Metabolic Syndrome And The Risk Of Digestive System Tumors:A Prospective Cohort Study

Background:The incidence and mortality of digestive system tumors in China are increasing,which is a major public health problem in China.The increasing prevalence of Metabolic syndrome(MS)is now both a major clinical problem and a common public health problem.Several studies have suggested that MS was related to an increased risk of colorectal cancer,liver cancer,and pancreatic cancer.Several studies have shown inconsistent results in different race,and in different genders.The evidence based on the prospective cohort study of Chinese adults is limited.Objective:To investigate the association between baseline MS components and the change of MS with the risk of digestive system tumors in the Kailuan cohort.Methods:1.All employees and retirees of the Kailuan Group were recruited,and they had been experienced routine check-up ever two years in the Kailuan cohort(2006-2015).Information on waist circumference,blood glucose,triglycerides,high-density lipoprotein cholesterol,blood pressure,as well as the information of digestive system tumors(esophageal cancer,gastric cancer,colorectal cancer,hepatocellular carcinoma,pancreatic carcinoma)were collected by questionnaires,physical measurements and laboratory tests.2.Cox proportional hazards regression models were used to estimate the hazard ratio(HR)and 95%confidence interval(95%CI)of baseline MS and MS components,combined with body mass index for digestive system tumors.3.The check-up data of the first time and the third time was used to explore the associations between the changes of MS and the risk of digestive system tumors.Participants with 3 complete health check-up data were selected to evaluate the associations between frequency and digestive system tumor.Results:1.Total of 129,763 participants(104,413 males and 25,450 females)were recruited in our study with a mean age of 50.52 years,with 1,030,706.94 person-years follow-up and the median follow-up time was 8.85 years.A total of 1,354 new digestive system cancer cases were identified in the Kailuan male cohort study,including colorectal cancer(461 cases),esophageal cancer(141 cases),gastric cancer(283 cases),liver cancer(364 cases),pancreatic cancer(105 cases).2.Compared with no MS components,the hazard ratios(HR)(95%CI)of developing overall digestive system tumor,liver cancer with≥3 MetS components was 1.42(1.13-1.78),1.47(0.96-2.25),respectively.When compared with normal level,the HR(95%CI)of colorectal cancer with MS was 1.27(1.03-1.58).3.In addition,a statistically significant trend(P<0.05)of increased overall digestive system tumor and colorectal cancer risk with an increasing number of abnormal MetS components was observed.4.The results showed that the association between MS and the colorectal cancer risk was still statistically significant in the old-age group(≥3 vs 0 components:HR=1.94,95%CI:1.21-3.10),no-smokers(yes vs no:HR=1.30,95%CI:0.99-1.70),no-drinkers(yes vs no:HR=1.30,95%CI:0.98-1.73),short daily sitting time group(yes vs no:HR=1.33,95%CI:1.04-1.70).And the association between MS and the liver cancer risk was still statistically significant in the old-age group(≥3 vs 0 components:HR=1.40,95%CI:1.84-2.32),HBsAg negative population(≥3 vs 0 components:HR=1.86,95%CI:1.01-3.42).5.Even if it didn’t meet the diagnostic criteria of MS,the combination of central obesity and elevated fasting blood glucose(HR=2.01,95%CI:1.36-2.99),central obesity and elevated blood pressure(HR=1.34,95%CI:1.03-1.75),elevated fasting blood glucose and elevated blood pressure(HR=1.45,95%CI:1.07-1.96)increased the overall digestive system tumor risk;the combination of central obesity and elevated fasting blood glucose(HR=2.36,95%CI:1.17-3.65),central obesity and elevated blood pressure(HR=1.60,95%CI:1.02-2.67)increased the colorectal risk;the combination of central obesity and elevated fasting blood glucose(HR=2.88,95%CI:1.52-5.45)increased the liver risk.6.The combination of MS and BMI increased the liver cancer risk(HR=1.59,95%CI:1.05-2.40).However,we found no significant association between the metabolically healthy obesity and digestive system tumors.7.We found no significant association between the change of MS with digestive system tumors.Conclusion:The study suggested that baseline MS increased digestive system tumor,colorectal cancer,and liver cancer risk.Among them,with the increased of MS components,the overall digestive system tumor and colorectal cancer increased,showing a clear linear increase trend;The association between MS and colorectal cancer was more significant in older,non-smokers,non-drinkers,and those with a short daily sitting time.The association between MS and liver cancer risk was more significant in older,HBsAg-negative people;Even if it didn’t meet the diagnostic criteria of MS,the combination of abnormal composition of MS can still increase the risk of overall digestive system tumor,colorectal cancer,and liver cancer;the combination of MS and BMI abnormalities increases the risk of liver cancer;There was no significant association between the metabolically healthy obesity and digestive system tumors.We found no significant association between the change of MS with digestive system tumors.A large number of prospective cohort studies still need to accumulate evidence in the future,and to provide a scientific basis for the prevention and control to decrease the digestive system tumors risk.