AIM To investigate the clinical utility of biological age(BA) measurement in screening colonoscopy for the detection of colorectal adenomas in the average-risk population.METHODS A consecutive series of asymptomatic subjects aged ≥ 30 years who underwent colonoscopy in routine check-ups were enrolled. Colorectal adenoma was classified according to size, number, and location. BAs were calculated using the MEDIAGETM Biological Age Measurement System.RESULTS A total of 2696 subjects were investigated(1876 men and 820 women). The mean chronological age(CA) was 46.0 years and the mean BA was 44.7 years. Metabolic syndrome(MS) was diagnosed in 218 subjects(8.1%). The prevalence of overall colorectal adenoma was 23.1%(622/2,696). When the subjects were divided into four groups based on BA(≤ 39 years; 40-49 years; 50-59 years; ≥ 60 years), the prevalence of colorectal adenoma was increased as BA increased(P < 0.001). Colorectal adenoma located in the proximal colon was more prevalent in the BA-dominant group(BA-CA ≥ 5years) than the CA-dominant group(CA-BA ≥ 5 years)(P = 0.034). When the subjects were categorized into four groups according to MS and age gap between BA and CA, the incidence of colorectal adenoma increased with MS and BA-dominance(P < 0.05).CONCLUSION Measurement of BA may help to assess the risk of colorectal adenoma in screening colonoscopy. AIM To investigate the clinical utility of biological age (BA) measurement in screening colonoscopy for the detection of colorectal adenomas in the average-risk population. METHODS A consecutive series of asymptomatic subjects aged ≥ 30 years who underwent colonoscopy in routine check-ups were enrolled The mean chronological age (CA) was 46.0 (1876 men and 820 women). The mean chronological age (CA) was 46.0 Metabolic syndrome (MS) was diagnosed in 218 subjects (8.1%). The prevalence of overall colorectal adenoma was 23.1% (622 / 2,696). When the subjects were divided into four groups based on BA (≤ 39 years; 40-49 years; 50-59 years; ≥ 60 years), the prevalence of colorectal adenoma was increased as BA increased (P <0.001). Colorectal adenoma located in the proximal colon was more prevalent in (BA-CA ≥ 5years) than the CA-dominant group (CA-BA ≥ 5 years) (P = 0.034). When the subjects were categorized into four groups according to MS and age gap between BA and CA , the incidence of colorectal adenoma increased with MS and BA-dominance (P <0.05) .CONCLUSION Measurement of BA may help to assess the risk of colorectal adenoma in screening colonoscopy.