Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical characteristics of colorectal polyps in patients with non-alcoholic fatty liver disease in high altitude areas
Chun-Yan Wang, Lin Ma, Ying Zhao, Xiao-Jiang Zhang, Shuang Li, Yong-Gang Liu, Hai-Ming Guo, Jun-Guo Qi, Jian-Quan Wang, Wei-Xin Ye, Jian-Zhou Li, Tao Zhang
Chun-Yan Wang, Department of Gastroenterology, Tianjin Second People’s Hospital, Tianjin Institute of Hepatology, Clinical School of the Second People’s Hospital, Tianjin Medical University, Tianjin 300110, China
Lin Ma, Ying Zhao, Xiao-Jiang Zhang, Graduate School, Tianjin Medical University, Tianjin 300070, China
Shuang Li, Endoscopy Center, Tianjin Second People’s Hospital, Tianjin 300110, China
Yong-Gang Liu, Department of Pathology, Tianjin Second People’s Hospital, Tianjin 300110, China
Hai-Ming Guo, Jun-Guo Qi, Jian-Quan Wang, Wei-Xin Ye, Jian-Zhou Li, Tao Zhang, Diagnosis and Treatment Center of High Altitude Digestive Disease, Xining Second People’s Hospital, Xining 810003, Qinghai Province, China
Co-first authors: Chun-Yan Wang and Lin Ma.
Co-corresponding authors: Jian-Zhou Li and Tao Zhang.
Author contributions: Wang CY and Ma L wrote the manuscript; Zhang XJ, Li S, Guo HM and Qi JG contributed to data collation; Zhao Y and Ma L contributed to statistical analysis; Liu YG contributed to liver pathology reading; Wang CY, Wang JQ and Ye WX contributed to manuscript revision; Wang CY, Li JZ and Zhang T contributed to research supervision; Wang CY contributed to project design. All authors have read and approve the final manuscript. Wang CY and Ma L contributed equally to this work as co-first authors. Li JZ, as the primary academic supervisor and the originator of the core research concept, was instrumental in the study's design, intellectual direction, and data interpretation. They will be the primary point of contact for inquiries related to the methodological framework and scientific hypotheses. Concurrently, Zhang T, as the principal investigator providing the essential clinical platform and financial support, oversaw the project's execution, ensured resource availability, and contributed significantly to the final critical revision of the manuscript. They will primarily address questions concerning the overall project governance, clinical implications, and resource management. We believe that this dual corresponding authorship structure ensures that all scholarly inquiries, from specific methodological details to broader project-related questions, can be addressed most comprehensively and efficiently during the peer-review process.
Supported by Tianjin Key Medical Discipline Construction Project, No. TJYXZDXK-3-019B.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Tianjin Second People’s Hospital.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment via written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tao Zhang, Diagnosis and Treatment Center of High Altitude Digestive Disease, Xining Second People’s Hospital, No. 892 Qilian Road, Chengbei District, Xining 810003, Qinghai Province, China.
zhangtaoqh@163.com
Received: August 5, 2025
Revised: September 14, 2025
Accepted: November 10, 2025
Published online: December 15, 2025
Processing time: 128 Days and 6.7 Hours
BACKGROUND
Colorectal cancer has high global incidence and mortality rates. Colorectal polyps are relatively common, with adenomatous polyps having a higher risk of malignant transformation. Non-alcoholic fatty liver disease (NAFLD) has been identified as a risk factor for the development of colorectal adenomas. Here, inpatients with NAFLD from the Second People's Hospital of Xining, in Qinghai Province, and the Second People's Hospital of Tianjin were investigated, comparing the biochemical indicators, colonoscopy findings, and pathological results of polyps between patients from low-altitude (Tianjin) and high-altitude (Qinghai Province) areas. Risk factors associated with the occurrence of adenomatous polyps in NAFLD patients from high-altitude areas were also explored.
AIM
To investigate the clinical characteristics of colorectal polyps in NAFLD patients from high-altitude areas.
METHODS
A total of 848 patients with NAFLD were enrolled. Of these, 118 underwent colonoscopy between January 2021 and January 2024 at the Second People's Hospital of Tianjin (low-altitude), while the remaining 730 patients were assessed during the same period at the Second People's Hospital of Xining, Qinghai (high-altitude). All enrolled patients met the diagnostic criteria for NAFLD, and the excised colorectal polyps were analyzed pathologically.
RESULTS
Colorectal polyps were found in 585 cases (80.1%) in the Qinghai cohort and 91 patients (77.1%) in the Tianjin group, indicating a slightly higher incidence in the Qinghai group, although the difference was non-significant (P = 0.449, P > 0.05). The two groups showed no significant difference in sex (P = 0.153, P > 0.05) but differed significantly in the proportion of younger patients (P < 0.01), although no differences were seen in terms of middle-aged and elderly patients (P > 0.05). No differences in polyp numbers were observed between the two regions (P > 0.05), while significant differences were found between the ≤ 0.5 cm and > 1 cm and ≤ 2 cm proportions in both regions (P < 0.05), with no differences in other size categories (P > 0.05). Polyp locations (proximal colon, distal colon) also differed significantly (P < 0.05). Patients in Qinghai were more prone to adenomatous polyps, accounting for 89.2% of polyps, compared to those from Tianjin (P < 0.05). Patients in Qinghai had a higher incidence of tubular adenomas with low-grade dysplasia, while tubular adenomas with high-grade dysplasia predominated in patients from Tianjin (P < 0.05). Patients in Tianjin had a significantly higher proportion of mixed hyperplastic-adenomatous polyps (P < 0.05), as well as greater proportions of mixed hyperplastic-adenomas with low-grade dysplasia (P < 0.05). The incidence of hyperplastic polyps was markedly higher in Tianjin, accounting for 58.4% (P < 0.05). Multivariate logistic regression indicated that sex [OR = 1.693, 95% confidence interval (CI): 1.131-2.536], smoking (OR = 0.604, 95%CI: 0.406-0.897), hypertension (OR = 0.683, 95%CI: 0.471-0.991), and white blood cell counts (WBC) (OR = 1.091, 95%CI: 1.015-1.173) were risk factors for the occurrence of adenomatous polyps in patients with NAFLD in high-altitude areas (Qinghai Province).
CONCLUSION
Patients with NAFLD from high-altitude regions have a higher incidence of colorectal polyps, with a significantly higher incidence of adenomatous polyps compared to other polyp types. Sex, smoking, hypertension, and WBC are risk factors for adenomatous polyps in NAFLD patients in high-altitude regions.
Core Tip: This retrospective study explored the incidence and characteristics of colorectal polyps in patients with non-alcoholic fatty liver disease (NAFLD) from high-altitude (Qinghai) and low-altitude (Tianjin) regions in China. Patient data were analyzed using SPSS 26.0. It was found that NAFLD patients from high-altitude regions had a higher incidence of colorectal polyps, of which the proportion of adenomatous polyps was significantly higher. Sex, smoking, hypertension, and white blood cell counts were observed to be risk factors for the development of adenomatous polyps. Proactive colonoscopy screening is recommended for NAFLD patients with these risk factors living at high altitudes to mitigate the risk of colorectal cancer.
