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Wang J, Huang L, Gao Y, Wang Y, Chen S, Huang J, Zheng W, Bao P, Gong Y, Zhang Y, Wang M, Wong MCS. Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies. Br J Sports Med 2019; 54:582-591. [PMID: 31296585 DOI: 10.1136/bjsports-2018-100350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have examined the associations between physical activity (PA), sedentary behaviour (SB) and risk of colorectal neoplasia (CN). METHODS We systematically searched Medline, Embase, PsyInfo, Cochrane and other sources from their inception to 30 September 2018 for cohort, case-control and cross-sectional studies that evaluated these associations in asymptomatic, average-risk subjects. Random-effect models were used to estimate relative risks (RRs) of any-type CN, advanced CN, and non-advanced CN, respectively, in individuals with the highest versus the lowest level of PA and SB. Dose-response analyses and subgroup analyses were conducted. The I2 statistic was used to examine heterogeneity among studies. RESULTS We identified 32 observational studies, including 17 cross-sectional studies, 10 case-control studies and five longitudinal studies. PA (highest vs lowest) was inversely associated with risk for any-type CN (n=23 studies) and advanced CN (n=15 studies), with a RR of 0.77 (95% CI=0.71 to 0.83, I2=57.5%) and 0.73 (95% CI=0.63 to 0.82, I2=45.5%), respectively. There was no association between PA and non-advanced CN (n=5 studies). There was an as association between PA and any-type CN in both sexes, and also for the distal colon. We found no dose-response relationship between PA and any-type or advanced CN. Based on three studies identified, SB time (longest vs shortest) was associated with an increased risk of advanced CN (RR=1.24, 95% CI 1.04 to 1.49, I2=14.4%). No publication bias was detected by Begg's test. CONCLUSION We report a 23% lower relative risk of any type of CN and a 27% lower risk of advanced CN in people with the highest level of PA compared with those in the lowest.
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Affiliation(s)
- Jingjing Wang
- National Physical Fitness Research Center, China Institute of Sport Science, Beijing, China
| | - Liwen Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Yang Gao
- Department of Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Yanhong Wang
- School of Basic Medicine, Peking Union Medical College and Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanquan Chen
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Wenjing Zheng
- The Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pingping Bao
- The Office of Chronic Disease Control, Shanghai CDC, Shanghai, China
| | - Yangming Gong
- The Office of Chronic Disease Control, Shanghai CDC, Shanghai, China
| | - Yanfeng Zhang
- National Physical Fitness Research Center, China Institute of Sport Science, Beijing, China
| | - Mei Wang
- National Physical Fitness Research Center, China Institute of Sport Science, Beijing, China
| | - Martin Chi Sang Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
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Kim B, Kim BC, Nam SY, Nam JH, Ryu KH, Park BJ, Sohn DK, Hong CW, Han KS, Kim HB. Visceral Adipose Tissue Volume and the Occurrence of Colorectal Adenoma in Follow-up Colonoscopy for Screening and Surveillance. Nutr Cancer 2017; 69:739-745. [PMID: 28569608 DOI: 10.1080/01635581.2017.1324632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Whether obesity accelerates adenoma recurrence is not yet clear; therefore, we analyzed the risk factors for adenoma occurrence at follow-up colonoscopy, with a focus on visceral adiposity. In total, 1516 subjects underwent index colonoscopy, computed tomography, and questionnaire assessment from February to May 2008; 539 subjects underwent follow-up colonoscopy at the National Cancer Center at least 6 mo after the index colonoscopy. The relationships between the presence of adenoma at follow-up colonoscopy and anthropometric obesity measurements, including body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) volume, and subcutaneous adipose tissue (SAT) volume, were analyzed. 188 (34.9%) had adenomatous polyps at follow-up colonoscopy. Multivariate analysis revealed that VAT volume ≥ 1000 cm3 and BMI ≥ 30 kg/m2 were related to the presence of adenoma at follow-up colonoscopy (VAT volume 1000-1500 cm3: odds ratio [OR] = 2.13(95% confidence interval, CI = 1.06-4.26), P = 0.034; VAT volume ≥ 1000 cm3: OR = 2.24(95% CI = 1.03-4.88), P = 0.043; BMI ≥ 30 kg/m2: OR = 4.22(95% CI = 1.12-15.93), P = 0.034). In contrast, BMI 25-29.9 kg/m2, SAT volume, and WC were not associated with the presence of adenoma at follow-up colonoscopy. In conclusion, excess VAT can contribute to the development and growth of new colorectal adenomas, and is a better predictor of colorectal adenoma occurrence at follow-up colonoscopy than BMI, WC, and SAT volume.
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Affiliation(s)
- Bun Kim
- a Center for Colorectal Cancer , National Cancer Center , Goyang , Korea.,b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Byung Chang Kim
- a Center for Colorectal Cancer , National Cancer Center , Goyang , Korea.,b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Su Youn Nam
- b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea.,c Department of Gastroenterology , Kyungpook National University Medical Center, Kyungpook National University School of Medicine , Daegu , Korea
| | - Ji Hyung Nam
- b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Kum Hei Ryu
- b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Bum Joon Park
- b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Dae Kyung Sohn
- a Center for Colorectal Cancer , National Cancer Center , Goyang , Korea.,b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Chang Won Hong
- a Center for Colorectal Cancer , National Cancer Center , Goyang , Korea.,b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Kyung Su Han
- a Center for Colorectal Cancer , National Cancer Center , Goyang , Korea.,b Center for Cancer Prevention and Detection , National Cancer Center , Goyang , Korea
| | - Hyun Bum Kim
- d Department of Diagnostic Radiology , National Cancer Center , Goyang , Korea
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Kwon JH, Ko HJ, Youn CH, Choi HI. Obesity Markers as Predictors for Colorectal Neoplasia. J Obes Metab Syndr 2017; 26:28-35. [PMID: 31089491 PMCID: PMC6484926 DOI: 10.7570/jomes.2017.26.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023] Open
Abstract
Background The goal of this study was to determine the relations between the risk of colorectal neoplasia and obesity markers: body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Methods The subjects who underwent screening colonoscopies at a Kyungpook National University Hospital in Daegu from July to December 2010 were enrolled. We defined colorectal neoplasia as tubular adenoma, advanced adenoma, or cancer. We performed a logistic regression analysis to investigate the correlations between obesity and colorectal neoplasia and a receiver operating characteristic (ROC) curve analysis to determine the cut-off obesity marker values for detecting colorectal neoplasia. Results Among the total of 268 subjects, 83 (31.0%) subjects had colorectal neoplasia. Subjects with neoplasia had higher BMI, WC, and WHtR than the subjects without any neoplasia. The adjusted odds ratio (aOR) of WHtR ≥0.5 with the association of neoplasia was 1.927 (95% confidence interval [CI], 1.041–3.569) in the total subjects. In women, the obesity markers of WC ≥85 cm (aOR 4.611; 95% CI, 10.166–18.240) and WHtR ≥0.5 (aOR 1.747; 95% CI, 1.149–19.617) were significantly related to neoplasia; however, there was no significant result in men. The ROC analysis showed the optimal cut-off values of BMI as >23.14 kg/m2 (P=0.002), WHtR as >0.50 (P<0.001), and WC as>82.5 cm (P=0.650) in men and >77 cm in women (P<0.001). Conclusion Obesity is significantly associated with the increased risk of colorectal neoplasia. WC and WHtR have more significant correlations with neoplasia; thus, obese people should undergo regular colonoscopy screenings to detect colorectal neoplasia.
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Affiliation(s)
- Jin-Hyun Kwon
- Department of Family Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hae-Jin Ko
- Department of Family Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang-Ho Youn
- Department of Family Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hye-In Choi
- Department of Family Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Chun EM, Kim SW, Lim SY. Prevalence of colorectal adenomatous polyps in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:955-60. [PMID: 26028968 PMCID: PMC4441357 DOI: 10.2147/copd.s83341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Colorectal adenomatous polyps are precancerous lesions of colorectal cancer. The aim of this study was to assess the prevalence of colorectal adenomatous polyps in chronic obstructive pulmonary disease (COPD) patients and determine whether COPD is associated with colorectal malignant potential. Methods Subjects who had undergone post-bronchodilator spirometry and colonoscopy and were 40 years or older were selected from the hospital database. COPD was defined as a spirometry in which the ratio of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) is <0.7 in post-bronchodilator spirometry. The non-COPD group was matched for both age and sex, and were defined as having an FEV1, FVC, and FEV1/FVC ≥0.7 in spirometry. Finally, 333 patients were retrospectively reviewed; of this group, 82 patients had COPD. Results Among the subjects, 201 patients (60%) were nonsmokers, while 78 (23%) were current smokers. The prevalence of colorectal adenomatous polyps was 39% (98/251) in the non-COPD group and 66% (54/82) in the COPD group. Among 54 patients with adenomatous polyps in the COPD group, 47 had tubular adenoma and seven had villous adenoma. Multiple logistic regression analyses revealed that only COPD patients whom matched to the criteria of COPD by pulmonary function test (odds ratio 2.1, 95% confidence interval: 1.1–3.8; P=0.019) were independently associated with colorectal malignant potential. Conclusion The risk of colorectal malignant potential in the COPD group was higher than in the non-COPD group. We may suggest that COPD patients should consider regular colonoscopic evaluation to screen for premalignant colon polyps regardless of smoking.
