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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 118-123

Study of the relation between the colorectal neoplasm and visceral fat accumulation in postmenopausal women


1 Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shebeen Elkom, Menoufia, Egypt
2 Department of Pathology, Faculty of Medicine, Menoufia University, Shebeen Elkom, Menoufia, Egypt

Date of Submission20-May-2019
Date of Decision12-Jun-2019
Date of Acceptance17-Jun-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Mostafa M Arafa
Menouf, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_181_19

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  Abstract 


Objective
This study aimed to show the relation ship between colorectal carcinoma (CRC) and visceral adiposity in Egyptian postmenopausal women.
Background
Obesity is known to be an important risk factor for CRC, especially in women. The risk of CRC is greater with the visceral fat accumulation not total body fat content.
Patients and methods
This case–control study included 90 postmenopausal female patients: 45 women with CRC, 20 women with colorectal polyps, and 25 healthy women. Data were collected and statistically analyzed. CRC was diagnosed by colonoscopy and histopathology. Metabolic parameters were assessed according to the BMI and the waist to hip ratio.
Results
Visceral fat was significantly higher in patients with CRC and colorectal polyps compared with the control group. The prevalence of CRC increased with increasing visceral fat content. The study showed that 37 (82.2%) patients with CRC were obese [19 (42.2%) of these patients were overweight and 18 (40%) were obese class I and class II]. Also, 19 (95%) patients with colorectal polyps were obese [11 (55%) of these patients were overweight and eight (40%) patients were obese class I and class II].
Conclusion
Visceral fat area is highly associated with CRC.

Keywords: BMI, colorectal carcinoma, colorectal polyps, visceral fat, waist to hip ratio


How to cite this article:
Abdel Atty EA, Elshayeb EI, Shaaban MI, Abd El-Alim AE, Arafa MM. Study of the relation between the colorectal neoplasm and visceral fat accumulation in postmenopausal women. Menoufia Med J 2021;34:118-23

How to cite this URL:
Abdel Atty EA, Elshayeb EI, Shaaban MI, Abd El-Alim AE, Arafa MM. Study of the relation between the colorectal neoplasm and visceral fat accumulation in postmenopausal women. Menoufia Med J [serial online] 2021 [cited 2021 Dec 4];34:118-23. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/118/312009




  Introduction Top


Obesity is one of the most serious health problems worldwide. Obesity is the most risk factor for cancers such as breast cancer, liver, esophageal, and colorectal carcinoma (CRC) [1],[2],[3]. CRC is the third most frequent malignancy worldwide and the fourth leading cause of death [4]. Visceral adipose tissue, not the total body fat, content plays an important role in CRC through secretion of adipokines, proinflammatory cytokines, and growth factors [5]. Recent epidemiological studies have shown that waist circumference and the waist to hip ratio (WHR) are more accurate in measuring visceral adipose tissue accumulation than the BMI [6]. The aim of this work was to study the relation between the colorectal neoplasm and visceral fat accumulation in postmenopausal women.


  Patients and methods Top


Study participants

This study included 90 postmenopausal women who visited the Internal Medicine Department and Menoufia Endoscopy Unit and were diagnosed with CRC during their visit during the period from December 2017 till December 2018.

Menopausal status was defined as having no menstrual periods for 12 consecutive months without any biological or physiological cause. Postmenopausal women with a history of colorectal adenoma or carcinoma or any type of cancer and IBD patients were excluded from the study; also, patients with a family history of CRC and postmenopausal women who had received hormonal replacement therapy were excluded from the study.

Patients were classified into three groups. Group I included the postmenopausal women with CRC (n = 45 patient), group II included postmenopausal women with colorectal adenoma (n20), and group III was the control group (n = 25).

Demographic data and special habits of the patients such as alcohol intake, smoking, regular exercise, and medication intake were recorded. Clinical examination was performed and physical examination was also carried out, with a special focus on the mean arterial pressure and BMI, which was calculated as body weight (kg) divided by height (m2), and the WHR, which was measured by determining the ratio between waist circumference and hip circumference.

