Overweight as an Additional Risk Factor for Colorectal Neoplasia in Lean Population

Document Type: Research Articles

Authors

1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.

2 Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

Background: Overweight in Thailand is not as common as in Western countries. We sought to evaluate overweight
as the additional risk factor that can increase the prediction of colorectal neoplasia (CRN) detection in Thais apart from
the Asia-Pacific Colorectal Screening (APCS) score. Methods: We prospectively enrolled asymptomatic 338 subjects
who underwent screening colonoscopy between November 2016 and September 2017. All risk factors according to
APCS, BMI and the presence of metabolic syndrome were collected. Overweight was defined as BMI ≥23 kg/m2. By
APCS score, subjects were categorized into 1) high-risk and 2) average-risk. Using the combination of APCS score
and overweight, subjects were stratified into 4 groups; high-risk with overweight (G1), average-risk with overweight
(G2), high-risk with normal weight (G3) average-risk and with normal weight (G4). Logistic regression analysis was
used to estimate the risk of detecting CRN. Results: The prevalence of CRN in the high-risk subjects was higher
than that of in the average-risk subjects (49%vs.32%; OR, 2.00; 95%CI, 1.17-3.41). After adjustment for APCS risk
factors and metabolic syndrome, overweight significantly increased the risk of detecting CRN (OR, 2.52; 95%CI,
1.57-4.05). Among the 4 groups, the detection rates of CRN were significantly different (G1=64%, G2=40%, G3=32%
and G4=21%, p<0.01). The relative risk of detecting CRN increased when G1 (OR 6.49; 95%CI, 2.87-14.67), and G2
(2.42; 1.39-4.21) were compared with G4. Conclusions: In addition to the APCS score, overweight is an independent
risk factor for detecting CRN. In Thai population, combining overweight and APCS score may be useful to improve
the prediction for CRN.

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