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Affiliation(s)
- Eun Mi Chun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Seo Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - So Yeon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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Liu J, Pattanaik S, Yao J, Dwyer AJ, Pickhardt PJ, Choi JR, Summers RM. Associations among pericolonic fat, visceral fat, and colorectal polyps on CT colonography. Obesity (Silver Spring) 2015; 23:408-14. [PMID: 25558027 PMCID: PMC4310815 DOI: 10.1002/oby.20987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/25/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the association between pericolonic fat and colorectal polyps using CT colonography (CTC). METHODS A total of 1169 patients who underwent CTC and optical colonoscopy on the same day were assessed. Pericolonic fat was measured on CTC in a band surrounding the colon. Visceral adipose tissue volume was measured at the L2-L3 levels. Student's t-tests, odds ratio, logistic regression, binomial statistics, and weighted kappa were performed to ascertain associations with the incidence of colorectal polyps. RESULTS Pericolonic fat volume fractions (PFVF) were 61.5 ± 11.0% versus 58.1 ± 11.5%, 61.6 ± 11.1% versus 58.7 ± 11.5%, and 62.4 ± 10.6% versus 58.8 ± 11.5% for patients with and without any polyps, adenomatous polyps, and hyperplastic polyps, respectively (P<0.0001). Similar trends were observed when examining visceral fat volume fractions (VFVF). When patients were ordered by quintiles of PFVF or VFVF, there were 2.49-, 2.19-, and 2.39-fold increases in odds ratio for the presence of any polyp, adenomatous polyps, or hyperplastic polyps from the first to the fifth quintile for PFVF and 1.92-, 2.00-, and 1.71-fold increases in odds ratio for VFVF. Polyps tended to occur more commonly in parts of the colon that had more PFVF than the spatially adjusted average for patients in the highest quintile of VFVF. CONCLUSIONS Pericolonic fat accumulations, like visceral fat, are correlated with an increased risk of adenomatous and hyperplastic polyps.
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Affiliation(s)
- Jiamin Liu
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Sanket Pattanaik
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Jianhua Yao
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Andrew J. Dwyer
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Perry J. Pickhardt
- Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792
| | | | - Ronald M. Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
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Kim HB, Lee YJ, Shim JY, Lee HR. The association between coronary calcification and adenomatous polyps of colon in Korean adults. Clin Res Hepatol Gastroenterol 2014; 38:649-54. [PMID: 24969685 DOI: 10.1016/j.clinre.2014.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Adenomatous polyps of colon is a precancerous lesion. Many studies have shown that the adenomatous polyps of colon and cardiovascular disease share several common risk factors. This cross-sectional study aimed to investigate whether coronary calcification is associated with the adenomatous polyps of colon. METHODS Among 1637 Korean adults, we examined the association between coronary calcium score (CCS) as a measurement of coronary calcification and the presence of adenomatous polyps of colon via multi-detected row computed tomography (MDCT) and colonoscopy, respectively. CCS values were categorized as follows: 0, 1-17, 18-105, or≥106. The odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of adenomatous polyps of colon were calculated across CCS groups. RESULTS AND CONCLUSIONS After adjusting for confounding variables, the adjusted ORs (95% CIs) for the presence of adenomatous polyps of colon in each of the four CCS groups were 1.00 (reference), 1.44 (0.91-2.33), 1.88 (1.15-3.01) and 3.61 (2.23-5.74). And higher CCS values were associated with multiple polyps (P≤0.001), villous histologic features or high-grade dysplasia (P=0.02), and advanced adenomatous polyps (P≤0.001). A higher level of CCS was found to be strongly and independently associated with the presence of adenomatous polyps of colon in Korean adults. This finding suggests that people at high risk for coronary atherosclerosis through MDCT should be considered for further evaluation of adenomatous polyps.
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Affiliation(s)
- Hong-Bae Kim
- Myongji Hospital, GyungGi-Do Goyang City, Republic of Korea
| | - Yong-Jae Lee
- Yongin Severance Hospital, GyungGi-Do Yongin City, Republic of Korea
| | - Jae-Yong Shim
- GangNam Severance Hospital, Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Ree Lee
- GangNam Severance Hospital, Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Yamada E, Ohkubo H, Higurashi T, Sakai E, Endo H, Takahashi H, Uchida E, Tanida E, Izumi N, Kanesaki A, Hata Y, Matsuura T, Fujisawa N, Komatsu K, Maeda S, Nakajima A. Visceral obesity as a risk factor for left-sided diverticulitis in Japan: a multicenter retrospective study. Gut Liver 2013; 7:532-8. [PMID: 24073310 PMCID: PMC3782667 DOI: 10.5009/gnl.2013.7.5.532] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/12/2012] [Accepted: 12/09/2012] [Indexed: 01/20/2023] Open
Abstract
Background/Aims Left-sided diverticulitis is increasing in Japan, and many studies report that left-sided diverticulitis is more likely to be severe. Therefore, it is important to identify the features and risk factors for left-sided diverticulitis. We hypothesized that left-sided diverticulitis in Japan is related to obesity and conducted a study of the features and risk factors for this disorder in Japan. Methods Right-sided diverticulitis and left-sided diverticulitis patients (total of 215) were compared with respect to background, particularly obesity-related factors to identify risk factors for diverticulitis. Results There were 166 (77.2%) right-sided diverticulitis patients and 49 (22.8%) left-sided diverticulitis patients. The proportions of obese patients (body mass index ≥25 kg/m2, p=0.0349), viscerally obese patients (visceral fat area ≥100 cm2, p=0.0019), patients of mean age (p=0.0003), and elderly patients (age ≥65 years, p=0.0177) were significantly higher in the left-sided-diverticulitis group than in the right-sided-diverticulitis group. The proportion of viscerally obese patients was significantly higher in the left-sided-diverticulitis group than in the left-sided-diverticulosis group (p=0.0390). Conclusions This study showed that obesity, particularly visceral obesity, was a risk factor for left-sided diverticulitis in Japan.
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
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DeBarros M, Steele SR. Colorectal cancer screening in an equal access healthcare system. J Cancer 2013; 4:270-80. [PMID: 23459768 PMCID: PMC3584840 DOI: 10.7150/jca.5833] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/13/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The military health system (MHS) a unique setting to analyze implementation programs as well as outcomes for colorectal cancer (CRC). Here we look at the efficacy of different CRC screening methods, attributes and results within the MHS, and current barriers to increase compliance. MATERIALS AND METHODS A literature search was conducted utilizing PubMed and the Cochrane library. Key-word combinations included colorectal cancer screening, racial disparity, risk factors, colorectal cancer, screening modalities, and randomized control trials. Directed searches were also performed of embedded references. RESULTS Despite screening guidelines from several national organizations, extensive barriers to widespread screening remain, especially for minority populations. These barriers are diverse, ranging from education and access problems to personal beliefs. Screening rates in MHS have been reported to be generally higher at 71% compared to national averages of 50-65%. CONCLUSION CRC screening can be highly effective at improving detection of both pre-malignant and early cancers. Improved patient education and directed efforts are needed to improve CRC screening both nationally and within the MHS.
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Affiliation(s)
| | - Scott R. Steele
- Department of Surgery, Madigan Healthcare System, Tacoma, Washington, USA
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Summers RM, Liu J, Sussman DL, Dwyer AJ, Rehani B, Pickhardt PJ, Choi JR, Yao J. Association between visceral adiposity and colorectal polyps on CT colonography. AJR Am J Roentgenol 2012; 199:48-57. [PMID: 22733893 PMCID: PMC3412298 DOI: 10.2214/ajr.11.7842] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to determine whether there is an association between visceral adiposity measured on CT colonography (CTC) and colorectal polyps. MATERIALS AND METHODS Patients who underwent CTC and same-day optical colonoscopy (n = 1186) were analyzed. Visceral adipose tissue volumes and volume percentages relative to total internal body volume were measured on slices in the L2-L3 regions on supine CTC scans with validated fully automated software. Student t test, odds ratio, logistic regression, and receiver operating characteristic analyses were performed. RESULTS For subjects with (n = 345) and without (n = 841) adenomatous polyps, the mean (± SD) volume percentages were 31.2% ± 10.8% and 28.2% ± 11.3%, respectively (p < 0.0001). For subjects with (n = 244) and without (n = 942) hyperplastic polyps, the volume percentages were 31.8% ± 10.7% and 28.3% ± 11.2%, respectively (p < 0.0001). Comparing the lowest and highest quintiles of volume percentage, the odds ratios for having at least one adenomatous polyp or hyperplastic polyp versus no polyp were 2.06 (95% CI, 1.36-3.13) and 1.71 (95% CI, 1.08-2.71), and the prevalence of having adenomatous polyps or hyperplastic polyps increased by 14% and 8%, respectively. CONCLUSION Subjects with higher visceral adiposity measurements on CTC have a greater risk for the presence of colonic polyps.
