Doubled risk of colorectal polyp occurrence in adults under 50 with a high-level mildly elevated body mass index trajectory: a retrospective cohort study based on latent class mixed modeling

ZHENG Qingyun; WANG Yumeng; CHANG Jiali; FU Xuan; TIAN Shuxin

doi:10.16016/j.2097-0927.202603068

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Doubled risk of colorectal polyp occurrence in adults under 50 with a high-level mildly elevated body mass index trajectory: a retrospective cohort study based on latent class mixed modeling

Monographic Reports | 更新时间：2026-07-15

- Doubled risk of colorectal polyp occurrence in adults under 50 with a high-level mildly elevated body mass index trajectory: a retrospective cohort study based on latent class mixed modeling
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1837-1845(2026)
- 作者机构：
  
  石河子大学第一附属医院消化内科，国家卫生健康委中亚高发病防治重点实验室（共建），新疆石河子
- 作者简介：
  
  TIAN Shuxin， E-mail：endo0726@shzu.edu.cn
- 基金信息：
  
  the Regional Science Fund Program of National Natural Science Foundation of China(82460539);the Project of Science and Technology Plan of the First Affiliated Hospital of Shihezi University(BS202201);the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2020-PT330-003)
- DOI：10.16016/j.2097-0927.202603068
  CLC： R181.23;R194.3;R735.35
- Received：16 March 2026，
  
  Revised：2026-05-03，
  
  Accepted：04 June 2026，
  
  Published：15 July 2026
- 稿件说明：
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郑清允，王雨萌，常佳丽，等.体质指数轨迹高水平轻度升高的50岁以下成年人结直肠息肉发生风险成倍增加：一项基于潜类别混合模型的回顾性队列研究［J］.陆军军医大学学报，2026，48（13）：1837-1845.DOI：10.16016/j.2097-0927.202603068.

ZHENG Q Y，WANG Y M，CHANG J L，et al.Doubled risk of colorectal polyp occurrence in adults under 50 with a high-level mildly elevated body mass index trajectory： a retrospective cohort study based on latent class mixed modeling［J］.J Army Med Univ，2026，48（13）：1837-1845.DOI：10.16016/j.2097-0927.202603068.
郑清允，王雨萌，常佳丽，等.体质指数轨迹高水平轻度升高的50岁以下成年人结直肠息肉发生风险成倍增加：一项基于潜类别混合模型的回顾性队列研究［J］.陆军军医大学学报，2026，48（13）：1837-1845.DOI：10.16016/j.2097-0927.202603068. DOI：

ZHENG Q Y，WANG Y M，CHANG J L，et al.Doubled risk of colorectal polyp occurrence in adults under 50 with a high-level mildly elevated body mass index trajectory： a retrospective cohort study based on latent class mixed modeling［J］.J Army Med Univ，2026，48（13）：1837-1845.DOI：10.16016/j.2097-0927.202603068. DOI：

摘要

目的

早发性结直肠癌发病率呈上升趋势，肥胖作为可干预因素可能与50岁以下成年人结直肠息肉发生有关，而单一时间点体质指数（body mass index，BMI）难以反映个体长期体质量状态及其动态变化。本研究旨在探讨该人群BMI纵向轨迹与结直肠息肉发生风险的关系，并进一步分析不同BMI轨迹与腺瘤性息肉发生的关联。

方法

本研究为回顾性队列研究，纳入2016年1月至2025年2月在石河子大学第一附属医院消化内镜中心至少行2次肠镜检查且符合纳排标准的50岁以下成年人组成研究队列，依据研究对象3个时间点的BMI数据（T0为首次肠镜检查所在自然年前连续2个自然年，T1为首次肠镜检查所在自然年，T2为首次肠镜检查所在自然年后连续2个自然年），采用潜类别混合模型（latent class mixed model，LCMM）构建BMI轨迹，并综合考虑贝叶斯信息准则、平均后验概率、熵值及各轨迹组样本量比例，以确定最佳模型。采用Log-rank检验比较最佳模型各轨迹组结直肠息肉累计发病率差异，使用Cox比例风险回归模型评估各BMI轨迹组发生结直肠息肉的

及其95%

，应用Firth惩罚最大似然Logistic回归分析BMI轨迹分组与腺瘤性息肉的关联。

结果

最终纳入研究对象共603人，其中男性258例（42.79%），女性345例（57.21%），基于LCMM最终选取3组线性轨迹模型作为最佳模型：轨迹分组分别为低水平稳定组、中水平稳定组和高水平轻度升高组。低水平稳定组共243人（40.30%），3个时间点BMI均值分别为21.11、20.93、21.06 kg/m

，BMI总体稳定。中水平稳定组共272人（45.11%），3个时间点BMI均值分别为25.08、25.24、25.32 kg/m

，BMI总体稳定。高水平轻度升高组共88人（14.59%），3个时间点BMI均值分别为30.20、30.51、30.77 kg/m

，BMI总体呈持续轻度升高趋势。Log-rank检验结果显示，3组BMI轨迹的结直肠息肉累积发病率差异有统计学意义（

²=58.219，

0.001）。Cox比例风险回归模型分析显示，调整混杂因素后，与低水平稳定组相比，中水平稳定组（

=2.90，95%

：1.67~5.01，

0.001）及高水平轻度升高组（

=6.01，95%

：3.26~11.10，

0.001）结直肠息肉的发病风险均增加；而高水平轻度升高组息肉发生风险较中水平稳定组增加约1.08倍（

=2.08，95%

：1.35~3.20，

0.001）。在121例新发息肉患者中，63例（52.07%）为腺瘤性息肉。Firth惩罚最大似然Logistic回归分析显示，调整年龄、性别、吸烟史及饮酒史等因素后，与低水平稳定组相比，高水平轻度升高组发生腺瘤性息肉的可能性显著增加（

