Objectives Obesity is associated with the activation of the molecular pathways that increase the risk of colorectal cancer. Increasing body mass index may accelerate the development of adenomatous polyps, the antecedent lesion of colorectal cancer. The aim of this study was to assess the BMI effect on the risk of colonic polyp and adenoma in African American. Design and Methods We examined the records of 923 patients who underwent colonoscopy. Demographic and clinical data were collected before colonoscopy. Polyp and adenoma diagnosis were confirmed by pathology examinations. Results Overall, 43% of the patients were male, median age was 57 years and 77% had BMI≥25.0 kg/m2. The frequency of colorectal polyps and adenomas were 61% and 35%, respectively. BMI≥25.0 (OR=1.61, 95%CI=1.14-2.26), smoking (OR=1.61, 95%CI=1.15-2.26) and history of colon polyps (OR=1.64, 95%CI=1.09-2.47) were associated with higher risk of colon polyp. BMI≥25.0 (OR=1.81, 95%CI=1.24-2.62), age (OR=1.04, 95%CI=1.02-2.05 for each year), male gender (OR=1.38, 95%CI=1.02-1.86), and smoking (OR=1.73, 95%CI=1.23-2.42) were associated with higher risk of colon adenoma. Conclusion Male and overweight African Americans are at higher risk of colorectal adenoma. The findings of this study could be applied for risk stratification and modifying the colorectal cancer prevention including screening guideline in African Americans.

Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

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