Body mass index category as a risk factor for colorectal adenomas: A systematic review and meta-analysis

Koji Okabayashi, Hutan Ashrafian, Hirotoshi Hasegawa, Jae Hoon Yoo, Vanash M. Patel, Leanne Harling, Simon P. Rowland, Mariam Ali, Yuukou Kitagawa, Ara Darzi, Thanos Athanasiou

Research output: Contribution to journalArticle

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Abstract

Objectives: The association between increasing body weight and colorectal adenoma prevalence has been suggested to follow a similar pattern to excess weight and colorectal cancer, although the magnitude of this relationship has not been validated. The objective of this study was to quantify the association and dose-response relationship between body mass index (BMI) and colorectal adenoma prevalence in clinical trials. Methods: We systematically reviewed 23 studies (168,201 participants), which compared the prevalence of colorectal adenomas according to World Health Organization BMI categories. We assessed the effects of each BMI category on colorectal adenomas where odds ratio (OR) was used as a surrogate for effect size, and applied multivariate meta-analysis as a method of sensitivity analysis to evaluate the robustness of our findings and to analyze adenoma prevalence by multiple BMI categories simultaneously to assess for a dose-response relationship. Heterogeneity and publication bias were assessed. Results: Subjects with a BMI of ≥ 25 had a significantly higher prevalence of colorectal adenomas (OR1.24 (95% confidence interval (CI): 1.16-1.33), P=0.01) when compared with those with BMI25. Multivariate meta-analysis also confirmed a positive association between higher BMI categories and the prevalence of colorectal adenoma (BMI: 25-30 vs. BMI25; OR1.21 (95% CI: 1.07-1.38), P=0.01; BMI30 vs. BMI25; OR1.32 (95% CI: 1.18-1.48), P=0.01) and revealed a dose-response relationship. Conclusions: The positive association between obesity and colorectal adenoma prevalence demonstrates an underlying dose-response relationship according to BMI. Colorectal centers may benefit from the timely screening of obese patients for colorectal adenomas in addition to clarifying the biological role of adiposity on colorectal tumor initiation and progression.

Original languageEnglish
Pages (from-to)1175-1185
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume107
Issue number8
DOIs
Publication statusPublished - 2012 Aug

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Adenoma
Meta-Analysis
Body Mass Index
Confidence Intervals
Colorectal Neoplasms
Multivariate Analysis
Publication Bias
Adiposity
Obesity
Odds Ratio
Body Weight
Clinical Trials
Weights and Measures

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Body mass index category as a risk factor for colorectal adenomas : A systematic review and meta-analysis. / Okabayashi, Koji; Ashrafian, Hutan; Hasegawa, Hirotoshi; Yoo, Jae Hoon; Patel, Vanash M.; Harling, Leanne; Rowland, Simon P.; Ali, Mariam; Kitagawa, Yuukou; Darzi, Ara; Athanasiou, Thanos.

In: American Journal of Gastroenterology, Vol. 107, No. 8, 08.2012, p. 1175-1185.

Research output: Contribution to journalArticle

Okabayashi, K, Ashrafian, H, Hasegawa, H, Yoo, JH, Patel, VM, Harling, L, Rowland, SP, Ali, M, Kitagawa, Y, Darzi, A & Athanasiou, T 2012, 'Body mass index category as a risk factor for colorectal adenomas: A systematic review and meta-analysis', American Journal of Gastroenterology, vol. 107, no. 8, pp. 1175-1185. https://doi.org/10.1038/ajg.2012.180
Okabayashi, Koji ; Ashrafian, Hutan ; Hasegawa, Hirotoshi ; Yoo, Jae Hoon ; Patel, Vanash M. ; Harling, Leanne ; Rowland, Simon P. ; Ali, Mariam ; Kitagawa, Yuukou ; Darzi, Ara ; Athanasiou, Thanos. / Body mass index category as a risk factor for colorectal adenomas : A systematic review and meta-analysis. In: American Journal of Gastroenterology. 2012 ; Vol. 107, No. 8. pp. 1175-1185.
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abstract = "Objectives: The association between increasing body weight and colorectal adenoma prevalence has been suggested to follow a similar pattern to excess weight and colorectal cancer, although the magnitude of this relationship has not been validated. The objective of this study was to quantify the association and dose-response relationship between body mass index (BMI) and colorectal adenoma prevalence in clinical trials. Methods: We systematically reviewed 23 studies (168,201 participants), which compared the prevalence of colorectal adenomas according to World Health Organization BMI categories. We assessed the effects of each BMI category on colorectal adenomas where odds ratio (OR) was used as a surrogate for effect size, and applied multivariate meta-analysis as a method of sensitivity analysis to evaluate the robustness of our findings and to analyze adenoma prevalence by multiple BMI categories simultaneously to assess for a dose-response relationship. Heterogeneity and publication bias were assessed. Results: Subjects with a BMI of ≥ 25 had a significantly higher prevalence of colorectal adenomas (OR1.24 (95{\%} confidence interval (CI): 1.16-1.33), P=0.01) when compared with those with BMI25. Multivariate meta-analysis also confirmed a positive association between higher BMI categories and the prevalence of colorectal adenoma (BMI: 25-30 vs. BMI25; OR1.21 (95{\%} CI: 1.07-1.38), P=0.01; BMI30 vs. BMI25; OR1.32 (95{\%} CI: 1.18-1.48), P=0.01) and revealed a dose-response relationship. Conclusions: The positive association between obesity and colorectal adenoma prevalence demonstrates an underlying dose-response relationship according to BMI. Colorectal centers may benefit from the timely screening of obese patients for colorectal adenomas in addition to clarifying the biological role of adiposity on colorectal tumor initiation and progression.",
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AU - Harling, Leanne

AU - Rowland, Simon P.

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AU - Darzi, Ara

AU - Athanasiou, Thanos

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