Visceral adiposity and colorectal adenomas: Dose-response meta-analysis of observational studies

Na Na Keum, D. H. Lee, R. Kim, D. C. Greenwood, E. L. Giovannucci

Research output: Contribution to journalArticlepeer-review


Background: Obesity-related hormonal and metabolic perturbations implicated in colorectal carcinogenesis are mainly driven by visceral adipose tissue (VAT) rather than subcutaneous adipose tissue (SAT). Yet, most epidemiologic studies have examined the relationship between excess adiposity and colorectal neoplasia using body mass index (BMI) and waist circumference (WC). Due to the inability of BMI and WC to distinguish VAT from SAT, they are likely to have underestimated the true association. Patients and methods: We conducted a dose-response meta-analysis to summarize the relationships between VAT and colorectal adenomas and to examine the value of VAT as an independent risk factor beyond BMI, WC, and SAT. PubMed and Embase were searched through September 2014 to identify relevant observational studies. The summary odds ratio (OR) 95% confidence interval (CI) were estimated using a random-effects model. Results: In linear dose-response meta-analysis, the summary OR for each 25 cm2 increase in VAT area was 1.13 (95% CI 1.05-1.21; I2 = 62%; 6 studies; 2776 cases; range of VAT area = 30-228 cm2). The dose-response curve suggested no evidence of nonlinearity (Pnon-linearity = 0.37). In meta-analysis comparing the highest versus lowest category of VAT based on 12 studies, a positive association between VAT and adenomas remained statistically significant even after adjustment for BMI, WC, and SAT. In contrast, adjustment for VAT substantially attenuated associations of BMI, WC, and SAT with adenomas. Across the studies, VAT was more strongly associated with advanced adenomas than nonadvanced adenomas. Conclusions: VAT may be the underlying mediator of the observed associations of BMI andWC with adenomas, increasing adenoma risk continuously over a wide range of VAT area. Considering that the joint use of BMI and WC better captures VAT than the use of either one, clinicians are recommended to use both BMI and WC to identify those at high risk for colorectal neoplasia.

Original languageEnglish
Pages (from-to)1101-1109
Number of pages9
JournalAnnals of Oncology
Issue number6
Publication statusPublished - 2015 Jun 1

Bibliographical note

Publisher Copyright:
© 2014 The Author.

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology


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