代谢健康型肥胖与结直肠腺瘤的较高患病率相关。
Metabolically-healthy obesity is associated with higher prevalence of colorectal adenoma.
作者信息
Sinn Dong Hyun, Min Yang Won, Son Hee Jung, Rhee Poong-Lyul, Paik Seung Woon, Hong Sung Noh, Gwak Geum-Youn
机构信息
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Health Promotion, Samsung Medical Center, Seoul, South Korea.
出版信息
PLoS One. 2017 Jun 21;12(6):e0179480. doi: 10.1371/journal.pone.0179480. eCollection 2017.
BACKGROUND
The risk of colorectal adenoma (CRA), an important precursor of colorectal cancer, is largely unknown among obese individuals without obesity-related metabolic abnormalities, a condition described as metabolically-healthy obese (MHO). The aim of this study was to examine the association among metabolic status, the different categories of body mass index (BMI), and CRA in a large cohort of adults.
METHODS
We analyzed the association among metabolic status, BMI categories and CRA in asymptomatic adults who underwent a first-time colonoscopy as part of the comprehensive health check-up program at the Health Promotion Center of Samsung Medical Center, from January 2005 to December 2012. Being metabolically healthy was defined as lacking any metabolic syndrome components and having a homeostasis model assessment of insulin resistance <2.5.
RESULTS
The prevalence of "any," "multiple," and "high-risk" CRA was 25.6%, 8.3%, and 4.4% among 9,182 metabolically-healthy participants, and 35.9%, 12.5%, and 7.0% among 17,407 metabolically-unhealthy participants, respectively. Increased BMI showed a significant dose-dependent relationship with the prevalence of "any," "multiple," and "high-risk" CRA, in both metabolically-healthy and unhealthy participants. In multivariable-adjusted models that accounted for potential confounders including age, sex, smoking, alcohol, first-degree family history of colorectal cancer, and aspirin use, the odds ratio (OR) for any CRA comparing MHO with metabolically-healthy normal-weight (MHNW) participants was 1.25 (95% confidence interval (CI), 1.09-1.43). Further adjustment for metabolic components associated with obesity did not significantly change the association. Similarly, the ORs for multiple CRAs and high risk CRA were higher in MHO participants than MHNW participants [ORs (95% CI), 1.63 (1.31-2.04) and 1.53 (1.14-2.04), respectively].
CONCLUSIONS
The MHO phenotype was closely associated with higher prevalence of CRA, including high-risk adenoma. This finding supports the conclusion that MHO increases the risk of colorectal cancer.
背景
结直肠腺瘤（CRA）是结直肠癌的重要前体，在无肥胖相关代谢异常的肥胖个体（即代谢健康的肥胖者，MHO）中，其风险 largely unknown。本研究旨在调查一大群成年人的代谢状态、不同类别体重指数（BMI）与CRA之间的关联。
方法
我们分析了2005年1月至2012年12月在三星医疗中心健康促进中心作为综合健康检查项目一部分接受首次结肠镜检查的无症状成年人中代谢状态、BMI类别与CRA之间的关联。代谢健康定义为缺乏任何代谢综合征成分且胰岛素抵抗的稳态模型评估<2.5。
结果
在9182名代谢健康参与者中，“任何”、“多个”和“高危”CRA的患病率分别为25.6%、8.3%和4.4%，在17407名代谢不健康参与者中分别为35.9%、12.5%和7.0%。在代谢健康和不健康参与者中，BMI升高均与“任何”、“多个”和“高危”CRA的患病率呈显著剂量依赖性关系。在多变量调整模型中，考虑了年龄、性别、吸烟、饮酒、结直肠癌一级家族史和阿司匹林使用等潜在混杂因素，将MHO与代谢健康的正常体重（MHNW）参与者相比，任何CRA的优势比（OR）为1.25（95%置信区间（CI），1.09 - 1.43）。对与肥胖相关的代谢成分进行进一步调整并未显著改变这种关联。同样，MHO参与者中多个CRA和高危CRA的OR高于MHNW参与者[OR（95%CI）分别为1.63（1.31 - 2.04）和1.53（1.14 - 2.04）]。
结论
MHO表型与CRA的较高患病率密切相关，包括高危腺瘤。这一发现支持MHO增加结直肠癌风险的结论。
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