Dr. Alpert 7202 Tara Blvd Jonesboro, GA 30236 Tel: 770 472 8989

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Colorectal Cancer & Obesity

I was reading through interesting articles and found this information. It is important as I have just had a colorectal screening and they found that I had one adenoma and three polyps. I had put it off for years and just decided to book the appointment. I am glad that I did. I believe that all people should have the procedure and rule out any colorectal problems.
 
Yours in Health,
Dr. Alpert
  
 
Body Mass Index as a Predictor of Colorectal Neoplasia in Ethnically Diverse Screening Population.

Dig Dis Sci. 2010 Jan 29. [Epub ahead of print]

Stein B, Anderson JC, Rajapakse R, Alpern ZA, Messina CR, Walker G.
Division of Gastroenterology-Hepatology, Stony Brook University, Stony Brook, NY, USA.

BACKGROUND: Recent guidelines from the American College of Gastroenterology for screening for colorectal cancer have included obesity as an important risk factor. The recommendation for screening obese people at earlier age was tempered by the need for more data regarding obesity and colorectal neoplasia.

AIMS: We designed a cross-sectional study to further examine the predictive value of obesity for colorectal adenomas in asymptomatic patients.

METHODS: We prospectively collected demographic, medical, lifestyle, and dietary history from asymptomatic patients presenting for screening colonoscopy. Patients underwent complete colonoscopy using high-definition colonoscope to detect colorectal adenomas. We defined advanced neoplasia as large (>/=1 cm) adenoma, villous adenoma, high-grade dysplasia or cancer.

RESULTS: Six hundred patients with median age of 56 years completed the study. Over 40% of these patients did not consider themselves Caucasian, and less than 5% had a first-degree relative with colorectal cancer. Overall, 40 patients (6.7%) had advanced neoplasia and 216 (36.3%) had any adenoma. There were 185 obese patients (30.8%), who had a prevalence of 44.3% for any adenoma and 13.0% for advanced neoplasia. After multivariate analysis, obesity [body mass index (BMI) >/= 30 kg/m(2)] was significantly associated with increased risk of advanced neoplasia [odds ratio (OR) = 3.83; 95% confidence interval (CI): 1.94-7.55].

CONCLUSIONS: Obesity was associated with advanced neoplasia in this screening population. Our data regarding the association of colorectal neoplasia with this modifiable risk factor has implications for screening and prevention of colorectal cancer.
Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events.

Cancer Epidemiol Biomarkers Prev. 2007 Dec;16(12):2533-47.

Moghaddam AA, Woodward M, Huxley R.
The George Institute for International Health, Sydney, Australia.

BACKGROUND: Colorectal cancer is the second most common cause of death and illness in developed countries. Previous reviews have suggested that obesity may be associated with 30% to 60% greater risk of colorectal cancer, but little consideration was given to the possible effect of publication bias on the reported association.

METHODS: Relevant studies were identified through EMBASE and MEDLINE. Studies were included if they had published quantitative estimates of the association between general obesity [defined here as body mass index (BMI) > or = 30 kg/m(2)] and central obesity (measured using waist circumference) and colorectal cancer. Random-effects meta-analyses were done, involving 70,000 cases of incident colorectal cancer from 31 studies, of which 23 were cohort studies and 8 were case-control studies.

RESULTS: After pooling and correcting for publication bias, the estimated relative risk of colorectal cancer was 1.19 [95% confidence interval (95% CI), 1.11-1.29], comparing obese (BMI > or = 30 kg/m(2)) with normal weight (BMI <25 kg/m(2)) people; and 1.45 (95% CI, 1.31-1.61), comparing those with the highest, to the lowest, level of central obesity. After correcting for publication bias, the risk of colorectal cancer was 1.41 (95% CI, 1.30-1.54) in men compared with 1.08 (95% CI, 0.98-1.18) for women (P(heterogeneity) <0.001). There was evidence of a dose-response relationship between BMI and colorectal cancer: for a 2 kg/m(2) increase in BMI, the risk of colorectal cancer increased by 7% (4-10%). For a 2-cm increase in waist circumference, the risk increased by 4% (2-5%).

