Objective:

To identify factors associated with high-risk adenomas (HRAs) among first-degree relatives (FDRs) and evaluate the predictive performance of a multivariable model that integrates lifestyle, clinical, and laboratory variables for improved risk stratification.

Key Findings:

• HRAs were detected in 34.8% of FDRs.
• Alcohol consumption was significantly associated with higher odds of HRAs (OR = 5.75, 95% CI: 1.49–22.20, P = 0.011).
• Proband HRA status did not significantly correlate with HRAs among FDRs.
• The prediction model showed moderate discrimination (AUC = 0.707) and acceptable calibration.

Interpretation:

Alcohol consumption is a significant modifiable risk factor for HRAs among FDRs, suggesting that targeted interventions could reduce risk. Proband HRA status offers limited additional value for risk stratification.

Limitations:

• No external validation of the prediction model was performed.
• The observed difference in HRA prevalence between groups was smaller than expected, which may limit the generalizability of the findings.

Conclusion:

Targeted screening and lifestyle interventions are essential for FDRs, with alcohol consumption identified as a key modifiable risk factor. Further studies are needed to enhance predictive accuracy and explore additional risk factors.