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Obesity and Colorectal Cancer Risk
896
CORRESPONDENCE
THOMAS G. GROSS Non-Hodgkin’s Lymphoma Disease Committee Children’s Oncology Group and Section of Hematology/Oncology/Blood and Marrow Transplant Department of Pediatrics The Ohio State University Nationwide Children’s Hospital Columbus, Ohio 1. Plevy S, Salzberg B, Van Assche G, et al. A phase I study of visilizumab, a humanized anti-CD3 monoclonal antibody, in severe steroid-refractory ulcerative colitis. Gastroenterology 2007;133: 1414 –1422. 2. Guthery SL, Heubi JE, Bucuvalas JC, et al. Determination of risk factors for Epstein-Barr virus-associated posttransplant lymphoproliferative disorder in pediatric liver transplant recipients using objective case ascertainment. Transplantation 2003;75:987–993. 3. Swerdlow AJ, Higgins CD, Hunt BJ, et al. Risk of lymphoid neoplasia after cardiothoracic transplantation. A cohort study of the relation to Epstein-Barr virus. Transplantation 2000;69:897–904. doi:10.1053/j.gastro.2008.01.023
Obesity and Colorectal Cancer Risk Dear Sir:
The scientific and the news media recently have extensively reported on the burden of diseases associated with obesity. Obesity is recognized as an important cofactor in several cancers, including colorectal cancer.1,2 Studies have suggested that the overall incidence of colorectal cancer is increased by an average of about 50% in obese individuals with a body mass index (BMI) ⬎30, more specifically with increasing abdominal obesity with waist circumference ⬎39 inches in women and ⬎40 in men.3 Thus, an important question is the need to stratify the added risk to enhance colorectal preventive measures; that is, the timing and frequency of surveillance colonoscopy in obese individuals. Children and young adults are developing obesity and metabolic syndrome at an increasingly early age. A recent study suggested that 16% of children are overweight.4 If obesity results in increased colorectal carcinogenesis, how long does this process take? Kim et al5 recently reported on the association of colorectal neoplasia and metabolic syndrome. In this study, subjects ⬍50 years old showed an increased incidence of colorectal neoplasia in both men and women (personal communication). Further studies on the timing of colorectal neoplasia develop-
GASTROENTEROLOGY Vol. 134, No. 3
ment are urgently needed to establish how early surveillance might be indicated in patients with obesity, particularly abdominal obesity and the metabolic syndrome. A further issue is whether recurrence of colorectal adenoma occurs more rapidly in obese subjects with prior adenomas. Previous studies on this question have been contradictory.6,7 However, a recent study by Jacobs et al8 showed a trend only in men for developing advanced adenomas (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.04 –2.53 ) in those with obesity and significantly increased risk (OR, 2.25; 95% CI, 1.32–3.84) in those with a family history of adenomas and obesity at 3 years after polypectomy.8 On the basis of these data, the authors did not advocate more frequent surveillance colonoscopy after an initial adenoma in obese individuals. However, it appears important in future studies of colorectal adenoma recurrence to report on BMI and waist circumference to clarify this issue. SWAROOP PENDYALA PETER HOLT Rockefeller University New York, New York 1. Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007 Nov 6; [Epub ahead of print] 2. Calle EE, Rodriguez C, Walker–Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625–1638. 3. Moore LL, Bradlee ML, Singer MR, et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 2004;28:559 –567. 4. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999 – 2002. JAMA 2004;292:2847–2850. 5. Kim JH, Lim YJ, Kim YH, et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol Biomarkers Prev 2007; 16:1543–1546. 6. Sass DA, Schoen RE, Weissfeld JL, et al. Relationship of visceral adipose tissue to recurrence of adenomatous polyps. Am J Gastroenterol 2004;99:687– 693. 7. Davidow AL, Neugut AI, Jacobson JS, et al. Recurrent adenomatous polyps and body mass index. Cancer Epidemiol Biomarkers Prev 1996;5:313–315. 8. Jacobs ET, Martínez ME, Alberts DS, et al. Association between body size and colorectal adenoma recurrence. Clin Gastroenterol Hepatol 2007;5:982–990. doi:10.1053/j.gastro.2008.01.024
