9% and 25.3% in the osteopenia and osteoporosis groups, respectively, and 18.0% in the normal BMD group. After adjustment for potential confounders including age, sex, race, body mass index (BMI), tobacco use, alcohol use, history of diabetes, hypertension, or dyslipidemia, osteoporosis was found to be associated with presence of colorectal adenomas more than 2, compared to the normal BMD group. No significant associations were found for the prevalence, size, and location of adenomas. Our study suggests that osteoporosis is significantly associated with the presence of multiple colorectal adenomas. Prospective studies with a larger sample size are warranted in the future.

Meta-analysis of the association between APC promoter methylation and colorectal cancer.

Previous studies investigating the association between adenomatous polyposis coli (APC) gene promoter methylation and colorectal cancer (CRC) have yielded conflicting results. The aim of this study was to comprehensively evaluate the potential application of the detection of APC promoter methylation to the prevention and treatment of CRC. PubMed, Embase, and MEDLINE (results updated to October 2014) were searched for relevant studies. The effect size was defined as the weighted odds ratio (OR), which was calculated using either the fixed-effects or random-effects model. Prespecified subgroup and sensitivity analyses were conducted to evaluate potential heterogeneity among the included studies. Nineteen studies comprising 2,426 participants were selected for our meta-analysis. The pooled results of nine studies comprising a total of 740 subjects indicated that APC promoter methylation was significantly associated with CRC risk (pooled OR 5.53; 95% confidence interval [CI] 3.50–8.76; P<0.01). Eleven studies with a total of 1,219 patients evaluated the association between APC promoter methylation and the presence of CRC metastasis, and the pooled OR was 0.80 (95% CI 0.44–1.46; P=0.47). A meta-analysis conducted with four studies with a total of 467 patients found no significant correlation between APC promoter methylation and the presence of colorectal adenoma (pooled OR 1.85; 95% CI 0.67–5.10; P=0.23). No significant correlation between APC promoter methylation and patients’ Dukes’ stage, TNM stage, differentiation grade, age, or sex was identified. In conclusion, APC promoter methylation was found to be significantly associated with a higher risk of developing CRC. The findings indicate that APC promoter methylation may be a potential biomarker for the carcinogenesis of CRC.

Association Between Bone Mineral Density and Colorectal Adenomas: A Cross-Sectional Study

Introduction: Epidemiologic studies suggest that lower bone mineral density (BMD) is associated with an increased risk for colorectal adenoma/cancer, especially in postmenopausal women. The aim of this study is to investigate the association between osteopenia and/or osteoporosis and colorectal adenomas in patients from a New York community hospital. Methods: We performed a cross-sectional observational study on 200 patients who underwent screening colonoscopies and bone density scan (dual-energy, X-ray absorptiometry) at Nassau University Medical Center from November 2009 to March. Among these, 83 patients were identified as osteoporosis (T score of −2.5 or below) and 67 were osteopenia (T score between −1.0 and −2.5). Logistic regression model was performed to assess the association between osteopenia and/or osteoporosis and colorectal adenomas. Results: Among the patients with osteopenia and osteoporosis, the mean age were 59.1 years (standard deviation [SD] 8.9) and 61.5 (SD 8.9), respectively. There were 94.0%, 85.1%, and 74.7% women respectively in normal BMD, osteopenia, and osteoporosis group. The prevalences of colorectal adenomas were 17.9% and 25.3% in osteopenia and osteoporosis group, respectively, and 18.0% in the normal BMD group. After adjustment for potential confounders including age, sex, race, BMI, tobacco use, alcohol use, history of diabetes, hypertension, or dyslipidemia, osteoporosis was found to be associated with presence of colorectal adenomas more than 2, compared to the normal BMD group. No significant associations were found for the prevalence, size, and location of adenomas. Conclusion: Our study suggests that osteoporosis is significantly associated with the presence of multiple colorectal adenomas. Prospective studies with a larger sample size are warranted in the future.Table 1Table 2

Association between nonalcoholic fatty liver disease and colorectal adenoma: a systemic review and meta-analysis.