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Affiliation(s)
- Ronald M. Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Jiamin Liu
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Daniel L. Sussman
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Andrew J. Dwyer
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Bhavya Rehani
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
| | - Perry J. Pickhardt
- Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792
| | | | - Jianhua Yao
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182
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Ben Q, An W, Jiang Y, Zhan X, Du Y, Cai QC, Gao J, Li Z. Body mass index increases risk for colorectal adenomas based on meta-analysis. Gastroenterology 2012; 142:762-72. [PMID: 22245665 DOI: 10.1053/j.gastro.2011.12.050] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/13/2011] [Accepted: 12/29/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS There have been inconsistent results published about the relationship between excess body weight, expressed as increased body mass index (BMI), and risk of colorectal adenoma (CRA). We conducted a meta-analysis to explore this relationship. We focused on whether the relationship varied based on the sex of the study subjects, study design, features of the polyps, or potential confounders, including alcohol use, nonsteroidal anti-inflammatory drug use, smoking, and exercise. METHODS We identified studies by performing a literature search of Medline, EMBASE, and ISI Web of Science through July 31, 2011, and by searching the reference lists of pertinent articles. We analyzed 36 independent studies, which included 29,860 incident cases of CRA. Summary relative risks with their 95% confidence intervals (CIs) were calculated with a random-effects model. Between-study heterogeneity was assessed using Cochran's Q statistic and I(2) analyses. RESULTS Overall, a 5-unit increase in BMI (calculated as kg/m(2)) increased the risk for CRA (summary relative risk = 1.19; 95% CI: 1.13-1.26), although there was a high level of heterogeneity among studies (P(heterogeneity) < .001; I(2) = 76.8%). Subgroup analyses revealed that the increased risk of CRA in obese individuals was independent of race, geographic location, study design, sex, adenoma progression, and confounders. The association between increased BMI and risk for CRA was stronger for colon than rectal adenoma. CONCLUSIONS Based on a meta-analysis, increased BMI increases the risk for colon but not rectal adenoma. Unlike colorectal cancer, there is no sex difference in the relationship between increased BMI and risk of CRA.
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Affiliation(s)
- Qiwen Ben
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University, Shanghai, China
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Jain SS, AshokKumar M, Bird RP. Differential expression of TNF-α signaling molecules and ERK1 in distal and proximal colonic tumors associated with obesity. Tumour Biol 2011; 32:1005-12. [DOI: 10.1007/s13277-011-0202-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/08/2011] [Indexed: 01/03/2023] Open
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Adiposity and the risk of colorectal adenomatous polyps: a meta-analysis. Cancer Causes Control 2011; 22:1021-35. [PMID: 21604177 DOI: 10.1007/s10552-011-9777-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/07/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The findings from epidemiological studies addressing the association between adiposity and the risk of colorectal adenomatous polyps are inconsistent. We performed a meta-analysis of epidemiological studies including cross-sectional, case-control, and cohort studies. METHODS We searched PubMed and EMBASE in June, 2010. All searched articles were reviewed and selected independently by two evaluators according to pre-determined selection criteria. RESULTS We included 25 studies (nine cross-sectional studies, eleven case-control studies, and five prospective cohort studies) that comprised a total of 300,671 participants and 20,903 cases in the final analysis. When all studies were pooled, the odds ratio (OR) or relative risk (RR) of adiposity and abdominal adiposity for colorectal adenomatous polyp risk was 1.43 (95% confidence interval (CI) 1.23-1.67; n = 22) and 1.42 (95% CI 1.30-1.56; n = 12), respectively. Similarly, an increased risk of colorectal adenomatous polyps was observed in most of the subgroup meta-analyses. CONCLUSIONS Overall, we found that adiposity and abdominal adiposity significantly increased the risk of colorectal adenomatous polyps in a meta-analysis of epidemiological studies.
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Thoma MN, Castro F, Golawala M, Chen R. Detection of colorectal neoplasia by colonoscopy in average-risk patients age 40-49 versus 50-59 years. Dig Dis Sci 2011; 56:1503-8. [PMID: 21286937 DOI: 10.1007/s10620-011-1565-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/05/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40-49 was similar to that among those aged 50-59. AIM To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients. METHODS Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40-49, 747 ages 50-59). We included consecutive patients of ages 40-59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI. RESULTS The prevalence of colorectal neoplasia was 12.1% in patients aged 40-49 and 22.6% in those aged 50-59. Compared with individuals aged 40-49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50-59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33-0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00-1.06). The number that had to be screened to detect one advanced lesion in the 40-49 age group was 49 compared with 20 in those aged 50-59. CONCLUSION Individuals aged 40-49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50-59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.
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Affiliation(s)
- Matthew N Thoma
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
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Abstract
BACKGROUND Little evidence is available on the relation of physical activity with colon adenomas, a colon cancer precursor. METHODS We conducted a systematic literature review and meta-analysis of published studies (in English) through April 2010, examining physical activity or exercise and risk or prevalence of colon adenoma or polyp. Random effects models were used to estimate relative risks (RRs) and corresponding confidence intervals (CIs). A total of 20 studies were identified that examined the association and provided RRs and corresponding 95% CIs. RESULTS A significant inverse association between physical activity and colon adenomas was found with an overall RR of 0.84 (CI: 0.77-0.92). The association was similar in men (RR=0.81, CI: 0.67-0.98) and women (RR=0.87, CI: 0.74-1.02). The association appeared slightly stronger in large/advanced polyps (RR=0.70, CI: 0.56-0.88). CONCLUSION This study confirms previous reports of a significant inverse association of physical activity and colon adenoma, and suggests that physical activity can have an important role in colon cancer prevention.
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Campa D, Pardini B, Naccarati A, Vodickova L, Novotny J, Steinke V, Rahner N, Holinski-Feder E, Morak M, Schackert HK, Görgens H, Kötting J, Betz B, Kloor M, Engel C, Büttner R, Propping P, Försti A, Hemminki K, Barale R, Vodicka P, Canzian F. Polymorphisms of genes coding for ghrelin and its receptor in relation to colorectal cancer risk: a two-step gene-wide case-control study. BMC Gastroenterol 2010; 10:112. [PMID: 20920174 PMCID: PMC2954942 DOI: 10.1186/1471-230x-10-112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 09/28/2010] [Indexed: 01/01/2023] Open
Abstract
Background Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor (GHSR), has two major functions: the stimulation of the growth hormone production and the stimulation of food intake. Accumulating evidence also indicates a role of ghrelin in cancer development. Methods We conducted a case-control study to examine the association of common genetic variants in the genes coding for ghrelin (GHRL) and its receptor (GHSR) with colorectal cancer risk. Pairwise tagging was used to select the 11 polymorphisms included in the study. The selected polymorphisms were genotyped in 680 cases and 593 controls from the Czech Republic. Results We found two SNPs associated with lower risk of colorectal cancer, namely SNPs rs27647 and rs35683. We replicated the two hits, in additional 569 cases and 726 controls from Germany. Conclusion A joint analysis of the two populations indicated that the T allele of rs27647 SNP exerted a protective borderline effect (Ptrend = 0.004).
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Affiliation(s)
- Daniele Campa
- Genomic Epidemiology Group, German Cancer Research Center DKFZ, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
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Abstract
BACKGROUND Awareness of risk factors for colorectal neoplasia could address risk reduction strategies in asymptomatic subjects. METHODS This is a post hoc analysis of a prospective, cross-sectional study of 1321 asymptomatic adults. All the subjects underwent same-day CT colonography and colonoscopy to determine the prevalence of colorectal neoplasia. The variables examined included body mass index, smoking, alcohol consumption, age, and gender. Univariate and logistic regression analyses were performed for detection of colorectal neoplasia and hyperplastic polyps. Odds ratios with 95% confidence intervals were calculated. RESULTS Colorectal adenomas and hyperplastic polyps were detected in 378 (28.6%) and 157 (11.9%) participants, respectively. In both univariate and multivariate analysis, increasing age, male gender, and body mass index > or =25 were significantly associated with the detection of colorectal adenomas, with an odds ratio of 1.22 (95% CI,1.09-1.36), 1.28 (95% CI, 1.06-1.45), and 1.34 (95% CI, 1.02-1.77), respectively. A history of smoking was the only identifiable risk factor for hyperplastic polyps (odds ratio, 1.98; 95% CI, 1.41-2.78). CONCLUSIONS Body mass index > or =25, increasing age, and male gender were all associated with an increased likelihood of colorectal adenomas at screening, whereas smoking was strongly associated with hyperplastic polyps.
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Kim BJ, Kim YH, Sinn DH, Kang KJ, Kim JY, Chang DK, Son HJ, Rhee PL, Kim JJ, Rhee JC. Clinical usefulness of glycosylated hemoglobin as a predictor of adenomatous polyps in the colorectum of middle-aged males. Cancer Causes Control 2010; 21:939-44. [PMID: 20373014 DOI: 10.1007/s10552-010-9543-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 02/05/2010] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We investigated the clinical usefulness of HbA1c in screening an average-risk group <50 years of age who need colonoscopy for colorectal cancer (CRC) screening. METHODS Eight hundred nineteen asymptomatic males who underwent colonoscopy for CRC screening with blood chemistries between January 2006 and December 2006 were enrolled. The ages of the subjects ranged from 40 to 59. RESULTS Subjects in their 50 s had significantly more adenomatous polyps than subjects in their 40 s (32.7% vs. 26.0%, p < 0.05). The incidence of adenomatous polyp increased with increasing quartiles of HbA1C as follows: first quartile (19.9%, HbA1c 4.0-5.0), second quartile (27.8%, HbA1c 5.1-5.3), third quartile (32.7%, HbA1c 5.4-5.5), and fourth quartile (34.9%, HbA1c = 5.6-8.8)(p = 0.008). When combining quartile of HbA1c and age (40 s vs. 50 s) according to HbA1C levels, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1c <5.4% was significantly lower than that in subjects in their 50 s. However, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1c > or =5.4% was similar to that in subjects in their 50 s with average risk for CRC. CONCLUSIONS An elevated HbA1c may be useful as a clinical predictor of adenomatous polyps in male subjects <50 years of age who have average risk for CRC.
