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Epidemiology

A healthy lifestyle pattern has a protective association with colorectal polyps

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Abstract

Background

Colorectal cancer is associated with lifestyle characteristics such as diet, physical inactivity, obesity, and smoking, but these are not incorporated in screening recommendations. Moreover, the joint association of these factors with various colorectal polyps is not established.

Methods

A case–control study, among consecutive subjects aged 40–70 years, undergoing colonoscopy. Cases with colorectal polyps were compared with controls. Detailed information was gathered regarding polyp histology and anatomic location, demographics, medical history, anthropometrics, and lifestyle. The healthy lifestyle index was estimated as the sum of: non-smoking, maintaining a healthy weight, healthy diet, and physical activity.

Results

A total of 788 participants were included (cases n = 403, controls n = 385). The healthy lifestyle index had a negative association with colorectal polyps (OR = 0.72, 95% CI 0.62–0.85, P < 0.001), both adenomas and serrated polyps (OR = 0.75, 0.64–0.89, and OR = 0.59, 0.44–0.79, respectively), and both proximal and distal adenomas (OR = 0.77, 0.62–0.95, and OR = 0.73, 0.59–0.90, respectively). Adherence to ≥ 2 healthy lifestyle components was strongly related with colorectal polyps (OR = 0.50, 0.34–0.75, P = 0.001). Abstinence from smoking, and a healthy diet were the factors most strongly associated with lower odds of colorectal polyps (OR = 0.58, 0.42–0.79, and OR = 0.61, 0.44–0.85, respectively).

Conclusions

Adherence to a healthy lifestyle (≥2 healthy lifestyle components) is inversely associated with colorectal polyps, especially serrated and distal polyps, with no dose–response association. Components most strongly associated with lower odds of colorectal polyps were maintaining a healthy diet and abstinence from smoking. Lifestyle-related characteristics may assist in risk stratification and are potential goals for colorectal neoplasia prevention.

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Author information

Author notes

  1. These authors contributed equally: Naomi Fliss-Isakov, Revital Kariv

Authors and Affiliations

  1. Department of Gastroenterology Tel Aviv Medical Center, Tel Aviv, Israel

    Naomi Fliss-Isakov, Revital Kariv, Muriel Webb, Oren Shibolet & Shira Zelber-Sagi

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Naomi Fliss-Isakov, Revital Kariv, Muriel Webb & Oren Shibolet

  3. School of Public Health, University of Haifa, Haifa, Israel

    Dana Ivancovsky-Wajcman, Dana Margalit & Shira Zelber-Sagi

  4. School of Nursing, University of Washington, Seattle, WA, USA

    Oleg Zaslavsky

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  1. Naomi Fliss-Isakov
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  2. Revital Kariv
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  3. Muriel Webb
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  4. Dana Ivancovsky-Wajcman
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  5. Oleg Zaslavsky
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  8. Shira Zelber-Sagi
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Contributions

Fliss-Isakov N. conceived the study; designed the study; collected the data; and preformed statistical analysis, interpreted the results, and wrote the manuscript. Kariv R. conceived the study; designed the study; interpreted the results; and wrote the manuscript. Zaslavsky O. critically reviewed the manuscript. Webb M. performed medical data collection. Ivancovsky-Wajcman D. performed the data collection. Margalit D. performed the data collection. Shibolet O. critically reviewed the manuscript. Zelber-Sagi S. conceived the study; designed the study; interpreted the results; and wrote the manuscript.

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Correspondence to Naomi Fliss-Isakov.

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Fliss-Isakov, N., Kariv, R., Webb, M. et al. A healthy lifestyle pattern has a protective association with colorectal polyps. Eur J Clin Nutr 74, 328–337 (2020). https://doi.org/10.1038/s41430-019-0481-2

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