Nonalcoholic fatty liver disease (NAFLD) is considered to be a hepatic manifestation of metabolic syndrome (MetS) and the most common chronic liver disease worldwide. The association between NAFLD and colorectal adenoma has been investigated in multiples studies but the results have been conflicting. We performed a systematic review and meta-analysis to evaluate this in asymptomatic patients who underwent screening colonoscopy. We searched the literatures of all languages from PubMed, EMBASE and the Cochrane library from January 1, 1980 through July 15, 2014. Combined and subgroup analyses stratified by study designs, study locations, characteristics of adenoma (location, size, number, and advanced adenoma) were performed. Four cross-sectional and one cohort studies with a total of 6,263 subjects were included in the meta-analysis. NAFLD was significantly associated with colorectal adenoma [pooled odds ratio (OR) 1.74, 95% confidence interval (CI): 1.53-1.97]. The association was more significant in Asian population (pooled OR =1.77, 95% CI: 1.52-2.05, n=3 studies), compared to European/North American population (pooled OR =1.42, 95% CI: 0.75-2.67, n=2 studies). NAFLD was significantly associated with the number of colorectal adenoma (pooled OR =1.78, 95% CI: 1.10-2.86, n=2 studies), but not the location, size, or presence of advanced adenoma. Our results suggest NAFLD is significantly associated with the presence of colorectal adenoma in asymptomatic patients undergoing screening colonoscopy. This finding provides additional risk stratifications for applying colorectal cancer (CRC) screening strategies. However, more studies of western population are needed to further investigate the ethnic disparity.

Serum C‐peptide is positively associated with the presence of colorectal adenomas (136.7)

Activation of the insulin ‐‐ insulin‐like growth factor (IGF) signaling axis is hypothesized to increase colon cancer risk. The aim of this study was to determine if serum factors related to insulin or insulin signaling were associated with advanced colon polyps in males. 126 men (48 ‐ 65 yr) were recruited at time of colonoscopy, and blood was collected. Odds ratios were determined using logistic regression for polyp number and polytomous logistic regression for polyp severity. 29% of the men in our study had a tubular adenoma. Participants with C‐peptide levels above 3.3ng/ml were 3.8 (CI: 1.3 ‐ 11.1) times more likely than those with C‐peptide levels less than 1.8ng/ml to have a tubular adenoma. For each category increase in C‐peptide, an individual was 2.0 (CI: 1.2 ‐ 3.4) times more likely to have a tubular adenoma than no polyp. Those individuals with serum soluble receptor for advanced glycation end products (sRAGE) greater than 120.4pg/ml were 0.3 (CI: 0.1 ‐ 0.9) times less likely than those with sRAGE lower than 94.5pg/ml to have 蠅3 polyps than no polyps. For each category increase in sRAGE, an individual was 0.5 (CI: 0.3 ‐ 0.9) times less likely to have 蠅3 polyps than no polyps. Other factors, such as insulin growth factor binding proteins, were not associated with polyp presence or severity in this population. Serum C‐peptide levels are a potential biomarker of polyp severity in white males.Grant Funding Source: Supported by NCI 1R03CA142000 and MSU CTSI

Association Between Markers of Glucose Metabolism and Risk of Colorectal Adenoma

Diabetes is a risk factor for colorectal cancer. We studied the association between markers of glucose metabolism and metabolic syndrome and the presence of colorectal adenomas in a large number of asymptomatic men and women attending a health screening program in South Korea. We also investigated whether these associations depend on adenoma location. In a cross-sectional study, we measured fasting levels of glucose, insulin, hemoglobin A1c, and C-peptide and calculated homeostatic model assessment (HOMA) values (used to quantify insulin resistance) for 19,361 asymptomatic South Korean subjects who underwent colonoscopy examinations from January 2006 to June 2009. Participants completed a standardized self-administered health questionnaire and a validated semiquantitative food frequency questionnaire. Blood samples were collected on the day of the colonoscopy; fasting blood samples were also collected. Robust Poisson regression was used to model the associations of glucose markers with the prevalence of any adenoma. Using detailed multivariable-adjusted dose-response models, the prevalence ratios (aPR, 95% confidence interval [CI]) for any adenoma, comparing the 90th with the 10th percentile, were 1.08 (1.00-1.16; P= .04) for fasting glucose, 1.07 (0.99-1.15; P=.10) for insulin, 1.09 (1.02-1.18, P= .02) for HOMA, 1.09 (1.01-1.17; P= .02) for hemoglobin A1c, and 1.14 (1.05-1.24; P= .002) for C-peptide. The corresponding ratios for nonadvanced adenomas were 1.11 (0.99-1.25; P= .08), 1.10 (0.98-1.24; P= .12), 1.15 (1.02-1.29; P= .02), 1.14 (1.01-1.28; P= .03), and 1.20 (1.05-1.37; P= .007), respectively. The corresponding ratios for advanced adenomas were 1.32 (0.94-1.84; P= .11), 1.23 (0.87-1.75; P= .24), 1.30 (0.92-1.85; P= .14), 1.13 (0.79-1.61; P= .50), and 1.67 (1.15-2.42; P=.007), respectively. Metabolic syndrome was associated with the prevalence of any adenoma (aPR, 1.18; 95% CI, 1.13-1.24; P< .001), nonadvanced adenoma (aPR, 1.30; 95% CI, 1.20-1.40; P < .001), and advanced adenoma (aPR, 1.42; 95% CI, 1.14-1.78; P= .002). Associations were similar for adenomas located in the distal versus proximal colon. Increasing levels of glucose, HOMA values, levels of hemoglobin A1c and C-peptide, and metabolic syndrome are significantly associated with the prevalence of adenomas. Adenomas should be added to the list of consequences of altered glucose metabolism.