Waist circumference was measured at the midpoint between the lower margin of the least palpable rib and the top of the iliac crest using a stretch-resistant tape that provided a constant 100 g tension. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. Laboratory data included complete blood picture analyzed in an automated ADVIA 120 Hematology (Siemens Healthineers, Erlangen, Germany), renal function tests (blood urea, serum creatinine) analyzed in COBAS INTEGRA® 400 plus analyzer (Roche Diagnostics, Rotkreuz, Switzerland), data on liver function tests [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum albumin], and lipid profile (total cholesterol, serum triglyceride, high-density lipoprotein, and low-density lipoprotein) analyzed in (AU480 BECK Man, USA analyzer) Thermo Fisher Scientific Inc , Waltham, Massachusetts, United States. Also, fasting and 2 h postprandial blood sugar of patients were determined.

Radiological investigations were performed such as ultrasound on the abdomen and pelvis, and computed tomography on the abdomen and pelvis.

Colonoscopy was done to cases with suspected masses or polyps and multiple biopsies were taken for histopathological examination and diagnosis.

Demographic, clinical, and laboratory data of the cases were tabulated.

Ethical statement

All patients participated in this study voluntarily and written informed consent was obtained from each participant. The study complied with the Faculty of Medicine, Menoufia University.

Statistical analysis

Data entry, coding, and analysis were carried out using SPSS (22) (IBM Corp. Released 2013, IBM SPSS Statistics for Windows, Version 22.0; IBM Corp., Armonk, New York, USA). The quantitative variables were described as mean ± SD and qualitative variables were described as frequency and percentage. The χ2 test was used to assess the relationship between two qualitative groups and the t test was to assess the relationship between two quantitative groups. P value less than or equal to 0.05 was considered to be statistically significant.


  Results Top


In terms of age, the mean age of group I was 56.4 ± 8.8 years, the mean age of group II was 58.9 ± 4.7 years, and the mean age of group III was 58.9 ± 8.1 years. Therefore, there was no significant difference between the groups studied in age (P = 0.3). In terms of diabetes mellitus (DM), in group I, 10 (22.2%) patients were diabetic and 35 (77.8%) patients were nondiabetic. In group II, six (30%) patients were diabetic and 14 (70%) patients were nondiabetic. In group III, eight (32%) patients were diabetic and 17 (68%) patients were nondiabetic. Therefore, there was no significant difference between the groups studied in terms of DM (P = 0.4) [Table 1].
Table 1: Comparison between the groups studied in sociodemographic data

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There was a highly significant difference between groups in body weight (P < 0.001).

In group I, eight (17.8%) patients had normal body weight, 19 (42.2%) patients were overweight and 18 (40%) patients were obese. In group II, one (5%) patient had normal body weight, 11 (55%) patients were overweight, and eight (40%) patients were obese. In group III, 15 (60) patients had normal body weight, eight (32%) patients were overweight, and two (8%) patients were obese [Table 2].
Table 2: Obesity in the groups studied

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In terms of BMI, the mean BMI in group I was 28.8 ± 4.4, the mean BMI in group II was 28.5 ± 2.3, and the mean BMI in group III was 24.3 ± 3.1. Therefore, there was no significant difference between group I and group II in BMI (P = 0.9). The mean BMI in group I was highly significantly higher than that of group III (P < 0.001). The mean BMI in group II was highly significantly higher than that of group III (P = 0.001). In terms of the WHR, the mean WHR in group I was 0.9 ± 0.1, the mean WHR in group II was 0.9 ± 0.1, and the mean WHR in group III was 0.8 ± 0.04. Therefore, there was no significant difference between group I and group II in the WHR (P = 0.9). The mean WHR in group I was highly significantly higher than that of group III (P = 0.001). The mean WHR in group II was significantly higher than that of group III (P = 0.008) [Table 3].
Table 3: Comparison between the groups studied in BMI and waist to hip circumference