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Affiliation(s)
- Beom Jin Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, 140-757, Korea
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Kang HW, Kim D, Kim HJ, Kim CH, Kim YS, Park MJ, Kim JS, Cho SH, Sung MW, Jung HC, Lee HS, Song IS. Visceral obesity and insulin resistance as risk factors for colorectal adenoma: a cross-sectional, case-control study. Am J Gastroenterol 2010; 105:178-87. [PMID: 19755965 DOI: 10.1038/ajg.2009.541] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Colorectal adenoma is known to be associated with obesity, but the association between colorectal adenoma and visceral adipose tissue (VAT) area measured by abdominal computed tomography (CT) has not been documented clearly. In addition, the relationship between insulin resistance and colorectal adenomas, which underlies the mechanism that links obesity and colorectal adenoma, has not been studied extensively. The aim of this study was to examine VAT area and insulin resistance as risk factors of colorectal adenoma. METHODS A cross-sectional, case-control study was conducted in Koreans that presented for health check-ups. Subjects underwent various laboratory tests, abdominal CT, and colonoscopy. VAT, subcutaneous adipose tissue (SAT), and homeostatic metabolic assessment (HOMA) index were evaluated as potential risk factors of colorectal adenoma in 2,244 age- and sex-matched subjects. RESULTS According to univariate analysis, the prevalences of smoking, hypertension, metabolic syndrome, and family history of colorectal cancer were higher in the adenoma group than in the normal control group. In addition, body mass index, waist circumference, triglyceride, high-density lipoprotein cholesterol, and VAT and SAT areas were significantly different in the two groups. According to the multivariate analysis adjusted for multiple confounders, VAT area was independently associated with the risk of colorectal adenoma (odds ratio (OR)=3.09, 95% confidence interval (CI): 2.19-4.36, highest quintile vs. lowest quintile). Mean HOMA index was higher in the adenoma group than in the control group (OR=1.99, 95% CI: 1.35-2.92, highest vs. lowest quintile). CONCLUSIONS Visceral obesity was found to be an independent risk factor of colorectal adenoma, and insulin resistance was associated with the presence of colorectal adenoma.
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Affiliation(s)
- Hyoun Woo Kang
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Korea
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Abstract
Colorectal cancer is the third most common cancer globally and is a leading cause of cancer death. Gastric cancer contributes significantly to the global cancer burden, particularly in low- and middle-income countries. We reviewed the literature for studies on physical activity or exercise and colon, rectal, and gastric cancers as well as colonic adenomatous polyps. We identified 52 studies of colon cancer, 31 studies of rectal cancer, 23 studies of colon polyps, and 16 studies of gastric cancer. Of the 52 studies of physical activity and colon cancer, 37 found a statistically significant association between increased levels of physical activity and decreased colon cancer risk in at least one comparison. Accumulated evidence suggests that physical activity is associated with a 25% reduction in colon cancer risk. In line with previous reports, we found no indication that the association was more pronounced for occupational versus recreational physical activity, with both resulting in a risk reduction of about 22%. Evidence for other domains of physical activity (i.e., transportation or household physical activity) is limited. Evidence is emerging that individuals who are consistently active across the lifetime may obtain greater risk reductions than those who are only active in recent years. Despite consistent associations with colon cancer, evidence is more limited though suggestive that physical activity reduces risk of colon adenomas or adenoma recurrence. There is clear evidence that physical activity is not associated with rectal or gastric cancers.
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Yamaji T, Iwasaki M, Sasazuki S, Kurahashi N, Mutoh M, Yamamoto S, Suzuki M, Moriyama N, Wakabayashi K, Tsugane S. Visceral fat volume and the prevalence of colorectal adenoma. Am J Epidemiol 2009; 170:1502-11. [PMID: 19923108 DOI: 10.1093/aje/kwp311] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Few epidemiologic investigations of visceral adiposity and colorectal neoplasms have attempted the direct quantification of visceral fat. The authors measured visceral fat volume among middle-aged and elderly Japanese men and women who underwent colonoscopy and positron emission tomography/computed tomography for cancer screening in Tokyo, Japan, between February 2004 and February 2005, and examined the association between visceral adiposity and colorectal adenoma in 1,205 eligible subjects. Odds ratios and 95% confidence intervals for colorectal adenoma were estimated by using an unconditional logistic regression model after adjustment for potential confounders. Despite its high correlation with body mass index, visceral fat volume was associated with the prevalence of colorectal adenoma independently of body mass index in both sexes. After further adjustment for body mass index, the odds ratio of colorectal adenoma for the highest compared with the lowest quartile of visceral fat volume was 1.58 (95% confidence interval: 1.11, 2.24) for men and women combined. Conversely, body mass index was unlikely to modify the association between visceral fat volume and colorectal adenoma (P(interaction) = 0.39). These findings add to accumulating evidence that visceral adiposity exerts an important influence on the pathogenesis of colorectal neoplasms. The mechanisms of this potential association between visceral adiposity and colorectal carcinogenesis warrant further investigation.
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Affiliation(s)
- Taiki Yamaji
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
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Leitzmann MF, Flood A, Ferrucci LM, Schoenfeld P, Cash B, Schatzkin A, Cross AJ. Adiposity in relation to colorectal adenomas and hyperplastic polyps in women. Cancer Causes Control 2009; 20:1497-507. [PMID: 19387851 PMCID: PMC3170996 DOI: 10.1007/s10552-009-9346-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 04/03/2009] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine whether BMI is independently related to colorectal adenomas and hyperplastic polyps. METHODS We conducted a cross-sectional study among 1,420 asymptomatic women aged 40-79 years who had undergone complete colonoscopy. Logistic regression was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of adenomas and hyperplastic polyps. RESULTS We identified 953 women (67.1%) with no polyps, 292 (20.6%) with adenomas, and 175 (12.3%) with hyperplastic polyps. Among those with polyps, 75 women (5.3% of total women) were classified as having both adenomas and hyperplastic polyps. After adjusting for potential risk factors for colorectal cancer, BMI was related to increased risk of adenomas (OR comparing obese to normal weight women = 1.57; 95% CI = 1.07-2.29). Further, BMI was associated with enhanced risk of hyperplastic polyps (OR = 3.76; 95% CI = 2.35-6.01) and the combination of adenomas and hyperplastic polyps (OR = 2.84; 95% CI = 1.41-5.72). CONCLUSIONS Excess body mass is positively related to colorectal adenomas and hyperplastic polyps, particularly when both kinds of polyps are present in combination. Future studies should continue to delineate the possible differences in potential risk factors between colorectal adenomas and hyperplastic polyps. Such work should help further elucidate the possible causes of colorectal cancer.
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Affiliation(s)
- Michael F Leitzmann
- The Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, National Institutes of Health, 6120 Executive Blvd., Bethesda, MD 20892, USA.
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Sato Y, Nozaki R, Yamada K, Takano M, Haruma K. Relation between obesity and adenomatous polyps of the large bowel. Dig Endosc 2009; 21:154-7. [PMID: 19691761 DOI: 10.1111/j.1443-1661.2009.00877.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We compared the prevalence of colorectal adenoma (polyps) in men and women and examined the role of body mass index (BMI) on polyp risk according to patient age and gender. METHODS The risk of developing colorectal polyps was studied in 15 380 subjects (7155 men and 8225 women) who underwent colonoscopy for the first time from April 1998 to March 2006 at our 'Human Dry Dock', which is the check-up service provided in Japan. Eligible subjects were 20-86 years old (mean age +/- SD, 47.3 +/- 8.5) and were free of invasive cancer, hyperplastic polyps and familial polyposis. Polyps were found in 1590 subjects (1062 men and 528 women). The odds ratio (OR) of detection of polyps in relation to obesity was determined in all cases by multivariate logistic regression analysis after making an adjustment for gender and age. RESULTS The OR of polyp detection in obese subjects (BMI >or= 25) versus non-obese subjects (BMI < 25, OR = 1) was 1.34 (P < 0.001) in men and 1.13 (P = 0.26) in women. As the BMI increased in increments of one, the OR in men increased significantly to 1.01 (P < 0.001), whereas the OR in women was unchanged at 1.00 (P = 0.23), which was without significance. CONCLUSIONS We conclude that obesity in men is a risk factor for the development of polyps. These results must be confirmed by additional epidemiological studies.
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Affiliation(s)
- Yumi Sato
- Department of Human Dry Dock, Health Care Center, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan.
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Borg BB, Gupta NK, Zuckerman GR, Banerjee B, Gyawali CP. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2009; 7:670-5. [PMID: 19245852 PMCID: PMC4151157 DOI: 10.1016/j.cgh.2009.02.014] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/29/2009] [Accepted: 02/11/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS An inadequately cleansed colon can lead to missed lesions, repeat procedures, increased cost, and complications from colonoscopy. Because obesity, with its known link to colorectal neoplasia, might be associated with inadequate bowel cleansing, we investigated the impact of increased body mass index (BMI) on quality of bowel preparation at colonoscopy. METHODS All colonoscopy procedures performed at a tertiary referral center during a 4-month period were evaluated. Bowel preparation was assigned a unique composite outcome score that took into account a subjective bowel preparation score, earlier recommendation for follow-up colonoscopy as a result of inadequate bowel preparation, and the endoscopist's confidence in adequate evaluation of the colon. Univariate and multivariate logistic regression analyses were performed to identify the role of BMI in predicting an inadequate bowel preparation. RESULTS During the study period, 1588 patients (59.1% female; mean age, 57.4 +/- 0.34 years) fulfilled inclusion criteria. An abnormal BMI (> or =25) was associated with an inadequate composite outcome score (P = .002). In multivariate logistic regression analyses, both BMI > or =25 (P = .04) and > or =30 (P = .006) were retained as independent predictors of inadequate bowel preparation. Each unit increase in BMI increased the likelihood of an inadequate composite outcome score by 2.1%. Additional independent predictors of inadequate preparation exponentially increased the likelihood of an inadequate composite outcome score; 7 additional risk factors identified 97.5% of overweight patients with an inadequate composite outcome score. CONCLUSIONS Obesity is an independent predictor of inadequate bowel preparation at colonoscopy. The presence of additional risk factors further increases the likelihood of a poorly cleansed colon.