CORRESPONDENCE
THOMAS G. GROSS Non-Hodgkin’s Lymphoma Disease Committee Children’s Oncology Group and Section of Hematology/Oncology/Blood and Marrow Transplant Department of Pediatrics The Ohio State University Nationwide Children’s Hospital Columbus, Ohio 1. Plevy S, Salzberg B, Van Assche G, et al. A phase I study of visilizumab, a humanized anti-CD3 monoclonal antibody, in severe steroid-refractory ulcerative colitis. Gastroenterology 2007;133: 1414 –1422. 2. Guthery SL, Heubi JE, Bucuvalas JC, et al. Determination of risk factors for Epstein-Barr virus-associated posttransplant lymphoproliferative disorder in pediatric liver transplant recipients using objective case ascertainment. Transplantation 2003;75:987–993. 3. Swerdlow AJ, Higgins CD, Hunt BJ, et al. Risk of lymphoid neoplasia after cardiothoracic transplantation. A cohort study of the relation to Epstein-Barr virus. Transplantation 2000;69:897–904. doi:10.1053/j.gastro.2008.01.023
Obesity and Colorectal Cancer Risk Dear Sir:
The scientific and the news media recently have extensively reported on the burden of diseases associated with obesity. Obesity is recognized as an important cofactor in several cancers, including colorectal cancer.1,2 Studies have suggested that the overall incidence of colorectal cancer is increased by an average of about 50% in obese individuals with a body mass index (BMI) ⬎30, more specifically with increasing abdominal obesity with waist circumference ⬎39 inches in women and ⬎40 in men.3 Thus, an important question is the need to stratify the added risk to enhance colorectal preventive measures; that is, the timing and frequency of surveillance colonoscopy in obese individuals. Children and young adults are developing obesity and metabolic syndrome at an increasingly early age. A recent study suggested that 16% of children are overweight.4 If obesity results in increased colorectal carcinogenesis, how long does this process take? Kim et al5 recently reported on the association of colorectal neoplasia and metabolic syndrome. In this study, subjects ⬍50 years old showed an increased incidence of colorectal neoplasia in both men and women (personal communication). Further studies on the timing of colorectal neoplasia develop-
GASTROENTEROLOGY Vol. 134, No. 3
ment are urgently needed to establish how early surveillance might be indicated in patients with obesity, particularly abdominal obesity and the metabolic syndrome. A further issue is whether recurrence of colorectal adenoma occurs more rapidly in obese subjects with prior adenomas. Previous studies on this question have been contradictory.6,7 However, a recent study by Jacobs et al8 showed a trend only in men for developing advanced adenomas (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.04 –2.53 ) in those with obesity and significantly increased risk (OR, 2.25; 95% CI, 1.32–3.84) in those with a family history of adenomas and obesity at 3 years after polypectomy.8 On the basis of these data, the authors did not advocate more frequent surveillance colonoscopy after an initial adenoma in obese individuals. However, it appears important in future studies of colorectal adenoma recurrence to report on BMI and waist circumference to clarify this issue. SWAROOP PENDYALA PETER HOLT Rockefeller University New York, New York 1. Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007 Nov 6; [Epub ahead of print] 2. Calle EE, Rodriguez C, Walker–Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625–1638. 3. Moore LL, Bradlee ML, Singer MR, et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 2004;28:559 –567. 4. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999 – 2002. JAMA 2004;292:2847–2850. 5. Kim JH, Lim YJ, Kim YH, et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol Biomarkers Prev 2007; 16:1543–1546. 6. Sass DA, Schoen RE, Weissfeld JL, et al. Relationship of visceral adipose tissue to recurrence of adenomatous polyps. Am J Gastroenterol 2004;99:687– 693. 7. Davidow AL, Neugut AI, Jacobson JS, et al. Recurrent adenomatous polyps and body mass index. Cancer Epidemiol Biomarkers Prev 1996;5:313–315. 8. Jacobs ET, Martínez ME, Alberts DS, et al. Association between body size and colorectal adenoma recurrence. Clin Gastroenterol Hepatol 2007;5:982–990. doi:10.1053/j.gastro.2008.01.024