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Considering obesity as a risk factor for CRC, the odds ratio of BMI was 0.4 and 95% confidence interval was from 0.1 to 1.07 and P value was 0.05, while the odd ratio of WHR was 0.08 and 95% confidence interval was from 0.1 to 0.3 and P value was less than 0.001. Therefore, BMI and the WHR are statistically significant risk factors for CRC [Table 4].
Table 4: Obesity as a risk factor for colonic carcinoma

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In terms of AST, the mean AST in group I was 25.1 ± 12.9 U/l, the mean AST in group II was 24.2 ± 6.1 U/l, and the mean AST in group III was 26.6 ± 8.6 U/l. Therefore, there was no significant difference between group I and group II in AST (P = 0.9). There was no significant difference between group I and group III in AST (P = 0.8). There was no significant difference between group II and group III in AST (P = 0.7). In terms of ALT, the mean ALT in group I was 20.5 ± 8.5 U/l, the mean ALT in group II was 20.1 ± 6.5 U/l, and the mean ALT in group III was 21.2 ± 7.7 U/l. Therefore, there was no significant difference between group I and group II in ALT (P = 0.8). There was no significant difference between group I and group III in ALT (P = 0.7). There was no significant difference between group II and group III in ALT (P = 0.9). In terms of albumin, the mean albumin in group I was (3.6 ± 0.3 g/dl, the mean albumin in group II was 3.6 ± 0.2 g/dl, and the mean albumin in group III was 3.5 ± 0.3 g/dl. Therefore, there was no significant difference between group I and group II in albumin (P = 0.2). There was no significant difference between group I and group III in albumin (P = 0.5). There was no significant difference between group II and group III in albumin (P = 0.8).

In terms of total cholesterol, the mean total cholesterol in group I was 209.9 ± 44.4 mg/dl, the mean total cholesterol in group II was 187.05 ± 37.9 mg/dl, and the mean total cholesterol in group III was 175 ± 54.9 mg/dl. Therefore, there was no significant difference between group I and group II in total cholesterol (P = 0.1). The mean total cholesterol in group I was significantly higher than that of group III (P = 0.009). There was no significant difference between group II and group III in total cholesterol (P = 0.6). In terms of triglyceride, the mean triglyceride in group I was 139.5 ± 20.1 mg/dl, the mean triglyceride in group II was 135.5 ± 17.7 mg/dl, and the mean triglyceride in group III was 115.1 ± 34.3 mg/dl. Therefore, there was no significant difference between group I and group II (P = 0.8). The mean triglyceride in group I was highly significantly higher than that in group III (P < 0.001). The mean triglyceride in group II was significantly higher than that in group III (P = 0.01) [Table 5].
Table 5: Comparison between the groups studied in laboratory investigations

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  Discussion Top


The results of our study are summarized as follows: the mean age of patients with carcinoma was 56.4 ± 8.8 years, the mean age of patients with adenoma was 58.9 ± 4.7 years, and the mean age of the controls was 58.9 ± 8.1 years. Lee et al. [7] reported that the mean age of postmenopausal women with CRC was 60.7 ± 12.29 years and the mean age of the control group was 58.3 ± 9.8 years. Similar results were obtained by Terry et al. [8], who reported in their study that the mean age at diagnosis of colon and rectal cancer was 59 and 58 years, respectively.

In this study, there was no association between DM and CRC outcomes. Our study is in agreement with the study of Campbell et al. [9]. This was not in agreement with the studies carried out by Sinagra et al. [10], who showed a positive association between DM and the incidence of CRC.