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Affiliation(s)
- Brian B Borg
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110., USA
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Adiposity in relation to colorectal adenomas and hyperplastic polyps in women. Cancer Causes Control 2009. [PMID: 19387851 DOI: 10.1007/s10552- 009-9346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine whether BMI is independently related to colorectal adenomas and hyperplastic polyps. METHODS We conducted a cross-sectional study among 1,420 asymptomatic women aged 40-79 years who had undergone complete colonoscopy. Logistic regression was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of adenomas and hyperplastic polyps. RESULTS We identified 953 women (67.1%) with no polyps, 292 (20.6%) with adenomas, and 175 (12.3%) with hyperplastic polyps. Among those with polyps, 75 women (5.3% of total women) were classified as having both adenomas and hyperplastic polyps. After adjusting for potential risk factors for colorectal cancer, BMI was related to increased risk of adenomas (OR comparing obese to normal weight women = 1.57; 95% CI = 1.07-2.29). Further, BMI was associated with enhanced risk of hyperplastic polyps (OR = 3.76; 95% CI = 2.35-6.01) and the combination of adenomas and hyperplastic polyps (OR = 2.84; 95% CI = 1.41-5.72). CONCLUSIONS Excess body mass is positively related to colorectal adenomas and hyperplastic polyps, particularly when both kinds of polyps are present in combination. Future studies should continue to delineate the possible differences in potential risk factors between colorectal adenomas and hyperplastic polyps. Such work should help further elucidate the possible causes of colorectal cancer.
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Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009; 104:739-50. [PMID: 19240699 DOI: 10.1038/ajg.2009.104] [Citation(s) in RCA: 1040] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).
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Affiliation(s)
- Douglas K Rex
- Indiana University Medical Center, IU Hospital, Indianapolis 46202, USA.
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Kim Y, Kim Y, Lee S. An association between colonic adenoma and abdominal obesity: a cross-sectional study. BMC Gastroenterol 2009; 9:4. [PMID: 19144203 PMCID: PMC2635368 DOI: 10.1186/1471-230x-9-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 01/15/2009] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Colorectal adenoma is a precursor lesion of colorectal cancer and thus, it is an important target for preventing colorectal cancer. Only a few studies suggest an association between colorectal adenoma and obesity, but results show considerable heterogeneity. In this study, we investigated the association between colorectal adenoma and waist circumference. METHODS 165 adenoma cases and 365 polyp-free controls with a normal colon were compared in this cross-sectional study. Subjects underwent screening colonoscopy by experienced endoscopists. Demographic data, including smoking habit, were obtained by interview and waist circumference and anthropometric measurements were examined. Dietary intakes were evaluated using a food frequency questionnaire, and abdominal obesity was evaluated by measuring waist circumference. Statistical analysis was performed using SPSS for 13.0. RESULTS Age, waist circumference, and BMI were significantly higher in cases than controls. And smokers and men were more prevalent among cases than controls.Among the abdominal obese subjects, 45.6% had 1 or more adenoma, and 9.0% of these had advanced adenoma, whereas among subjects with a normal waist circumference, only 25.7% had 1 or more adenomas. The prevalence of adenoma was higher among abdominal obese group (P < 0.05). Logistic regression analysis showed that abdominal obesity was associated with an increased risk of colorectal adenoma (OR, 2.74; 95% CI, 1.66~4.51 in men, OR, 2.58; 95% CI, 1.08~6.12 in women). These associations persisted even after adjusting for BMI. While BMI was found to be weekly associated with the risk of adenoma among men at the highest BMI levels. However, BMI was not associated with the risk for adenoma after adjusting for waist circumference. CONCLUSION Our data suggest that abdominal obesity is associated with an increased risk of colorectal adenoma.
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Affiliation(s)
- YoungJoo Kim
- Department of Family Medicine, Pusan National University Hospital, 1-10 Ami-dong, Seo-Gu, Busan 602-739, South Korea
| | - YunJin Kim
- Department of Family Medicine, Pusan National University Hospital, 1-10 Ami-dong, Seo-Gu, Busan 602-739, South Korea
| | - Sangyeoup Lee
- Department of Family Medicine, Pusan National University Hospital, 1-10 Ami-dong, Seo-Gu, Busan 602-739, South Korea
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Abstract
This chapter posits that cancer is a complex and multifactorial process as demonstrated by the expression and production of key endocrine and steroid hormones that intermesh with lifestyle factors (physical activity, body size, and diet) in combination to heighten cancer risk. Excess weight has been associated with increased mortality from all cancers combined and for cancers of several specific sites. The prevalence of obesity has reached epidemic levels in many parts of the world; more than 1 billion adults are overweight with a body mass index (BMI) exceeding 25. Overweight and obesity are clinically defined indicators of a disease process characterized by the accumulation of body fat due to an excess of energy intake (nutritional intake) relative to energy expenditure (physical activity). When energy intake exceeds energy expenditure over a prolonged period of time, the result is a positive energy balance (PEB), which leads to the development of obesity. This physical state is ideal for intervention and can be modulated by changes in energy intake, expenditure, or both. Nutritional intake is a modifiable factor in the energy balance-cancer linkage primarily tested by caloric restriction studies in animals and the effect of energy availability. Restriction of calories by 10 to 40% has been shown to decrease cell proliferation, increasing apoptosis through anti-angiogenic processes. The potent anticancer effect of caloric restriction is clear, but caloric restriction alone is not generally considered to be a feasible strategy for cancer prevention in humans. Identification and development of preventive strategies that "mimic" the anticancer effects of low energy intake are desirable. The independent effect of energy intake on cancer risk has been difficult to estimate because body size and physical activity are strong determinants of total energy expenditure. The mechanisms that account for the inhibitory effects of physical activity on the carcinogenic process are reduction in fat stores, activity related changes in sex-hormone levels, altered immune function, effects in insulin and insulin-like growth factors, reduced free radical generation, and direct effect on the tumor. Epidemiologic evidence posits that the cascade of actions linking overweight and obesity to carcinogenesis are triggered by the endocrine and metabolic system. Perturbations to these systems result in the alterations in the levels of bioavailable growth factors, steroid hormones, and inflammatory markers. Elevated serum concentrations of insulin lead to a state of hyperinsulinemia. This physiological state causes a reduction in insulin-like growth factor-binding proteins and promotes the synthesis and biological activity of insulin-like growth factor (IGF)-I, which regulates cellular growth in response to available energy and nutrients from diet and body reserves. In vitro studies have clearly established that both insulin and IGF-I act as growth factors that promote cell proliferation and inhibit apoptosis. Insulin also affects on the synthesis and biological availability of the male and female sex steroids, including androgens, progesterone, and estrogens. Experimental and clinical evidence also indicates a central role of estrogens and progesterone in regulating cellular differentiation, proliferation, and apoptosis induction. Hyperinsulinemia is also associated with alterations in molecular systems such as endogenous hormones and adipokines that regulate inflammatory responses. Obesity-related dysregulation of adipokines has the ability to contribute to tumorigenesis and tumor invasion via metastatic potential. Given the substantial level of weight gain in industrialized countries in the last two decades, there is great interest in understanding all of the mechanisms by which obesity contributes to the carcinogenic process. Continued focus must be directed to understanding the various relationships between specific nutrients and dietary components and cancer cause and prevention. A reductionist approach is not sufficient for the basic biological mechanisms underlying the effect of diet and physical activity on cancer. The joint association between energy balance and cancer risk are hypothesized to share the same underlying mechanisms, the amplification of chemical mediators that modulate cancer risk depending on the responsiveness to those hormones to the target tissue of interest. Disentangling the connection between obesity, the insulin-IGF axis, endogenous hormones, inflammatory markers, and their molecular interaction is vital.
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Pan SY, DesMeules M. Energy intake, physical activity, energy balance, and cancer: epidemiologic evidence. Methods Mol Biol 2009; 472:191-215. [PMID: 19107434 DOI: 10.1007/978-1-60327-492-0_8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Energy intake, physical activity, and obesity are modifiable lifestyle factors. This chapter reviews and summarizes the epidemiologic evidence on the relation of energy intake, physical activity, and obesity to cancer. High energy intake may increase the risk of cancers of colon-rectum, prostate (especially advanced prostate cancer), and breast. However, because physical activity, body size, and metabolic efficiency are highly related to total energy intake and expenditure, it is difficult to assess the independent effect of energy intake on cancer risk. There are sufficient evidences to support a role of physical activity in preventing cancers of the colon and breast, whereas the association is stronger in men than in women for colon cancer and in postmenopausal than in premenopausal women for breast cancer. The evidence also suggests that physical activity likely reduces the risk of cancers of endometrium, lung, and prostate (to a lesser extent). On the other hand, there is little or no evidence that the risk of rectal cancer is related to physical activity, whereas the results have been inconsistent regarding the association between physical activity and the risks of cancers of pancreas, ovary and kidney. Epidemiologic studies provide sufficient evidence that obesity is a risk factor for both cancer incidence and mortality. The evidence supports strong links of obesity with the risk of cancers of the colon, rectum, breast (in postmenopausal women), endometrium, kidney (renal cell), and adenocarcinoma of the esophagus. Epidemiologic evidence also indicates that obesity is probably related to cancers of the pancreas, liver, and gallbladder, and aggressive prostate cancer, while it seems that obesity is not associated with lung cancer. The role of obesity in other cancer risks is unclear.
