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American Journal of Epidemiology Advance Access originally published online on January 15, 2009
American Journal of Epidemiology 2009 169(6):657-666; doi:10.1093/aje/kwn401
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Association Between Body Mass Index and Colorectal Neoplasia at Follow-Up Colonoscopy: A Pooling Study

Elizabeth T. Jacobs, Dennis J. Ahnen, Erin L. Ashbeck, John A. Baron, E. Robert Greenberg, Peter Lance, David A. Lieberman, Gail McKeown-Eyssen, Arthur Schatzkin, Patricia A. Thompson and María Elena Martínez

Correspondence to Dr. Elizabeth T. Jacobs, Arizona Cancer Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, P.O. Box 245024, Tucson, AZ 85724-5024 (e-mail: jacobse{at}u.arizona.edu).

Received for publication September 12, 2008. Accepted for publication December 3, 2008.

A direct relation between body mass index (BMI) and risk of colorectal adenomas and cancer has been reported, but few studies have had adequate sample size for conducting stratified analyses by sex, family history, colorectal subsite, or features of metachronous lesions. Data from 8,213 participants in 7 prospective studies of metachronous colorectal adenomas were pooled to assess whether the association between BMI and metachronous neoplasia varied by these factors. A statistically significant direct association between BMI and the odds of nonadvanced adenomas (Ptrend < 0.001) was observed, while the relation for advanced adenomas was of marginal significance (Ptrend < 0.07). In sex-stratified analyses, obesity was statistically significantly associated with the odds of any metachronous lesion among men (odds ratio = 1.36, 95% confidence interval: 1.17, 1.58) but not among women (odds ratio = 1.10, 95% confidence interval: 0.89, 1.37). The associations with BMI appeared to be limited to proximal neoplasia, with statistically significant results for BMI and proximal (Ptrend < 0.001), but not distal (Ptrend < 0.85), neoplasia. Exploratory analyses indicated that BMI was significantly related to most histologic characteristics of metachronous adenomas among men but not among women. Our results provide further support for the association between BMI and metachronous colorectal adenomas, particularly among men, thereby indicating that body size may affect colorectal carcinogenesis at comparatively early stages.

adenoma; body mass index; colorectal neoplasms; meta-analysis as topic; neoplasms, second primary; recurrence

Abbreviations: BMI, body mass index; CI, confidence interval; HRT, hormone replacement therapy; OR, odds ratio


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