Association between metabolic obesity phenotypes and risk of colorectal neoplasia in a south Australian surveillance colonoscopy population.

Objective: To assess association between metabolic obesity phenotypes and risk of colorectal neoplasia in a South Australian surveillance colonoscopy population. Methods: A retrospective cohort study in individuals undergoing surveillance colonoscopy between February 24, 2021, to May 25, 2024, was conducted. The four groups based on obesity and metabolic health status were: metabolically healthy non-obesity (MHNO) or obesity (MHO) and metabolically unhealthy non-obesity (MUNO) or obesity (MUO). Metabolically unhealthy status based on the presence of type 2 diabetes, hypertension, or dyslipidemia) and colonoscopy outcomes were collected from clinical databases. Multivariable logistic regression was applied in the overall as well as subgroup analysis by sex of participants. Results: Both MHO (adjusted odds ratio (AOR) = 1.36, 95 % CI 1.00, 1.85) and MUO (AOR = 1.39, 95 % CI 1.11,1.76) were positively associated with the risk of conventional adenoma but not with serrated polyps as compared to non-neoplastic groups. An increased risk of advanced conventional adenoma was observed in individuals with MHO (AOR = 1.38, 95 % CI 1.04, 1.83) and MUO (AOR = 1.27, 95 % CI 1.03,1.58). This risk for advanced conventional adenomas was significant in male participants, but not in females. Conclusions: Obesity, independent of other metabolic diseases, was associated with a higher risk of conventional adenoma, particularly in males.