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Affiliation(s)
- Sai Yi Pan
- Public Health Agency of Canada, Centre for Chronic Disease Prevention and Control, Ottawa, Ontario, Canada
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Abstract
It is estimated that almost 1.5 million people in the USA are diagnosed with cancer every year. However, due to the substantial effect of modifiable lifestyle factors on the most prevalent cancers, it has been estimated that 50% of cancer is preventable. Physical activity, weight loss, and a reduction in alcohol use can strongly be recommended for the reduction of breast cancer risk. Similarly, weight loss, physical activity, and cessation of tobacco use are important behavior changes to reduce colorectal cancer risk, along with the potential benefit for the reduction of red meat consumption and the increase in folic acid intake. Smoking cessation is still the most important prevention intervention for reducing lung cancer risk, but recent evidence indicates that increasing physical activity may also be an important prevention intervention for this disease. The potential benefit of lifestyle change to reduce prostate cancer risk is growing, with recent evidence indicating the importance of a diet rich in tomato-based foods and weight loss. Also, in the cancers for which there are established lifestyle risk factors, such as physical inactivity for breast cancer and obesity for colorectal cancer, there is emerging information on the role that genetics plays in interacting with these factors, as well as the interaction of combinations of lifestyle factors. Integration of genetic information into lifestyle factors can help to clarify the causal relationships between lifestyle and genetic factors and assist in better identifying cancer risk, ultimately leading to better-informed choices about effective methods to enhance health and prevent cancer.
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Affiliation(s)
- Yvonne M Coyle
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Lee HM, Lee S, Lim JK, Seo JW, Lee KS, Baek SC, Kim YC, Shin BC, Kang SO. Relationship of Colorectal Polyps and the Risk Factors Including Obesity, Age, Alcohol and Smoking. Chonnam Med J 2009. [DOI: 10.4068/cmj.2009.45.3.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Hyun-Min Lee
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Soong Lee
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Jae-Kyu Lim
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Jang-Won Seo
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Ki-Sang Lee
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Seung-Chul Baek
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Yun-Cheol Kim
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Byung-Chul Shin
- Department of Internal Medicine, College of Medicine, Seonam University, Gwangju, Korea
| | - Sin-Ok Kang
- Department of Internal Medicine, College of Medicine, Seonam University, Namkwang Hospital, Gwangju, Korea
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31
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Abstract
Adenomatous polyps are common and factors that increase risk include race, gender, smoking, and obesity. This author summarizes the evidence supporting increased risk with these factors and describes how epidemiological data may be used to tailor screening programs.
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Affiliation(s)
- Sarah W. Grahn
- Department of Surgery, University of California–San Francisco, San Francisco, California
| | - Madhulika G. Varma
- Department of Surgery, University of California–San Francisco, San Francisco, California
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Yamaji Y, Okamoto M, Yoshida H, Kawabe T, Wada R, Mitsushima T, Omata M. The effect of body weight reduction on the incidence of colorectal adenoma. Am J Gastroenterol 2008; 103:2061-7. [PMID: 18796100 DOI: 10.1111/j.1572-0241.2008.01936.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Obesity is thought to be associated with colorectal cancer and adenoma. We aimed to investigate the effect of body weight on the risk of colorectal adenoma both in cross-sectional and longitudinal analyses. METHODS This is a retrospective cohort study in a large-scale health appraisal institution in Japan. A total of 7,963 asymptomatic, average-risk Japanese were enrolled at initial examinations, and 2,568 subjects who underwent a second colonoscopy after 1 yr were investigated. The association with the prevalence of colorectal adenoma was evaluated according to the body mass index (BMI) at the initial examination. The incidence of colorectal adenoma at the second colonoscopy was investigated according to the initial BMI and body weight changes during the year. RESULTS The prevalence of colorectal adenoma increased in relation to increases in the BMI: 15.4%, 20.6%, 22.7%, and 24.2%, respectively, in the first (BMI < 21.350), second (21.350 < or = BMI < 23.199), third (23.199 < or = BMI < 25.156), and fourth (25.156 < or = BMI) quartiles. The adjusted odds ratios in reference to Group Q1 were 1.15 (95% CI 0.97-1.37, P= 0.1) for Group Q2, 1.19 (1.01-1.41, P= 0.04) for Group Q3, and 1.32 (1.12-1.56, P= 0.001) for Group Q4. The incidence rates of colorectal adenoma after 1 yr also increased proportionally according to the initial BMI: Group Q1 (12.9%), Group Q2 (15.7%), Group Q3 (18.3%), and Group Q4 (19.0%). CONCLUSIONS Obesity was associated with the risk for colorectal adenoma, and body weight reduction was suggested to decrease this risk.
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Affiliation(s)
- Yutaka Yamaji
- Department of Gastroenterology, University of Tokyo, Tokyo, Japan
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Wise LA, Rosenberg L, Palmer JR, Adams-Campbell LL. Anthropometric risk factors for colorectal polyps in African-American women. Obesity (Silver Spring) 2008; 16:859-68. [PMID: 18239567 DOI: 10.1038/oby.2007.139] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Colorectal adenomas are thought to be precursor lesions to colorectal cancer, a leading cause of cancer incidence and mortality in African-American women. Studies suggest that obesity is associated with risk of adenomas in white women, but little is known about the relation in African-American women. We prospectively examined the association between selected anthropometric factors and colorectal polyps in African-American women. METHODS AND PROCEDURES Data were obtained from the Black Women's Health Study (BWHS), a prospective cohort study of African-American women. From 1997 to 2003, we followed 33,403 women aged > or =30 years with no prior diagnosis of cancer or polyps. Cox regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for risk of polyps, with adjustment for potential confounders. RESULTS After 211,797 person-years of follow-up, 1,189 cases of colorectal polyps were reported. The IRR comparing women with a current BMI > or =35 to <25 kg/m(2) was 1.35 (95% CI = 1.12-1.62), after adjustment for covariates including waist-to-hip ratio (WHR). Women who gained > or =30 kg since age 18 were 1.76 times as likely as those who gained <5 kg to report polyps (95% CI = 1.33-2.33). The IRR comparing the highest (>or =0.87) to lowest (<0.71) quintiles of WHR was 1.26 (95% CI = 1.04-1.54), after adjustment for covariates including BMI. BMI at age 18, adult height, and waist circumference (BMI-adjusted) were not materially associated with risk. Results were similar among women with a recent endoscopy. DISCUSSION Weight gain and obesity in adulthood may increase the risk of colorectal polyps in African-American women.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA.
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Giovannucci E. Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr 2007; 86:s836-42. [PMID: 18265477 DOI: 10.1093/ajcn/86.3.836s] [Citation(s) in RCA: 377] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
An impressive body of epidemiologic data collected over the past decade indicates that the risk of colon cancer is elevated in those with metabolic syndrome. This evidence includes studies that examined the risk of colon cancer or adenoma in relation to determinants of the metabolic syndrome (obesity, abdominal distribution of adiposity, and physical inactivity), clinical consequences of this syndrome (type 2 diabetes and hypertension), plasma or serum components of the definition of metabolic syndrome (hypertriglyceridemia, hyperglycemia, and low HDL cholesterol), and markers of hyperinsulinemia or insulin resistance (insulin and C-peptide), which is the underlying metabolic defect of the metabolic syndrome. The mechanism underlying these associations is unknown but may involve the influence of hyperinsulinemia in enhancing free or bioavailable concentrations of insulin-like growth factor-1. Future studies should also be based on better measurements of insulin resistance, beta-cell depletion, and insulin responses to better assess which aspects of insulin resistance are most closely related to the risk of colon neoplasia.
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Affiliation(s)
- Edward Giovannucci
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
The association between diet and colorectal cancer has been studied in depth for many decades, with equivocal results. It has been hypothesized that cancers arising in the distal and proximal colon have different pathologies, and therefore different risk factors. As such, it is possible that diet-related factors might influence colorectal neoplasia differently depending on the subsite. Recent evidence indicates that women may be more likely to develop proximal cancers than men. Additionally, the link between certain dietary factors and colorectal neoplasia in women seems to vary by menopausal status. Given these observations, women may be affected differently than men by diet-related factors. The objective of this article was therefore to review the data for diet and colorectal adenomas and cancer, and then attempt to address the potential differences in the association of diet-related factors and colorectal neoplasia in men and women. For total energy intake, selenium, and fiber, it seems that there may be slightly stronger effects in men as compared with women, whereas calcium and folate seem to affect both sexes similarly. With regard to vitamin D and colorectal cancer, women may exhibit stronger associations than men. Perhaps the most evidence for a sex-specific effect is observed for obesity, where more substantial direct relationships between body size and colorectal neoplasia have been reported for men than for women. However, this observation may be influenced by the differential effects in women by menopausal status. Further research on sex-specific dietary effects is warranted.
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Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman Arizona College of Public Health, Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA.
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Sedjo RL, Byers T, Levin TR, Haffner SM, Saad MF, Tooze JA, D'Agostino RB. Change in body size and the risk of colorectal adenomas. Cancer Epidemiol Biomarkers Prev 2007; 16:526-31. [PMID: 17372248 DOI: 10.1158/1055-9965.epi-06-0229] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Rebecca L Sedjo
- Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, P.O. Box 6508, 13001 East 17th Place, MS F519, Aurora, CO 80045, USA.
