Visceral Fat Quantitated From CT Colonography Is Associated With the Presence of Colorectal Polyps

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Saowanee Srirattanapong
Yasinee Panyawaraporn
Wichan Prasertsilpakul
Jiraporn Laothamatas


Background: An adenomatous polyp is known as a precancerous lesion of colorectal cancer. Detection and removal of adenomatous polyps are essential for colon cancer prevention. Previous studies have found the association between obesity and adenomatous polyp using many parameters.

Objective: To determine the association between visceral fat visualized on computed tomography (CT) colonography (CTC) and colorectal polyps.

Methods: This retrospective case-control study consisted of 280 adult subjects who underwent colon cancer screening by CTC at Ramathibodi Hospital; 129 cases with CT detected colorectal polyps who underwent polypectomy within 6 months, and 151 control subjects who were negative for significant polyps on CTC. Visceral fat areas of all subjects were measured on CT at the umbilical level by a semiautomatic method. Statistical analysis was performed to ascertain associations with the presence of colorectal polyps.

Results: Of 280 adult subjects, there were classified into 4 groups; no polyps (n = 151), hyperplastic polyp (n = 23), low-risk adenomatous polyp (n = 75), and high-risk adenomatous polyp (n = 31). The mean visceral fat areas in 4 groups were 125.1 ± 55.7 cm2, 140.2 ± 63.8 cm2, 147.9 ± 74.2 cm2, and 156.6 ± 63.7 cm2, respectively. There were statistically significant differences in these means visceral fat between the no polyp group and both the low-risk and high-risk adenomatous polyp groups. In multivariate analyses, subjects who had visceral fat areas more than 168.60 cm2 were more likely to have polyps than subjects whose visceral fat areas were less than 93.65 cm2 (P < .05).

Conclusions: Visceral fat was positively associated with the presence of adenomatous colorectal polyps.


Article Details

How to Cite
Srirattanapong, S., Panyawaraporn, Y., Prasertsilpakul, W., & Laothamatas, J. (2020). Visceral Fat Quantitated From CT Colonography Is Associated With the Presence of Colorectal Polyps. Ramathibodi Medical Journal, 43(2), 1 - 8.
Original Articles


1. Williams TG, Cubiella J, Griffin SJ, Walter FM, Usher-Smith JA. Risk prediction models for colorectal cancer in people with symptoms: a systematic review. BMC Gastroenterol. 2016;16(1):63. doi:10.1186/s12876-016-0475-7.

2. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D; ESMO Guidelines Working Group. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii1-iii9. doi:10.1093/annonc/mdu260.

3. Chindaprasirt J, Sookprasert A, Wirasorn K, Limpawattana P, Sutra S, Thavornpitak Y. Cost of colorectal cancer care in hospitalized patients of Thailand. J Med Assoc Thai. 2012;95 Suppl 7:S196-S200.

4. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22(4):191-197. doi:10.1055/s-0029-1242458.

5. Soetikno RM, Kaltenbach T, Rouse RV, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299(9):1027-1035. doi:10.1001/jama.299.9.1027.

6. Løberg M, Kalager M, Holme Ø, Hoff G, Adami HO, Bretthauer M. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med. 2014;371(9):799-807. doi:10.1056/NEJMoa1315870.

7. Strum WB. Colorectal adenomas. N Engl J Med. 2016;374(11):1065-1075. doi:10.1056/NEJMra1513581.

8. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370(14):1298-1306. doi:10.1056/NEJMoa1309086.

9. Kim Y, Kim Y, Lee S. An association between colonic adenoma and abdominal obesity: a cross-sectional study. BMC Gastroenterol. 2009;9:4. doi:10.1186/1471-230X-9-4.

10. Summers RM, Liu J, Sussman DL, et al. Association between visceral adiposity and colorectal polyps on CT colonography. AJR Am J Roentgenol. 2012;199(1):48-57. doi:10.2214/AJR.11.7842.

11. Comstock SS, Hortos K, Kovan B, McCaskey S, Pathak DR, Fenton JI. Adipokines and obesity are associated with colorectal polyps in adult males: a cross-sectional study. PLoS One. 2014;9(1):e85939. doi:10.1371/journal.pone.0085939.

12. Liu J, Pattanaik S, Yao J, et al. Associations among pericolonic fat, visceral fat, and colorectal polyps on CT colonography. Obesity (Silver Spring). 2015;23(2):408-414. doi:10.1002/oby.20987.

13. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881-887. doi:10.1038/nature05488.

14. Donohoe CL, Doyle SL, Reynolds JV. Visceral adiposity, insulin resistance and cancer risk. Diabetol Metab Syndr. 2011;3:12. doi:10.1186/1758-5996-3-12.

15. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163. doi:10.1016/S0140-6736(03)15268-3.

16. Jongjirasiri S, Noinark C, Kamtasila S, Laothamatas J. Comparison of visceral fat volume and visceral fat area at umbilical level assessed by mulhslice computed tomography. J Med Assoc Thai. 2019;102(11):1242-1247.

17. Erarslan E, Turkay C, Koktener A, Koca C, Uz B, Bavbek N. Association of visceral fat accumulation and adiponectin levels with colorectal neoplasia. Dig Dis Sci. 2009;54(4):862-868. doi:10.1007/s10620-008-0440-6.

18. Yamaji T, Iwasaki M, Sasazuki S, et al. Visceral fat volume and the prevalence of colorectal adenoma. Am J Epidemiol. 2009;170(12):1502-1511. doi:10.1093/aje/kwp311.

19. Kang HW, Kim D, Kim HJ, et al. Visceral obesity and insulin resistance as risk factors for colorectal adenoma: a cross-sectional, case-control study. Am J Gastroenterol. 2010;105(1):178-187. doi:10.1038/ajg.2009.541.

20. Engeli S, Feldpausch M, Gorzelniak K, et al. Association between adiponectin and mediators of inflammation in obese women. Diabetes. 2003;52(4):942-947. doi:10.2337/diabetes.52.4.942.

21. Ouchi N, Kihara S, Funahashi T, et al. Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue. Circulation. 2003;107(5):671-674. doi:10.1161/01.cir.0000055188.83694.b3.

22. Miyoshi Y, Funahashi T, Kihara S, et al. Association of serum adiponectin levels with breast cancer risk. Clin Cancer Res. 2003;9(15):699-5704.

23. 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):1012-1018.

24. Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection--systematic review and meta-analysis. Radiology. 2011;259(2):393-405. doi:10.1148/radiol.11101887.

25. Srirattanapong S, Leksrisawad P, Pantongrag-Brown L, Laothamatas J. Diagnostic performance of computed tomographic colonography using a hospital made fecal tagging agent for polyp detection in Thai adults. Thai J Gastroenterol. 2016;17(3):167-171.