Association between lifestyle factors and disease progression in patients with colorectal polyps and early-stage cancer

Table 1 Baseline demographic and clinical characteristics of study participants

Characteristic	Total (n = 120)
Age, years (mean ± SD)	56.3 ± 12.4
Sex, n (%)
Male	63 (52.5)
Female	57 (47.5)
BMI, kg/m² (mean ± SD)	24.8 ± 3.6
Educational level, n (%)
Primary school or below	15 (12.5)
Secondary school	48 (40.0)
College or above	57 (47.5)
Family history of CRC, n (%)	22 (18.3)
Comorbidities, n (%)
Hypertension	38 (31.7)
Diabetes mellitus	25 (20.8)
Dyslipidemia	42 (35.0)
Initial diagnosis, n (%)
Colorectal polyps	98 (81.7)
Early-stage cancer	22 (18.3)
Polyp characteristics (n = 98)
Number of polyps (median, IQR)	2 (1-3)
Size of largest polyp, mm (median, IQR)	12 (8-18)
Location, n (%)
Right colon	35 (35.7)
Left colon	41 (41.8)
Rectum	22 (22.5)

BMI: Body mass index; CRC: Colorectal cancer; IQR: Interquartile range.

Table 2 Distribution of lifestyle factors and their association with disease characteristics

Lifestyle factor	Number (%)	Disease progression HR (95% confidence interval)	P value
Physical activity level
Low (< 600 MET-min/week)	45 (37.5)	1.00 (reference)	-
Moderate (600-3000 MET-min/week)	52 (43.3)	0.68 (0.45-0.92)	0.015
High (> 3000 MET-min/week)	23 (19.2)	0.51 (0.33-0.78)	0.002
Dietary pattern
Poor adherence to healthy diet	38 (31.7)	1.00 (reference)	-
Moderate adherence	56 (46.7)	0.72 (0.54-0.96)	0.024
High adherence	26 (21.6)	0.59 (0.41-0.85)	0.005
Smoking status
Never smoker	65 (54.2)	1.00 (reference)	-
Former smoker	32 (26.7)	1.28 (0.92-1.78)	0.142
Current smoker	23 (19.1)	1.85 (1.32-2.59)	0.001
Sleep quality
Good (PSQI ≤ 5)	48 (40.0)	1.00 (reference)	-
Poor (PSQI > 5)	72 (60.0)	1.45 (1.12-1.88)	0.005

PSQI: Pittsburgh Sleep Quality Index; HR: Hazard ratio.

Table 3 Patterns of disease progression during follow-up

Progression pattern	n (%)
New polyp development	26 (61.9)
Increase in polyp size	8 (19.0)
Histological progression	5 (11.9)
Progression to invasive cancer	3 (7.2)
Total progression events	42 (100.0)

Table 4 Multivariate analysis of lifestyle factors associated with disease progression

Variable	Adjusted HR (95%CI)1	P value
Physical activity (vs low)
Moderate	0.71 (0.52-0.97)	0.032
High	0.55 (0.38-0.80)	0.002
Dietary pattern (vs poor adherence)
Moderate adherence	0.76 (0.56-1.03)	0.078
High adherence	0.62 (0.43-0.89)	0.009
Current smoking (vs never)	1.92 (1.35-2.73)	< 0.001
Poor sleep quality	1.38 (1.05-1.82)	0.021
High stress level	1.45 (1.12-1.88)	0.005
BMI (per 5 kg/m² increase)	1.28 (1.06-1.55)	0.011
Age (per 10 years)	1.15 (0.98-1.35)	0.089
Male sex	1.22 (0.91-1.64)	0.186

¹Adjusted for age, sex, body mass index, family history of colorectal cancer, comorbidities, and baseline disease characteristics.

BMI: Body mass index; HR: Hazard ratio.