The prevalence of CRC has increased rapidly in the past 20 years in conjunction with the increasing prevalence of obesity worldwide. Recent clinical studies have shown a significant association between CRC and visceral fat area [5]. Some possible mechanisms that explain the relationship between visceral fat and CRC are included. Visceral proinflammatory cytokines and adipokines including interleukin 6 and tumor necrosis factor-alpha may induce a state of protumerogenesis. Chronic inflammation enhances carcinogenesis by several mechanisms, including the enhancement of cancer cell proliferation and angiogenesis. Therefore, systemic chronic inflammation and altered metabolic function may serve as a link for the association between visceral obesity and CRC.

In terms of the distribution of obesity in the groups studied, there was a highly significant difference between groups in body weight. Obesity is considered the most important risk factor for CRC measured by BMI and WHR; our results showed a statistically significant association between BMI and CRC. Also, there was a statistically significant association between WHR and CRC, in contrast to previous studies that revealed weak or no association between visceral fat and CRC [11],[12].

In terms of BMI, there was no significant difference between the CRC group and the colorectal adenoma group, but the mean BMI in the CRC group was highly significantly higher than that in the control group.

Also, the mean BMI in the colorectal adenoma group was highly significantly higher than that in the control group.

In terms of CRC, our study was in agreement with the study carried out by Oxentenko et al. [13], who reported that there was a strong association between BMI and CRC. Similarity, Kwon et al. [14] also showed a highly significant association between BMI and CRC in the female group.

Renehan et al. [15] reported that there was a weak positive association between BMI and CRC in the female group. Also, Harriss et al. [16] showed a weak association between BMI and CRC in women. This was not in agreement the studies carried out by Pischon et al. [17], which showed no association between BMI and CRC in postmenopausal women. In terms of colorectal adenoma, our study was in agreement with Kwon et al. [14], who showed a highly significant association between BMI and colorectal adenoma in the female group. Our study was not in agreement with the study carried out by Ashktorab et al. [18], which showed no association between BMI and colorectal adenoma in females.

In terms of the WHR, there was no significant difference between the CRC group and the colorectal adenoma group, but the mean WHR in the CRC group was highly significantly higher than that of the control group. Also, the mean WHR in the colorectal adenoma group was significantly higher than that of the control group. Our study is in agreement with the study carried out by Ulaganathan et al. [19], and Dong et al. [20], which showed significant associations between higher WHR and increased risk of total CRC. Similar results were obtained by Kabat et al. [21] for WHR. Our results were similar to the results obtained by Kim et al. [22], who showed a highly significant association between WHR and colorectal adenoma.

In terms of liver function tests (AST, ALT, and albumin), there was no significant difference between CRC, adenoma, and control groups in AST, ALT, and albumin.

Lee et al. [7] reported no significant difference between the CRC group and the control group in AST or albumin, but the mean ALT in the CRC group was significantly higher than that of the control group in ALT.

In terms of total cholesterol, there was no significant difference between the CRC group and the adenoma group. There was no significant difference between the adenoma group and the control group in total cholesterol, but the mean cholesterol in the CRC group was significantly higher than that of the control group.

In terms of triglyceride, our study found no significant difference between the CRC group and the adenoma group, but the mean triglyceride in the CRC group was highly significantly higher than that of the control group; also, the mean triglyceride of the adenoma group was significantly higher than that of the control group.

Zhang et al. [23] showed that the levels of total cholesterol in patients with CRC were significantly lower than those in patients with colorectal adenoma and the controls. However, there were no statistically significant differences in the serum levels of triglyceride between the three groups.

Coppola et al. [24] showed that no association between the level of total cholesterol and colorectal adenoma, whereas a high level of triglyceride was associated significantly with colorectal adenoma.


  Conclusion Top


We concluded that obesity is associated positively with the prevalence of CRC. Central obesity rather than total body fat content measured by BMI and WHR is responsible for the occurrence of CRC. We did not determine the cause of the relationship between visceral fat and CRC; thus, further studies are required to determine the causality and effect of reduced visceral fat content on the incidence of CRC.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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