Risk Factors of Colorectal Polyps in Jeju Island

Mira Um; Mi Hee Kong; Hyeon Ju Kim; Yeoun Ja Na

doi:10.15384/kjhp.2014.14.4.141

Korean J Health Promot > Volume 14(4); 2014 > Article

Um, Kong, Kim, and Na: Risk Factors of Colorectal Polyps in Jeju Island

Original Article

Korean Journal of Health Promotion 2014;14(4):141-146.

Published online: January 20, 2014

DOI: https://doi.org/10.15384/kjhp.2014.14.4.141

Risk Factors of Colorectal Polyps in Jeju Island

Mira Um¹, Mi Hee Kong^1,², Hyeon Ju Kim^1,^2,, Yeoun Ja Na¹

¹Department of Family Medicine, Jeju National University Hospital, Jeju, Korea

²Department of Family Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea

Corresponding author：Hyeon Ju Kim, MD, PhD Department of Family Medicine, Jeju National University Hospital Jeju National University School of Medicine, 15 Aran 13-gil, Jeju 690-767, Korea
Tel: +82-64-717-1830, Fax: +82-64-717-1581 E-mail: fmhjukim@hanmail.net

Received March 26, 2014 Accepted November 26, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The incidence of colorectal polyps have been reported to be increasing in those aged 30–40 years who consume fast food, have low physical activity, and use alcohol and cigarettes. We analyzed the characteristics and risk factors of colorectal polyps in asymptomatic adults in Jeju Island.

Methods

Data on 1700 individuals who underwent a screening colonoscopy from 1 July, 2010 to 30 June, 2012 were analyzed based on age, gender, body mass index (BMI), blood pressure, blood tests, and behavioral habits including alcohol use, smoking, and exercise.

Results

The prevalence of colorectal polyps, including adenomatous and hyperplastic, is 43.1% and is higher in males (P<0.001). The prevalence according to age group shows increasing by age (P for trend<0.001). The most common histologic type of polyp is adenomatous in the <50 years and >50 years age groups, 27.3% and 45.3% respectively. And the percentage of adenomatous polyps has shown an increasing trend along with increasing number and size of polyps (P for trend<0.001). BMI, waist circumference (WC), fasting blood sugar, and triglyceride were higher in males with polyps than males in the control group. BMI and WC were higher and HDL-cholesterol was lower in females with polyps. The incidence of colorectal polyps was higher in male and female smokers (P<0.001 and P=0.035 respectively).

Conclusions

Our results showed that older age, male gender, obesity, and smoking are risk factors for colorectal polyps. The prevalence of colorectal adenomatous polyps is 27.3% in <50 yrs, 33.4% in the 40s. For early detection and treatment, we recommend a screening colonoscopy for those with risk factors.

Keywords: Colorectal polyp, Prevalence, Risk factors

Table 1.

General characteristics of subjects

Characteristics	Male (n=1,067)		P^b	Female ((n=633)		P^b
Characteristics	Polyps^a (n=543)	No (n=524)	P^b	Polypsc (n=189)	No (n=444)	P^b
Height, cm	169.11±5.71	170.22±5.87	0.513	155.90±5.15	156.51±5.34	0.294
Weight, kg	73.14±9.86	73.35±9.95	0.030	60.47±8.07	57.45±7.96	<0.001
BMI, kg/m²	25.53±2.85	25.28±2.85	0.033	24.87±3.03	23.46±3.12	<0.001
WC, cm	88.81±7.36	87.76±7.44	0.025	84.39±8.40	80.08±8.38	<0.001
SBP, mmHg	127.00±13.47	126.52±13.48	0.705	121.22±14.68	117.81±14.46	0.426
DBP, mmHg	77.76±9.89	77.59±9.97	0.933	73.46±10.40	71.30±9.38	0.154
FBS, mg/dL	99.92±30.36	92.91±17.50	0.001	93.79±19.68	90.67±19.28	0.249
TC, mg/dL	198.40±35.09	197.45±33.12	0.512	203.92±35.26	197.26±32.30	0.222
TG, mg/dL	141.24±109.41	132.02±79.90	0.019	90.80±50.50	82.92±49.28	0.649
HDL, mg/dL	49.80±12.06	49.83±11.97	0.509	57.27±13.00	61.33±14.32	0.013

Abbreviations: BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBS, fasting blood sugar; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol. Values are presented as means±SD.

^aPolyps: containing adenomatous and hyperplastic colorectal polyps.

^bCalculated by ANCOVA adjusted by age.

Table 2.

Age distribution of colorectal polyps and adenoma

Age, y	Polyps^a N (%)	P_b	Adenoma N (%)	P^b
20–29	2 (9.1)	<0.001	2 (9.1)	<0.001
30–39	108 (28.3)		76 (19.9)
40–49	216 (41.0)		176 (33.4)
50–59	248 (49.6)		206 (41.2)
60–69	137 (58.1)		122 (51.7)
70-	21 (63.6)		20 (60.6)
Total	732 (43.1)		602 (35.4)

Values are presented as number (%).