CONCLUSIONS: Obesity has a direct and independent relationship with colorectal cancer, although the strength of the association with general obesity is smaller than previously reported.
Association between body size and colorectal adenoma recurrence.

Clin Gastroenterol Hepatol. 2007 Aug;5(8):982-90. Epub 2007 Jun 5.

Jacobs ET, Martínez ME, Alberts DS, Jiang R, Lance P, Lowe KA, Thompson PA.
Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, Arizona 85724-5024, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BACKGROUND & AIMS: Obesity has been associated with increased risk for colorectal adenoma, although its role as a risk factor after polypectomy for recurrence is unclear. Therefore, we sought to evaluate the effect of anthropometric measures of obesity on adenoma after polypectomy.

METHODS: Subjects with baseline adenomas (n = 2465) and follow-up colonoscopy data were drawn from 2 randomized trials designed to prevent adenoma recurrence.

RESULTS: Over a mean follow-up period of 3.1 years presence of a body mass index (BMI) > or = 30 kg/m2 was associated with a nonsignificant 17% increase in the odds for any adenoma recurrence among all subjects (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.92-1.48). This result was confined to men (OR, 1.36; 95% CI, 1.01-1.83) and not observed for women (OR, 0.90; 95% CI, 0.60-1.33). Results for waist circumference did not reach statistical significance, although trends were similar to those for BMI. Analyses of the effects of obesity on more clinically significant lesions demonstrated that high BMI was a slightly stronger risk factor for advanced adenoma recurrences in men (OR, 1.62; 95% CI, 1.04-2.53) when compared with non-advanced lesions (OR, 1.26; 95% CI, 0.91-1.75). In addition, we observed an association for obesity and odds of adenoma recurrence among participants reporting a family history of colorectal cancer (OR, 2.25; 95% CI, 1.32-3.84) but not for those without (OR, 1.00; 95% CI, 0.77 to 1.31; P(int) = P = .008).

CONCLUSIONS: Our results support obesity as a risk factor for subsequent short-interval (mean follow-up time 3.1 years) development of colorectal adenomas, particularly among men and persons with a family history of colorectal cancer. Furthermore, obesity in men appears to be strongly associated with the development of clinically advanced lesions.
Body mass index: a marker for significant colorectal neoplasia in a screening population.

J Clin Gastroenterol. 2007 Mar;41(3):285-90.

Anderson JC, Messina CR, Dakhllalah F, Abraham B, Alpern Z, Martin C, Hubbard PM, Grimson R, Shaw RD.
Department of Gastroenterology and Hepatology, Stony Brook University, Stony Brook, NY 11794, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BACKGROUND AND AIMS: Although some studies suggest a positive association between increasing body mass index (BMI) and risk for colorectal neoplasia, the impact on screening has not been examined. We performed a cross-sectional study to examine the association of BMI and colorectal neoplasia in a screening population.

METHODS: Data collected for 2493 patients presenting for screening colonoscopy included known risk factors for colorectal neoplasia, demographic information, and lifestyle factors. Our outcome was the endoscopic detection of significant colorectal neoplasia which included adenocarcinoma, high-grade dysplasia, villous tissue, adenomas 1 cm or greater and multiple (>2) adenomas of any size.

RESULTS: Overall, we observed an increased risk and prevalence for significant colorectal neoplasia in women as BMI increased (P value for trend or =40 (odds ratios=4.26; 95% confidence intervals=2.00-9.11). There was no such relationship in our male population.

CONCLUSIONS: Increasing BMI, in our population, was associated with an increase risk for colorectal neoplasia in female patients. This study reinforces the importance of screening colonoscopy especially in obese women.
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