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The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 2007; 132:2208-25. [PMID: 17498513 DOI: 10.1053/j.gastro.2007.03.050] [Citation(s) in RCA: 396] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 01/12/2007] [Indexed: 12/21/2022]
Abstract
Recent evidence indicates that obesity and related metabolic abnormalities are associated with increased incidence or mortality for a number of cancers, including those of the colon, prostate, and pancreas. Obesity, physical inactivity, visceral adiposity, hyperglycemia, and hyperinsulinemia are relatively consistent risk factors for colon cancer and adenoma. Also, patients with type 2 diabetes mellitus have a higher risk of colon cancer. For prostate cancer, the relationship to obesity appears more complex. Obesity seems to contribute to a greater risk of aggressive or fatal prostate cancer but perhaps to a lower risk of nonaggressive prostate cancer. Furthermore, men with type 2 diabetes mellitus are at lower risk of developing prostate cancer. Long-standing type 2 diabetes increases the risk of pancreatic cancer by approximately 50%. Furthermore, over the past 6 years, a large number of cohort studies have reported positive associations between obesity and pancreatic cancer. Together with data from prediagnostic blood specimens showing positive associations between glucose levels and pancreatic cancer up to 25 years later, sufficient evidence now supports a strong role for diabetes and obesity in pancreatic cancer etiology. The mechanisms for these associations, however, remain speculative and deserve further study. Hyperinsulinemia may be important, but the role of oxidative stress initiated by hyperglycemia also deserves further attention.
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39
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Vehmas T. Factors influencing the detection of abnormalities in barium enemas performed by junior radiologists. Clin Radiol 2006; 61:270-5. [PMID: 16488209 DOI: 10.1016/j.crad.2005.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 10/21/2005] [Accepted: 10/29/2005] [Indexed: 11/20/2022]
Abstract
AIM To study the effects of patient variability, technical examination and radiologist-related factors on the radiological diagnosis of barium enema studies. MATERIALS AND METHODS Twenty-one residents (12 women and nine men, age 26-39 years) performed 523 double contrast barium enemas in a university hospital. Diagnoses were classified as normal (n = 203), diverticulosis (n = 224), polyps (n = 25), tumours (n = 20) and other (n = 46); five were missing diagnoses. Binary and multinomial logistic regressions were used to study the relations between the independent variables and the radiological diagnoses. RESULTS Patients' advanced age (p < 0.001) and obesity (p = 0.041) were significant positive predictors for the detection of any abnormalities, as was good or moderate study quality (p = 0.023). However, patients' obesity was negatively associated with the detection of polyps (p = 0.037). Pathological findings were associated with higher dose-area products (p = 0.047) than normal cases. Residents' advanced age (p = 0.029) and experience (a high number of previously performed barium enemas; p = 0.009) were negative predictors for the detection of pathological findings. CONCLUSION Patients' obesity hampers polyp detection, possibly due to decreased image quality or coexisting diverticula. The most experienced and oldest residents missed positive findings, possibly due to insufficient consultation of supervising radiologists, emphasizing the need for their optimal cooperation.
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Affiliation(s)
- T Vehmas
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.
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40
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Wallace K, Baron JA, Karagas MR, Cole BF, Byers T, Beach MA, Pearson LH, Burke CA, Silverman WB, Sandler RS. The association of physical activity and body mass index with the risk of large bowel polyps. Cancer Epidemiol Biomarkers Prev 2005; 14:2082-6. [PMID: 16172213 DOI: 10.1158/1055-9965.epi-04-0757] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE AND METHOD Several studies have suggested that physical inactivity and obesity increase the risk for colorectal neoplasia. In this study, we investigated the association of physical activity and body mass index (BMI) with the risk of different types of large bowel polyps. We did an observational analysis nested within a randomized double-blind placebo-controlled chemoprevention trial among patients with one or more recently resected histologically confirmed colorectal adenoma. Nine hundred thirty patients were randomized to calcium (1,200 mg/d, as carbonate) or placebo. Follow-up colonoscopies were conducted approximately 1 and 4 years after the qualifying examination. At study entry, we obtained each subject's current body weight and height, which we used to calculate BMI. After the second study colonoscopy, we asked subjects questions about their leisure time physical activity. Seven hundred eighty-seven subjects completed at least part of the physical activity questionnaire. RESULTS We found no association between measures of physical activity or BMI and tubular adenomas or hyperplastic polyps. However, among men, there were strong inverse associations observed between physical activity and advanced neoplastic polyps. Compared with men whose total daily energy expenditure was in the lowest tertile, those in the highest tertile had a risk ratio of 0.35 (95% confidence interval, 17-0.72); there was no similar reduction observed among women (risk ratio, 1.21; 95% confidence interval, 0.36-4.03; P for interaction = 0.04). DATA INTERPRETATIONS We found a significant inverse relationship between several measures of physical activity and risk of advanced colorectal neoplasms, particularly among men. No associations were found between BMI and hyperplastic polyps, tubular adenomas, or advanced neoplastic polyps.
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Affiliation(s)
- Kristin Wallace
- Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
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41
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Gunter MJ, Leitzmann MF. Obesity and colorectal cancer: epidemiology, mechanisms and candidate genes. J Nutr Biochem 2005; 17:145-56. [PMID: 16426829 DOI: 10.1016/j.jnutbio.2005.06.011] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Revised: 06/14/2005] [Accepted: 06/15/2005] [Indexed: 12/18/2022]
Abstract
There is increasing evidence that dysregulation of energy homeostasis is associated with colorectal carcinogenesis. Epidemiological data have consistently demonstrated a positive relation between increased body size and colorectal malignancy, whereas mechanistic studies have sought to uncover obesity-related carcinogenic pathways. The phenomenon of "insulin resistance" or the impaired ability to normalize plasma glucose levels has formed the core of these pathways, but other mechanisms have also been advanced. Obesity-induced insulin resistance leads to elevated levels of plasma insulin, glucose and fatty acids. Exposure of the colonocyte to heightened concentrations of insulin may induce a mitogenic effect within these cells, whereas exposure to glucose and fatty acids may induce metabolic perturbations, alterations in cell signaling pathways and oxidative stress. The importance of chronic inflammation in the pathogenesis of obesity has recently been highlighted and may represent an additional mechanism linking increased adiposity to colorectal carcinogenesis. This review provides an overview of the epidemiology of body size and colorectal neoplasia and outlines current knowledge of putative mechanisms advanced to explain this relation. Family based studies have shown that the propensity to become obese is heritable, but this is only manifest in conditions of excess energy intake over expenditure. Inheritance of a genetic profile that predisposes to increased body size may also be predictive of colorectal cancer. Genomewide scans, linkage studies and candidate gene investigations have highlighted more than 400 chromosomal regions that may harbor variants that predispose to increased body size. The genetics underlying the pathogenesis of obesity are likely to be complex, but variants in a range of different genes have already been associated with increased body size and insulin resistance. These include genes encoding elements of insulin signaling, adipocyte metabolism and differentiation, and regulation of energy expenditure. A number of investigators have begun to study genetic variants within these pathways in relation to colorectal neoplasia, but at present data remain limited to a handful of studies. These pathways will be discussed with particular reference to genetic polymorphisms that have been associated with obesity and insulin resistance.
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Affiliation(s)
- Marc J Gunter
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20852, USA.
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Guilera M, Connelly-Frost A, Keku TO, Martin CF, Galanko J, Sandler RS. Does physical activity modify the association between body mass index and colorectal adenomas? Nutr Cancer 2005; 51:140-5. [PMID: 15860435 DOI: 10.1207/s15327914nc5102_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although both physical inactivity and obesity have been associated with an increased risk of colorectal adenomas, it is unclear whether physical activity modifies the relationship between obesity and colorectal adenomas or through what mechanism this might occur. The aim of this study is to evaluate whether physical activity modifies the relationship between body mass index (BMI) and colorectal adenomas and whether apoptosis is a plausible mechanism responsible for this effect modification. Study subjects were part of a large, cross-sectional study, the Diet and Health Study III. Consecutive patients underwent colonoscopy between August 1998 and March 2000. Apoptosis was measured by morphological evaluation of hematoxylin and eosin-stained sections obtained from rectal pinch biopsy samples. There were 226 patients with adenomas and 494 adenoma-free controls. When comparing overweight subjects with the referent group (high physical activity/normal BMI), the relative odds of having an adenoma decreased as physical activity increased: low (odds ratio, OR=1.6; 95% confidence interval, CI=0.7-3.4); moderate (OR=1.1; 95% CI=0.6-2.0); and high (OR=0.8; 95% CI=0.4-1.6). When comparing obese subjects with the referent group, relative odds of having an adenoma were increased regardless of physical activity level. Apoptosis was not associated with obesity or physical activity. Our results suggest that physical activity may modify the association between obesity and colorectal adenoma until a high level of obesity is achieved. Apoptosis does not appear to be associated with obesity or physical activity.
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Affiliation(s)
- Magda Guilera
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599, USA
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43
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Abstract
This article discusses the evidence linking obesity to the different manifestations of gastroesophageal reflux disease and colorectal cancer.
