A body of evidence demonstrated a crucial role for FGF-21 in adaptation of glucose and lipid metabolism and an involvement in lifestyle-related metabolic diseases.29,38 Given the cross-sectional nature of our data, it is impossible to distinguish potential effects of FGF-21 on the risk of colorectal neoplasia from potential modification of FGF-21 during the course of colorectal tumourigenesis, possibly even as a result of tumour development or metabolism-related risk factors, such as alcohol consumption, red meat intake or obesity. This evidence concerns the gene FGF21 and metabolic disease.