^aPolyps: containing adenomatous and hyperplastic colorectal polyps.

^bCalculated by linear by linear association for trend test.

Table 3.

Characteristics of colorectal polyps

Characteristics	Number (%)
Characteristics	< 50yr	≥50yr
Pathology	362 (38.9)	438 (57.0)
Adenomatous	254 (27.3)	348 (45.3)
Hyperplastic	127 (13.6)	144 (18.7)
Cancer	1 (0.1)	1 (0.1)
Carcinoid tumor	3 (0.3)	1 (0.1)
Non-specific	78 (8.4)	94 (12.2)
Number
1	192 (53.2)	169 (38.5)
2	90 (24.9)	123 (15.4)
3	32 (8.9)	56 (12.8)
4	20 (5.5)	31 (7.1)
≥5	27 (7.5)	60 (13.7)
Size, mm
< 5.0	99 (27.4)	98 (22.3)
5.0 – 9.0	218 (60.4)	276 (62.9)
≥ 10.0	44 (12.2)	65 (14.8)

Values are presented as number (%).

Table 4.

Multivariate logistic regression analysis of colorectal polyps according to risk factors

	Male		Female
	OR (95% CI)	P^a	OR (95% CI)	P^a
Age, per year	1.073 (1.056–1.091)	<0.001	1.063 (1.035–1.353)	0.012
BMI, per 1kg/m²	1.054 (1.002–1.109)	0.042	1.183 (1.035–1.353)	0.014
Smoking^b	1.816 (1.349–2.444)	<0.001	3.470 (1.088–11.065)	0.035
Alcohol^c	1.180 (0.884–1.575)	0.261	0.572 (0.184–1.774)	0.333
Exercise^d	0.866 (0.631–1.188)	0.372	1.043 (0.461–2.362)	0.920

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index.

^aCalculated by multiple logistic regression analysis.

^bSmoking: current smoker.

^cAlcohol: use greater than three times per week,

^dExercise: over 30min in a day and over three times per week.

References

1. Korea National Statistical Office. Annual Report on the cause of death statistics;2011. [Accessed 24 December, 2012].Available from:. http://kostat.go.kr/portal/korea/index.action.

2. Ross WA. Colorectal cancer screening in evolution: Japan and the USA. J Gastroenterol Hepatol 2010;25(Suppl 1):S49-56.

3. Lee SH, Lee KS, Lee JY, Ji JH, Park JK, Park YS, et al. Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps. Korean J Gastroenterol 2006;48(6):388-94.

4. Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, et al. Korean guidelines for colorectal cancer screening and polyp detection. Korean J Gastroenterol 2012;59(2):65-84.

5. Jackman RJ, Mayo CW. The adenoma-carcinoma sequence in cancer of the colon. Surg Gynecol Obstet 1951;93(3):327-30.

6. Lee HM, Lee S, Lim JK, Seo JW, Lee KS, Baek SC, et al. Relationship of colorectal polyps and the risk factors including obesity, age, alcohol and smoking. Chonnam Med J 2009;45(3):168-74.

7. Kearney J, Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, et al. Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control 1995;6(1):45-56.

8. Morimoto LM, Newcomb PA, Ulrich CM, Bostick RM, Lais CJ, Potter JD. Risk factors for hyperplastic and adenomatous polyps: evidence for malignant potential? Cancer Epidemiol Biomarkers Prev 2002;11(10 Pt 1):1012-8.

9. Oh K, Redston M, Odze RD. Support for hMLH1 and MGMT silencing as a mechanism of tumorigenesis in the hyperplastic-adenoma-carcinoma (serrated) carcinogenic pathway in the colon. Hum Pathol 2005;36:101-11.

10. Kim MC, Kim DH, Jeong TH. Risk factors of colorectal polyps in Korean adults. J Korean Acad Fam Med 2002;23(7):890-6.

11. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994;331(25):1669-74.

12. Kim MC, Kim CS, Jeong TH. The effect of physical activity on colorectal polyps. J Korean Acad Fam Med 2005;26(7):391-6.

13. Kim MC, Kim CS, Lee DK, Jeong TH. The association between distal colon adenoma and the metabolic syndrome and lifestyle factors in male examinees in a university hospital. J Korean Acad Fam Med 2008;29(3):195-200.

14. Sanchez NF, Stierman B, Saab S, Mahajan D, Yeung H, Francois F. Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population. BMC Res Notes 2012;5:312.

15. Park SM, Chang YJ, Yun YH, Yoo TW, Huh BY, Kwon S. Cost-effectiveness analysis of colorectal cancer screening in Korean general population. J Korean Acad Fam Med 2004;25(4):297-306.

16. O'Leary BA, Olynyk JK, Neville AM, Platell CF. Cost-effectiveness of colorectal cancer screening: comparison of community-based flexible sigmoidoscopy with fecal occult blood testing and colonoscopy. J Gastroenterol Hepatol 2004;19(1):38-47.

17. Chung SJ, Kim YS, Yang SY, Song JH, Park MJ, Kim JS, et al. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. J Gastroenterol Hepatol 2010;25(3):519-25.