La obesidad abdominal aumenta el riesgo de pólipos colorrectales

  • Oscar Fernando Ruíz Morales Universidad Nacional de Colombia
  • William Otero Regino Universidad Nacional de Colombia
  • Martin Alonso Gómez Zuleta Universidad Nacional de Colombia
  • Dennys Javier Castro Soteldo Centro de Control de Cáncer Gastrointestinal “Luis E Anderson”
Palabras clave: obesidad, sobrepeso, pólipos, cáncer

Resumen

Introducción: recientemente varias publicaciones internacionales han encontrado asociación entre obesidad y pólipos y/o cánceres colorrectales. En nuestro país no se ha estudiado esta posible asociación. El objetivo del presente estudio fue determinar si los pacientes con obesidad tienen más frecuentemente pólipos o cánceres colorrectales.

Materiales y métodos: estudio transversal, prospectivo realizado entre marzo de 2012 y junio de 2013 con pacientes remitidos a colonoscopia total por tamización. Participaron en el estudio tres instituciones universitarias: Clínica Fundadores y Hospital El Tunal de Colombia y el Centro de Control de Cáncer Gastrointestinal “Luis E Anderson” de Venezuela. A todos los pacientes se les determinaron el peso, la talla, índice de masa corporal (kg/m2) y el perímetro abdominal en centímetros. Se estimó la prevalencia de pólipos en la población y se determinó el riesgo mediante OR con sus intervalos de confianza (IC) de 95%.

Resultados: se incluyeron 405 pacientes, 68,9% eran mujeres, edad promedio 56,1 años +/- 12,9 años, 154 (38%) presentaron pólipos, de estos 113 (73%) (p= 0,01) cumplían con criterios de obesidad abdominal y 41 (27%) (p= 0,03), no cumplían con estos criterios. El análisis de regresión logística encontró relación entre el aumento de perímetro abdominal y presencia de pólipos en el colon y por cada cm de aumento del perímetro abdominal se aumenta el riesgo de padecer pólipos en 5,3%.

Conclusión: en la población examinada se encontró que los pacientes con obesidad, más frecuentemente tienen pólipos del colon y este riesgo aumenta con la severidad de la obesidad.

Descargas

La descarga de datos todavía no está disponible.

Biografía del autor/a

Oscar Fernando Ruíz Morales, Universidad Nacional de Colombia

Médico Internista, Fellow Gastroenterología Universidad Nacional de Colombia

William Otero Regino, Universidad Nacional de Colombia

Profesor de Medicina, unidad de Gastroenterología, Universidad Nacional de Colombia, Gastroenterólogo Clínica Fundadores. Bogotá, Colombia

Martin Alonso Gómez Zuleta, Universidad Nacional de Colombia

Profesor de Medicina, Unidad de Gastroenterología Universidad Nacional de Colombia, Gastroenterólogo Hospital el Tunal. Bogotá, Colombia

Dennys Javier Castro Soteldo, Centro de Control de Cáncer Gastrointestinal “Luis E Anderson”

Director del Centro de Control de Cáncer Gastrointestinal “Luis E Anderson” San Cristóbal, Venezuela.

Referencias bibliográficas

Guffey CR, Fan D, Singh UP, et al. Linking obesity to colorectal cancer: recent insights into plausible biological mechanisms. Curr Opin Clin Nutr Metab Care 2013; 16: 595-600.

James WP. The epidemiology of obesity: the size of the problem. J Intern Med 2008; 4: 336-352.

Burke CA. Colonic complications of obesity. Gastroenterol Clin North Am 2010; 1: 47-55.

Rodríguez J, Ruiz F, Peñaloza E, et al. Encuesta Nacional de Salud 2007. Resultados nacionales. Bogotá, Colombia: Ministerio de la Protección Social; 2009.

Kim Y, Kim Y, Lee S. An association between colonic adenoma and abdominal obesity: a cross-sectional study. BMC Gastroenterol 2009; 9: 4-10.

Yamaji T, Iwasaki M, Sasazuki S, et al. Visceral fat volume and the prevalence of colorectal adenoma. Am J Epidemiol 2009; 170: 1502-11.

Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am 2010; 39: 1-7.

Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004; 79: 379-84.

Wise LA, Rosenberg L, Palmer JR, et al. Anthropometric risk factors for colorectal polyps in African-American women. Obesity 2008; 16: 859-868.

Liu CS, Hsu HS, Li CI, et al. Central obesity and atherogenic dyslipidemia in metabolic syndrome are associated with increased risk for colorectal adenoma in a Chinese population. BMC Gastroenterol 2010; 27: 10:51.

Kim YJ, Lee KM, Chung WC, et al. Association between measures of obesity and colorectal adenoma Chin Med J (Engl) 2011; 124: 3711-5.

Otake S, Takeda H, Suzuki Y, et al. Association of visceral fat accumulation and plasma adiponectin with colorectal adenoma: evidence for participation of insulin resistance. Clin Cancer Res 2005; 11: 3642-3646.

Yamamoto S, Nakagawa T, Matsushita Y, et al. Visceral fat area and markers of insulin resistance in relation to colorectal neoplasia. Diabetes Care 2010; 33: 184-9.

Larsson SC, Rutegård J, Bergkvist L, et al. Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur J Cancer 2006; 42: 2590-7.

Erarslan E, Turkay C, Koktener A, et al. Association of visceral fat accumulation and adiponectin levels with colorectal neoplasia. Dig Dis Sci 2009; 54: 862-868.

MacInnis RJ, English DR, Hopper JL, et al. Body size and composition and colon cancer risk in men. Cancer Epidemiol Biomarkers Prev 2004; 13: 553-559.

Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988; 319: 525-32.

Bujanda L, Cosme A, Gil I, et al. Malignant colorectal polyps. World J Gastroenterol 2010; 16: 3103-3111.

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-249.

National Cancer Institute. Surveillance Epidemiology and End Results. (2011). Colorectal Cancer Facts and Figures. Revisado julio 25, 2013, desde: http://www. cancer.org/Research/CancerFactsFigures/ colorectal-cancer-facts–figures-2011-2013.

Rivero M, Castro B, Fernández Gil PL. Pólipos y poliposis cólica. Medicine 2012; 11: 431-6

Piñeros M, Hernández G, Bray F. Increasing mortality rates of common malignancies in Colombia. Cancer 2004; 101: 2285-92.

Perea MD, Castaño-Vinyals G, Altzibar JM, et al. Cancer screening practices and associated lifestyles in population controls of the Spanish multi-case control study. Gac Sanit 2012; 26: 301-10

Teucher B, Rohrmann S, Kaaks R. Obesity: focus on all-cause mortality and cancer. Maturitas 2010; 65: 112-6.

Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 2007; 132: 2208-25.

Kristjansdottir S, Jonasson JG, Cariglia N, et al. Colonic adenomas found via colonoscopy: yield and risk factors for high-grade dysplasia. Digestion 2010; 82: 252-7.

Soultati A, Alexopoulou A, Dourakis SP, Colonic polyps as incidental findings. European Journal of Internal Medicine 2010; 21: 574-80.

Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut 1982; 23: 835-42.

Bacchiddu S, Álvarez-Urturri AC, Bessa Caserras J. Pólipos colorrectales. FMC 2012; 19: 472-80.

Calderwood AH, Jacobson BC. Comprehensive validation of the Boston bowel preparation scale. Gastrointest Endosc 2010; 72: 686-92.

Lai EJ, Calderwood AH, Doros G, et al. The Boston bowel preparation scale: A valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69(3 Pt 2): 620-5.

Gonzalez-Huix Llado F, Figa Francesch M, Huertas Nadal C. Essential quality criteria in the indication and performance of colonoscopy. Gastroenterol Hepatol 2010; 33: 33-42.

Morán Sánchez S, Torrella E, EP Delgado, et al. Colonoscopy quality assessment. Rev Esp Enferm Dig 2009; 101: 107-12.

Jover R, Herráiz M, Alarcón O, et al. Clinical practice Guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 2012; 44: 444-51.

Lorenzo-Zúñiga V, Moreno de Vega V, Boix J. Preparación para colonoscopia: tipos de productos y escalas de limpieza. Rev Esp enferm dig 2012; 104: 426-431.

Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol 1993; 88: 825-31.

World Health Organization. Obesity 2012. Disponible en: http://www.who.int/mediacentre/factsheets/ fs311/en/ Acceso julio 12, 2013.

Esposito K, Chiodini P, Colao A, et al. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care 2012; 35: 2402-11.

Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005; 366: 1059-72.

Alegría Ezquerra E, Castellano Vázquez JM, Alegría Barrero A. Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy. Rev Esp Cardiol 2008; 61: 752-64.

Calderwood AH, Jacobson BC. Colonoscopy Quality Metrics and Implementation. Gastroenterol Clin N Am 2013; 42: 599-618.

Schoenfeld PS, Cohen J. MD Quality indicators for colorectal cancer screening for colonoscopy. Techniques in Gastrointestinal Endoscopy 2013; 15: 59-68.

Lee RH, Tang RS, Muthusamy VR, et al. Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos). Gastrointest Endosc 2011; 74: 128-34.

Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-57.

Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care 2007; 30: 1647-52.

Lorenzo-Zúñiga V, Moreno-de-Vega V, Boix J. Preparation for colonoscopy: types of scales and cleaning products. Rev Esp Enferm Dig 2012; 104: 426-31.

Puckett J, Soop M. Optimizing colonoscopy preparation: the role of dosage, timing and diet. Curr Opin Clin Nutr Metab Care 2012; 15: 499-504.

Hazewinkel Y, Dekker E. Colonoscopy: basic principles and novel techniques. Nat Rev Gastroenterol Hepatol 2011; 8: 554-64

Comstock SS, Hortos K, Kovan B et al. Adipokines and obesity are associated with colorectal polyps in adult males: a cross-sectional study. PLoS One 2014; 17: e85939.

Kaneko R, Sato Y, An Y, et al. Clinico-epidemiologic study of the metabolic syndrome and lifestyle factors associated with the risk of colon adenoma and adenocarcinoma. Asian Pac J Cancer Prev 2010; 11: 975-83.

Kaneko R, Nakazaki N, Tagawa T et al. A new index of abdominal obesity which effectively predicts risk of colon tumor development in female Japanese. Asian Pac J Cancer Prev 2014; 15: 1005-10.

Thompson CL, Berger NA, Chak A, et al. Racial differences in measures of obesity and risk of colon adenoma. Obesity 2012; 20: 673-7.

Dai Z, Xu YC, Niu L. Obesity and colorectal cancer risk: a meta-analysis of cohort studies. World J Gastroenterol 2007; 13: 4199-206.

Otake S, Takeda H, Suzuki Y, et al. Association of visceral fat accumulation and plasma adiponectin with colorectal adenoma: evidence for participation of insulin resistance. Clin Cancer Res 2005; 11: 3642-3646.

Kono S, Handa K, Hayabuchi H, et al. Obesity, weight gain and risk of colon adenomas in Japanese men. Jpn J Cancer Res 1999; 90: 805-811.

Schoen RE, Weissfeld JL, Kuller LH, et al. Insulin-like growth factor-I and insulin are associated with the presence and advancement of adenomatous polyps. Gastroenterol 2005; 129: 464-475.

Gerson LB. Impact of obesity on endoscopy. Gastrointest Endosc 2009; 70: 758-62.

P. Somasundar P. McFadden DW, Hileman SM et al. Leptin is a growth factor in cancer. J Surg Res 2004; 116: 337-349.

Drew JE. Molecular mechanisms linking adipokines to obesity-related colon cancer: focus on leptin. Proc Nutr Soc 2012; 71: 175-80.

Aleksandrova K, Boeing H, Jenab M, et al. Leptin and soluble leptin receptor in risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Cancer Res 2012; 72: 5328-37.

Publicado
2014-12-30
Cómo citar
Ruíz Morales, O. F., Otero Regino, W., Gómez Zuleta, M. A., & Castro Soteldo, D. J. (2014). La obesidad abdominal aumenta el riesgo de pólipos colorrectales . Revista Colombiana De Gastroenterología, 29(4), 376-382. https://doi.org/10.22516/25007440.434
Sección
Trabajos Originales