Interaction between visfatin and resistin and the risk of colorectal adenoma.

438 Background: Colorectal adenoma is a well-established precursor lesion of colorectal cancer, so the prevention of adenoma may also contribute to the prevention of cancer. Adipocyte secretes hormones, namely adipocytokines, some of which are likely to be associated with malignancies such as colorectal, breast, and prostate gland cancer. Among several adipocytokines, resistin and visfatin have been suggested to be associated with the progression of colon cancer, and they could therefore be good biomarkers for colorectal adenoma and cancer. Methods: Prior to any procedures, healthy volunteers provided their venous blood, from which we obtained the plasma to measure concentrations of adiponectin, visfatin, and resistin. We underwent total colonoscopy, and identified 776 adenoma cases (522 males, 254 females), 734 controls (478 males, 256 females) were selected from those without adenoma. An unconditional logistic regression model was used to estimate odds ratios for colorectal adenoma after adjustment for potential confounders, including body mass index (BMI). Results: We found no positive association between the presence of colorectal adenoma and the levels of either visfatin (P trend: male 0.24, female 0.87), or resistin (P trend: male 0.85, female 0.71). After adjusting for potential confounders, we still saw no association. On the other hand, adiponectin levels showed a correlation with both BMI (P: male &lt;0.0001, female 0.0007) and the volume of fat. Furthermore, adiponectin levels indicated no positive correlation with visfatin (P: male 0.656, female 0.1445) or resistin (P: male 0.2116, female 0.1352). Conclusions: In this study, no association was observed between visfatin/resistin levels and colorectal adenoma, and they showed no positive correlation with BMI or the volume of intra-abdominal fat. However, other confounders may account for these results, so we plan to conduct further differential analyses.

Fasting serum insulin levels and insulin resistance are associated with colorectal adenoma in Koreans.

Insulin has been associated with the risk of colorectal cancer (CRC). However, few studies have evaluated the association between insulin and colorectal adenoma. We investigated the relationship between fasting serum insulin levels or homeostasis model assessment of insulin resistance (HOMA-IR) and colorectal adenoma. We retrospectively enrolled 15,427 participants who underwent both fasting serum insulin measurement and colonoscopy for a routine health examination at Asan Medical Center from January 2007 to December 2008. Participants with a history of any cancer, previous colectomy or polypectomy, those taking antidiabetic medications, and inflammatory bowel disease, non-specific colitis, non-adenomatous polyps only or CRC on colonoscopic findings were excluded. Finally, 3,606 participants with histologically confirmed colorectal adenoma and 6,019 controls with no abnormal findings on colonoscopy were included. Participants were categorized into quartiles (Q) based on fasting serum insulin levels and HOMA-IR. Fasting serum insulin and HOMA-IR were significantly higher in participants with colorectal adenomas compared with controls. Multivariate regression analysis adjusting for age, sex, smoking habits, drinking habits and family history of CRC showed that participants with higher quartiles of fasting serum insulin levels (odd ratio [OR] 1.17 for 2nd Q, 1.19 for 3rd Q, and 1.42 for 4th Q, P<0.05) or HOMA-IR (OR 1.18 for 2nd Q and 1.45 for 4th Q, P<0.05) showed significantly increased ORs of colorectal adenoma compared with the lowest quartiles. These findings showed that increased serum insulin levels and insulin resistance were significantly associated with the presence of colorectal adenoma.