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Original article
Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas and hyperplastic polyps
  1. James R Davenport1,2,
  2. Timothy Su1,
  3. Zhiguo Zhao1,3,
  4. Helen G Coleman4,
  5. Walter E Smalley2,5,
  6. Reid M Ness2,5,
  7. Wei Zheng1,5,
  8. Martha J Shrubsole1,5
  1. 1Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  2. 2Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  3. 3Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  4. 4Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
  5. 5Gastroenterology Section or Geriatric Research, Department of Veterans Affairs, Education and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  1. Correspondence to Dr Martha J Shrubsole, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue Room 837-A, Nashville, TN 37203, USA; martha.shrubsole{at}


Objective To identify modifiable factors associated with sessile serrated polyps (SSPs) and compare the association of these factors with conventional adenomas (ADs) and hyperplastic polyps (HPs).

Design We used data from the Tennessee Colorectal Polyp Study, a colonoscopy-based case–control study. Included were 214 SSP cases, 1779 AD cases, 560 HP cases and 3851 polyp-free controls.

Results Cigarette smoking was associated with increased risk for all polyps and was stronger for SSPs than for ADs (OR 1.74, 95% CI 1.16 to 2.62, for current vs never, ptrend=0.008). Current regular use of non-steroidal anti-inflammatory drugs was associated with a 40% reduction in SSP risk in comparison with never users (OR 0.68, 95% CI 0.48 to 0.96, ptrend=0.03), similar to the association with AD. Red meat intake was strongly associated with SSP risk (OR 2.59, 95% CI 1.41 to 4.74 for highest vs lowest intake, ptrend<0.001) and the association with SSP was stronger than with AD (ptrend=0.003). Obesity, folate intake, fibre intake and fat intake were not associated with SSP risk after adjustment for other factors. Exercise, alcohol use and calcium intake were not associated with risk for SSPs.

Conclusions SSPs share some modifiable risk factors for ADs, some of which are more strongly associated with SSPs than ADs. Thus, preventive efforts to reduce risk for ADs may also be applicable to SSPs. Additionally, SSPs have some distinctive risk factors. Future studies should evaluate the preventive strategies for these factors. The findings from this study also contribute to an understanding of the aetiology and biology of SSPs.


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  • Contributors RMN, WZ and MJS contributed to study conception, design and supervision. TS, WES, RMN and MJS contributed to acquisition of data. TS and MJS provided administrative, technical or material support. JRD, ZZ, HGC, WZ and MJS contributed to analysis and interpretation of data. All authors contributed to writing, review and/or revision of the manuscript and approved the final manuscript. MJS is the guarantor of the submitted manuscript.

  • Funding This study was supported by grants P50CA950103, R01CA97386 and K07CA122451. JRD was supported by the Molecular and Genetic Epidemiology of Cancer fellowship (R25CA160056). Surveys and sample collection and processing for this study were conducted by the Survey and Biospecimen Shared Resource, which is supported in part by P30CA68485. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. A portion of the participants were studied as the result of resources and the use of facilities at the VA Tennessee Valley Healthcare System.

  • Competing interests None declared.

  • Ethics approval Written informed consent was obtained from all study participants, and the study protocol was approved by the institutional review board at each study site.

  • Provenance and peer review Not commissioned; externally peer reviewed.