title: Multiple behavioral factors are associated with occurrence of large, flat colorectal polyps.
abstract: OBJECTIVE
  The prevalence of advanced dysplasia and synchronous lesions is particularly high in patients with large, flat colorectal polyps. However, the impact of lifestyle on the development of such polyps is poorly investigated. Hence, this study aims to identify associations between behavioral factors and the occurrence of large, flat colorectal polyps.
  
  
  METHODS
  Behavioral factors were retrospectively analyzed in patients with large, flat polyps and control patients with at most one diminutive polyp. Information on lifestyle factors, comorbidities, and demographic parameters were determined by a structured, self-administered questionnaire.
  
  
  RESULTS
  Questionnaires of 350 patients with large, flat polyps and 489 control patients were included in the analysis. Most large, flat colorectal polyps contained adenoma with low-grade neoplasia and were located in the right colon. Multivariate analysis showed that advanced age (per 1-year increase-OR 1.09, CI 1.07-1.11, p < 0.0001), frequent cigarette smoking (OR 2.04, CI 1.25-3.32, p = 0.0041), daily consumption of red meat (OR 3.61, CI 1.00-12.96, p = 0.0492), and frequent bowel movements (OR 1.62, CI 1.13-2.33, p = 0.0093) were independent risk factors for occurrence of large, flat colorectal polyps. In contrast, frequent intake of cereals (OR 0.62, CI 0.44-0.88, p = 0.0074) was associated with a reduced risk.
  
  
  CONCLUSIONS
  Multiple behavioral factors modulate the risk for developing large, flat colorectal polyps. This knowledge can be used to improve prevention of colorectal cancer.
authors.affiliation: Division of Signaling and Functional Genomics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany. t.zhan@dkfz.de.|Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany. t.zhan@dkfz.de.
authors.forename: Tianzuo
authors.initials: T
authors.lastname: Zhan
authors.affiliation: Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Hahn
authors.affiliation: Division of Biostatistics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hielscher
authors.affiliation: Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Asmé
authors.initials: A
authors.lastname: Bilge
authors.affiliation: Heilig Geist Hospital, Rodensteinstraße 94, 64625, Bensheim, Germany.|Praxis Dr. Knapp und Kollegen, Mathildenstraße 30, 64625, Bensheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Grüger
authors.affiliation: Gastroenterologische Schwerpunktpraxis, Lameystr. 2, 68165, Mannheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weers
authors.affiliation: Division of Signaling and Functional Genomics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.|Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Betge
authors.affiliation: Institute of Pathology, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Gaiser
authors.affiliation: Central Interdisciplinary Endoscopy Unit, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Kähler
authors.affiliation: Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Matthias P
authors.initials: MP
authors.lastname: Ebert
authors.affiliation: Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Universitätsmedizin Mannheim, Theodor-Kutzer Ufer 1-3, D-68167, Mannheim, Germany. sebastian.belle@umm.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Belle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior; D015331:Cohort Studies; D003111:Colonic Polyps / Q000453:epidemiology*; D015897:Comorbidity; D004032:Diet; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D055815:Young Adult
keywords: Adenoma; Colorectal cancer; Polyps