Novel approach to risk stratification: Integrating waist-hip ratio for predicting advanced colorectal neoplasia

The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer (CRC) continues to be a primary cause of global cancer mortality. Conventional models mostly rely on generalized obesity markers including body mass index (BMI), which does not effectively represent oncogenic risk linked with abdominal obesity. Liu <i>et al</i> undertook a large-scale case-control study comprising 6484 first-time colonoscopy patients at a prominent Chinese hospital between 2020 and 2023 to overcome this restriction. Age, male sex, smoking status, and raised waist-hip ratio (WHR) were found by multivariate logistic regression as independent predictors of advanced colorectal neoplasia (ACN). In a validation cohort of 1891 individuals, a new 7-point risk scoring model was created and stratified into low- (5.0%) ACN prevalence, moderate- (10.3%) and high-risk (17.6%). With C-statistic = 0.66 the model showed better discriminating ability than the Asia-Pacific Colorectal Screening (APCS) score (C-statistic = 0.63) and the BMI-modified APCS model. These results fit newly published data showing central obesity as a major carcinogenic driver <i>via</i> pro-inflammatory visceral adipokine channels. With the use of WHR, patient risk classification is greatly improved, providing a practical tool to make the most of screening resources in the face of rising CRC incidence rates. Finally, multi-ethnic validation is necessary for the WHR-based scoring model to be considered for integration into global CRC preventive frameworks, since it improves the accuracy of ACN risk prediction.