Yoon Jin Choi, Yong Chan Lee, Jung Mogg Kim, Jin Il Kim, Jeong Seop Moon, Yun Jeong Lim, Gwang Ho Baik, Byoung Kwan Son, Hang Lak Lee, Kyoung Oh Kim, Nayoung Kim, Kwang Hyun Ko, Hye-Kyung Jung, Ki-Nam Shim, Hoon Jai Chun, Byung-Wook Kim, Hyuk Lee, Jie-Hyun Kim, Hyunsoo Chung, Sang Gyun Kim, and Jae Young Jang. Gut and Liver 2022;16:535-46. https://doi.org/10.5009/gnl220055

Crohn's disease is associated with altered body composition, such as low muscle mass, which can affect clinical outcomes. However, there are few studies regarding the effect of sarcopenia on prognosis of Crohn's disease. In this study, we evaluated the body composition at the initial diagnosis of Crohn's disease and analyzed the clinical meaning of sarcopenia. We conducted a retrospective review of medical records of patients who were diagnosed as Crohn's disease and underwent computed tomography within 3 months after diagnosis. Sarcopenia was defined as an L3 skeletal muscle index (SMI) of < 49 cm2/m2 for men and < 31 cm2/m2 for women. Outcomes such as need for hospitalization, surgery, use of steroids, immunomodulators and biologics were analyzed. A total of 79 patients (male, 73.4%; mean age, 29.9 years) were included and 40 patients (51%) were diagnosed as sarcopenia. C-reactive protein (CRP) level was correlated with sarcopenia (P= 0.044). Erythrocyte sedimentation rate (ESR) showed a tendency to decrease inversely with SMI (r = -0.320, P= 0.008) and hemoglobin and albumin tended to increase in proportion to SMI (hemoglobin: r = 0.271, P= 0.016 and albumin: r = 0.350, P= 0.002). However, there was no statistically significance in time-to-first-event analysis in aspects of sarcopenia. Approximately 50% of patients with newly diagnosed as Crohn's disease had sarcopenia. CRP levels were higher in the sarcopenia group and SMI correlated with ESR, hemoglobin, and albumin. However, none of prognostic values were demonstrated.

PURPOSE: Given the increasing incidence of early-onset colorectal cancer (CRC; diagnosed before age 50 years) worldwide, it is important to identify modifiable risk factors. We investigated whether alcohol consumption in the young population correlated with an increased early-onset CRC risk that differed by tumor location and sex. PATIENTS AND METHODS: We investigated the association between average daily alcohol consumption and the risk of early-onset CRC among 5,666,576 individuals age 20-49 years using data from the Korean National Health Insurance Service (2009-2019). Alcohol consumption levels of nondrinker, light (reference), moderate, and heavy drinker were defined as 0, <10, 10 to <30, and ≥30 g/d for men and 0, <10, 10 to <20, and ≥20 g/d for women, respectively. Multivariate Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% CIs. RESULTS: We identified 8,314 incident early-onset CRC cases during the follow-up period. Moderate and heavy drinkers showed an increased risk of early-onset CRC compared with light drinkers (aHR, 1.09 [95% CI, 1.02 to 1.16] and aHR, 1.20 [95% CI, 1.11 to 1.29], respectively). Subgroup analysis by tumor location showed positive dose-response significance for early-onset distal colon and rectal cancers, but not for proximal colon cancer. The dose-response association between drinking frequency and risk of early-onset CRC was significant, with a 7%, 14%, and 27% increased risk for 1-2, 3-4, and ≥5 d/wk compared with nondrinkers, respectively. CONCLUSION: Excessive alcohol consumption increases the risk of CRC onset before age 50 years. Thus, effective interventions are required to discourage alcohol consumption among young people and to tailor CRC screening approaches for high-risk individuals.

Yoon Jin Choi, Eun Hyo Jin, Joo Hyun Lim, Cheol Min Shin, Nayoung Kim, Kyungdo Han, and Dong Ho Lee. Gut and Liver 2022;16:465-73. https://doi.org/10.5009/gnl210009

Purpose: To investigate the association between insomnia and the risk of various cancers using the Korean National Health Insurance Service database.Materials and methods: Patients who underwent a national health examination in 2009 were followed-up until 2018. Newly-diagnosed cancers were collected one year after the baseline. Insomnia was defined as having a diagnosis of F510 or G470 within one year prior to enrollment. The incidence of various cancers was compared between patients with and without insomnia.Results: In the overall study population (N = 3,982,012), the risk for any type of cancer was not different between controls and insomnia patients (adjusted hazard ratio [aHR]: 0.990). However, it was different by age; insomnia increased the risk of any cancer in younger age groups (20–39y and 40–59y, aHR:1.310 and 1.139, respectively) but it significantly decreased the risk in the 60–79y age group (aHR: 0.939). In cancer type, colorectal cancer risk was lower (aHR: 0.872,P< 0.0001), whereas leukemia risk was higher (aHR: 1.402,P< 0.0001) in patients with insomnia than in those without it, regardless of sex. In men, the risk of stomach cancer was lower (aHR: 0.882,P= 0.0003), and the risks of lung (aHR:1.114,P= 0.0005), kidney (aHR 1.226,P= 0.0107), and prostate (aHR:1.101,P= 0.0028) cancers were higher in insomnia patients than in control patients. In women, insomnia patients compared to control patients showed a lower risk of ovarian cancer (aHR:0.856,P= 0.0344, respectively), while they had a higher risk of oral (aHR:1.616,P= 0.002), thyroid (aHR:1.072,P= 0.0192), and nerve (aHR: 1.251,P= 0.016) cancers.Conclusion: Insomnia is associated with an increased or decreased risk of some cancers, depending on age, cancer type and sex.