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Affiliation(s)
- Hashem B El-Serag
- Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center at Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB, Macdonald JS, Fuchs CS. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 2003; 98:484-95. [PMID: 12879464 DOI: 10.1002/cncr.11544] [Citation(s) in RCA: 249] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is a risk factor for the development of colon carcinoma. The influence of body mass index (BMI) on long-term outcomes and treatment-related toxicity in patients with colon carcinoma has not been well characterized. METHODS This cohort study was conducted within a large, randomized adjuvant chemotherapy trial of 3759 men and women with high-risk, Stage II and Stage III colon carcinoma who were treated between 1988 and 1992 throughout the United States. With a median follow-up of 9.4 years, the authors examined the influence of BMI on disease recurrence, overall survival, and treatment-related toxicity. RESULTS Compared with women of normal weight (BMI, 21.0-24.9 kg/m(2)), obese women with colon carcinoma (BMI > or = 30.0 kg/m(2)) experienced significantly worse overall mortality (hazard ratio [HR], 1.34; 95% confidence interval [95% CI], 1.07-1.67) and a nonsignificant increase in the risk of disease recurrence (HR, 1.24; 95% CI, 0.98-1.59). The influence of BMI among women was not related to any differences in chemotherapy dose-intensity across categories of BMI. In contrast, BMI was not related significantly to long-term outcomes among male patients in this cohort. Among all study participants, obese patients had significantly lower rates of Grade 3-4 leukopenia and lower rates of any Grade > or = 3 toxicity compared with patients of normal weight. CONCLUSIONS Among women with Stage II-III colon carcinoma, obesity was associated with a significant increase in overall mortality as well as a borderline significant increase in disease recurrence. Nonetheless, obesity was not associated with any increase in chemotherapy-related toxicity.
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Miyake Y, Eguchi H, Shinchi K, Oda T, Sasazuki S, Kono S. Glucose intolerance and serum aminotransferase activities in Japanese men. J Hepatol 2003; 38:18-23. [PMID: 12480555 DOI: 10.1016/s0168-8278(02)00323-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIMS Elevated activities of serum aminotransferase are commonly observed in patients with diabetes mellitus. Few studies have addressed the relation between glucose intolerance and serum activities of aminotransferase in free-living populations. METHODS Using a 75 g oral glucose tolerance test, we examined the association of impaired fasting glycemia (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus with serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) among 4621 men aged 49-59 years of the Japan Self-Defense Forces. Statistical adjustment was made for body mass index, waist-hip ratio, and other possible confounding factors. RESULTS Proportions of an elevated ALT (>50 IU/l) in men with normal glucose tolerance, IFG, IGT, and newly diagnosed diabetes mellitus were 3.5%, 9.5%, 7.7%, and 18.0%, respectively. Adjusted odds ratios of an elevated ALT for IFG, IGT, and newly diagnosed diabetes mellitus were 2.2 (95% confidence interval 1.1-4.3), 1.7 (1.2-2.4), and 4.4 (3.0-6.6), respectively. IGT and diabetes mellitus were also significantly positively associated with elevated AST (>40 IU/l) and GGT (>50 IU/l). CONCLUSIONS Glucose intolerance is associated with elevated serum aminotransferase independent of obesity, but even a mildly elevated ALT is relatively uncommon in free-living men with glucose intolerance.
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Affiliation(s)
- Yumi Miyake
- Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Teramukai S, Rohan T, Lee KY, Eguchi H, Oda T, Kono S. Insulin-like growth factor (IGF)-I, IGF-binding protein-3 and colorectal adenomas in Japanese men. Jpn J Cancer Res 2002; 93:1187-94. [PMID: 12460458 PMCID: PMC5926902 DOI: 10.1111/j.1349-7006.2002.tb01222.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Several epidemiological studies have found that high levels of plasma insulin-like growth factor (IGF)-I and low levels of IGF-binding protein (IGFBP)-3 are related to an increased risk of colorectal cancer or late-stage adenomas. We examined the relation of body mass index, fasting and 2-h postload plasma glucose levels and plasma concentrations of IGF-I and IGFBP-3 to colorectal adenomas in middle-aged Japanese men. The study subjects comprised 157 cases of histologically diagnosed colorectal adenomas and 311 controls with normal colonoscopy or non-polyp benign lesions in a consecutive series of 803 men receiving a preretirement health examination at two hospitals of the Self Defense Forces (SDF). After adjustment for rank in the SDF, hospital, smoking and IGFBP-3, a statistically nonsignificant modest increase in the prevalence odds of colorectal adenomas was observed for the highest versus the lowest quartile level of IGF-I. The increase was slightly greater with further adjustment for 2-h glucose concentrations (adjusted odds ratio 1.8, 95% confidence interval 1.0-4.5, trend P=0.06). Men with high levels of IGFBP-3 showed only a minimal decrease in risk after adjustment for IGF-I. The association with IGF-I was less evident for advanced adenomas (>5 mm in size or tubulovillous/villous). Fasting and 2-h glucose and body mass index were more strongly positively associated with colorectal adenomas than IGF-I, especially with advanced adenomas, independently of IGF-I and IGFBP-3. The findings suggest that plasma IGF-I and IGFBP-3 may be involved in colorectal tumorigenesis regardless of the stage in growth of adenoma, but not as a mediator for the effects of being overweight or of hyperglycemia.
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Affiliation(s)
- Satoshi Teramukai
- Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
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Abstract
Primary prevention of colonic adenomas and cancer through dietary interventions or chemoprevention has great appeal. This article discusses primary prevention goals and promising nutritional or chemopreventive strategies. There is substantial observational evidence that diets high in total calories and fat and or low in fruits and vegetables or total fiber as well as low levels of physical activity are related to the risk of colonic neoplasia. Similar observational data indicate that diets high in specific nutrients such as antioxidant vitamins or calcium may be protective. The article describes some of the newer chemopreventive agents and reviews the data linking diet and lifestyle to colorectal cancer risk, focusing on interventions that have also been studied in prospective clinical trials. Finally the evidence supporting the role of non-steroidal anti-inflammatory drugs for the chemoprevention of CRC is reviewed and the status of several other promising newer agents that are entering human trials is summarized.
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Affiliation(s)
- David Gatof
- Division of Gastroenterology, University of Colorado Health Sciences Center, University of Colorado School of Medicine B158, 4200 E. Ninth Avenue, Denver, CO 80262, USA
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Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr 2001; 131:3109S-20S. [PMID: 11694656 DOI: 10.1093/jn/131.11.3109s] [Citation(s) in RCA: 653] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Insulin and insulin-like growth factor (IGF) axes are major determinants of proliferation and apoptosis and thus may influence carcinogenesis. In various animal models, modulation of insulin and IGF-1 levels through various means, including direct infusion, energy excess or restriction, genetically induced obesity, dietary quality including fatty acid and sucrose content, inhibition of normal insulin secretion and pharmacologic inhibition of IGF-1, influences colonic carcinogenesis. Human evidence also associates high levels of insulin and IGF-1 with increased risk of colon cancer. Clinical conditions associated with high levels of insulin (noninsulin-dependent diabetes mellitus and hypertriglyceridemia) and IGF-1 (acromegaly) are related to increased risk of colon cancer, and increased circulating concentrations of insulin and IGF-1 are related to a higher risk of colonic neoplasia. Determinants and markers of hyperinsulinemia (physical inactivity, high body mass index, central adiposity) and high IGF-1 levels (tall stature) are also related to higher risk. Many studies indicate that dietary patterns that stimulate insulin resistance or secretion, including high consumption of sucrose, various sources of starch, a high glycemic index and high saturated fatty acid intake, are associated with a higher risk of colon cancer. Although additional environmental and genetic factors affect colon cancer, the incidence of this malignancy was invariably low before the technological advances that rendered sedentary lifestyles and obesity common, and increased availability of highly processed carbohydrates and saturated fatty acids. Efforts to counter these patterns are likely to have the most potential to reduce colon cancer incidence, as well as cardiovascular disease and diabetes mellitus.
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Affiliation(s)
- E Giovannucci
- Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.
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Nishii T, Kono S, Abe H, Eguchi H, Shimazaki K, Hatano B, Hamada H. Glucose intolerance, plasma insulin levels, and colon adenomas in Japanese men. Jpn J Cancer Res 2001; 92:836-40. [PMID: 11509114 PMCID: PMC5926827 DOI: 10.1111/j.1349-7006.2001.tb01169.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hyperinsulinemia may be related to colon carcinogenesis. Several studies have suggested that diabetes mellitus is related to increased risk of colon cancer. We examined cross-sectionally the relation of fasting plasma insulin levels and glucose tolerance status to colon adenomas. In a consecutive series of 951 men undergoing total colonoscopy for a health examination at the Japan Self Defense Forces Fukuoka Hospital from April 1998 to August 1999, we identified 233 cases of colon adenomas and 497 controls with normal colonoscopy. Glucose tolerance status was determined by a 75-g oral glucose tolerance test, and subjects were classified as normal, impaired glucose tolerance (IGT) or non-insulin dependent diabetes mellitus (NIDDM). Plasma insulin levels were measured after subjects had fasted overnight. Logistic regression analysis and analysis of covariance was used to control for age and obesity. While plasma insulin levels were unrelated to colon adenomas, NIDDM was associated with a significantly increased risk of colon adenomas. There was no association between IGT and colon adenomas. NIDDM was more strongly associated with proximal colon adenomas. The findings suggest that long-term hyperinsulinemic status associated with NIDDM may increase the risk of colon adenomas, and subsequently of colon cancer.
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Affiliation(s)
- T Nishii
- Self Defense Forces Fukuoka Hospital, Kasuga-shi, Fukuoka 816-0826, Japan.
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