=3.77，95%

：1.11~13.83，

=0.033）。

结论

较高BMI轨迹水平与50岁以下成年人结直肠息肉发生风险增加独立相关，其中高水平轻度升高轨迹还可能与腺瘤性息肉相关。动态监测BMI变化并加强体质量管理，有助于结直肠息肉及腺瘤性病变的风险识别和预防。

Abstract

Objective

In recent years

the incidence of early-onset colorectal cancer(diagnosed before the age of 50 years) has been increasing. As a modifiable factor

obesity may be associated with the occurrence of colorectal polyps in adults under 50. Since body mass index(BMI) measured at a single time point is insufficient to reflect an individual’s long-term body weight status and its dynamic changes

this study aims to investigate the relationship between longitudinal BMI trajectories and the risk of colorectal polyps in this population

and to further analyze the relationship between different BMI trajectories and the occurrence of adenomatous polyps.

Methods

A retrospective cohort study was conducted on the adults younger than 50 years who met the eligibility criteria and underwent at least 2 colonoscopic examinations at Digestive Endoscopy Center of our hospital between January 2016 and February 2025. Based on BMI data at 3 time points(T0: 2 consecutive calendar years prior to the calendar year of the first colonoscopy; T1: the calendar year of the first colonoscopy; T2: 2 consecutive calendar years following the calendar year of the first colonoscopy)

latent class mixed model(LCMM) was used to construct BMI trajectories. The optimal model was determined by comprehensively considering the Bayesian information criterion

average posterior probability

entropy

and the sample size proportion of each trajectory group. Log-rank test was employed to compare the cumulative incidence of colorectal polyps among the trajectory groups in the optimal model. Cox proportional hazards regression model was utilized to estimate hazard ratios(HRs) and 95% confidence intervals(95%CIs) for colorectal polyps in each BMI trajectory group. Firth’s penalized maximum likelihood logistic regression was applied to analyze the association between BMI trajectory grouping and adenomatous polyps.

Results

A total of 603 participants were finally included

comprising 258 males(42.79%) and 345 females(57.21%). Based on LCMM

a 3-group linear trajectory model was ultimately selected as the optimal model: low-level stable group

middle-level stable group

and high-level mildly elevated group. The low-level stable group included 243 participants(40.30%)

with mean BMI values of 21.11

20.93

and 21.06 kg/m² at the 3 time points

respectively

indicating an overall stable BMI. The middle-level stable group included 272 participants(45.11%)

with mean BMI values of 25.08

25.24

and 25.32 kg/m² at the 3 time points

respectively

indicating an overall stable BMI. The high-level mildly elevated group included 88 participants(14.59%)

with mean BMI values of 30.20

30.51

and 30.77 kg/m² at the 3 time points

respectively

indicating an overall trend of mild elevation in BMI. Log-rank test showed statistically significant differences in the cumulative incidence of colorectal polyps among the 3 BMI trajectory groups(

²=58.219

0.001). Cox proportional hazards regression analysis showed that

after adjusting for confounding factors

compared with the low-level stable group

the risk of colorectal polyps was increased in both the middle-level stable group(

=2.90

95%

: 1.67 to 5.01

0.001) and the high-level mildly elevated group(

=6.01

95%

: 3.26 to 11.10

0.001). In addition

compared with the middle-level stable group

the high-level mildly elevated group had an approximately 1.08-fold increased risk of colorectal polyps(

=2.08

95%

: 1.35 to 3.20

0.001). Among 121 patients with newly developed polyps

63(52.07%) had adenomatous polyps. Firth’s penalized maximum likelihood logistic regression showed that

after adjusting for age

sex

smoking history

drinking history

and other factors

the high-level mildly elevated group had a significantly increased likelihood of adenomatous polyps compared with the low-level stable group(

=3.77

95%

: 1.11 to 13.83

=0.033).

Conclusion

Higher BMI trajectory levels are independently associated with an increased risk of colorectal polyps in adults younger than 50 years. In particular

the high-level mildly elevated trajectory may also be associated with adenomatous polyps. Dynamic monitoring of BMI changes and strengthened body weight management may contribute to risk identification and prevention of colorectal polyps and adenomatous lesions.

关键词

Keywords

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Related Institution

Department of Gastroenterology, Second Affiliated Hospital, Army Medical University(Third Military Medical University)

Department of Gastroenterology, First Affiliated Hospital, Army Medical University(Third Military Medical University)

石河子大学医学院病理系/石河子大学新疆地方与民族高发病教育部重点实验室;Faculty of Pathology, School of Medicine and Key Laboratory for Xinjiang Endemic and Ethnic Diseases of Ministry of Education, Shihezi University, Shihezi, Xinjiang Uyghur Autonomous Region

新疆喀什地区第二人民医院胸外科;Department of Thoracic Surgery, Second People's Hospital of Kashi Prefecture, Kashi, Xinjiang Uyghur Autonomous Region, 844000, China

Department of Gastroenterology， Second Affiliated Hospital， Army Medical University （Third Military Medical University）

⁰