Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5320-5327
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5320
Metabolic syndrome and colorectal neoplasms: An ominous association
Daniel Trabulo, Suzane Ribeiro, Cláudio Martins, Cristina Teixeira, Cláudia Cardoso, João Mangualde, Ricardo Freire, Élia Gamito, Ana L Alves, Fátima Augusto, Ana P Oliveira, Isabelle Cremers
Daniel Trabulo, Suzane Ribeiro, Cláudio Martins, Cristina Teixeira, Cláudia Cardoso, João Mangualde, Ricardo Freire, Élia Gamito, Ana L Alves, Fátima Augusto, Ana P Oliveira, Isabelle Cremers, Gastroenterology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal, 2910-446 Setúbal, Portugal
Author contributions: Trabulo D designed the research, analyzed the data, and wrote the paper; Cremers I reviewed the paper; all authors performed the research.
Ethics approval: The study was reviewed and approved by the Centro Hospitalar de Setúbal E.P.E. Institutional Review Board.
Clinical trial registration: This study is registered by the National Data Protection Committee of Portugal (registration identification number: 9955/2013).
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declare no conflict-of-interest.
Data sharing: Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniel Trabulo, MD, Gastroenterology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal, E.P.E., Rua Camilo Castelo Branco, 2910-446 Setúbal, Portugal. danieltrabulo@yahoo.com
Telephone: +351-96-8148206
Received: November 22, 2014
Peer-review started: November 24, 2014
First decision: December 11, 2014
Revised: January 7, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 7, 2015
Processing time: 171 Days and 11.7 Hours
Abstract

AIM: To evaluate the association of metabolic syndrome (MS) and colorectal cancer and adenomas in a Western country, where the incidence of MS is over 27%.

METHODS: This was a prospective study between March 2013 and March 2014. MS was diagnosed according to the National Cholesterol Education Program-ATP III. Demographic characteristics, anthropometric measurements, metabolic risk factors, and colonoscopic pathologic findings were assessed in patients with MS (group 1) who underwent routine colonoscopy at our department. This data was compared with consecutive patients without metabolic syndrome (group 2), with no differences regarding sex and age. Patients with incomplete colonoscopy, family history, or past history of colorectal neoplasm were excluded. Informed consent was obtained and the ethics committee approved this study. Statistical analysis was performed using Student’s t-test and χ2 test, with a P value ≤ 0.05 being considered statistically significant.

RESULTS: Of 258 patients, 129 had MS; 51% males; mean-age 67.1 years (50-87). Among the MS group, 94% had high blood pressure, 91% had increased waist circumference, 60% had diabetes, 55% had low high-density lipoprotein cholesterol level, 50% had increased triglyceride level, and 54% were obese [body mass index (BMI) 30 kg/m2]. 51% presented 4 criteria of MS. MS was associated with increased prevalence of adenomas (43% vs 25%, P = 0.004) and colorectal cancer (13% vs 5%, P = 0.027), compared with patients without MS. MS was also positively associated with multiple (≥ 3) adenomas (35% vs 9%, P = 0.024) and sessile adenomas (69% vs 53%, P = 0.05). No difference existed between location (P = 0.086), grade of dysplasia (P = 0.196), or size (P = 0.841) of adenomas. In addition, no difference was found between BMI (P = 0.078), smoking (P = 0.146), alcohol consumption (P = 0.231), and the presence of adenomas.

CONCLUSION: MS is positively associated with adenomas and colorectal cancer. However, there is not enough information in western European countries to justify screening in patients with MS. To our knowledge, no previous study has evaluated this association in Portuguese patients.

Keywords: Metabolic syndrome; Colorectal cancer; Colorectal adenomas; Obesity; Western countries

Core tip: In light of recent findings on the association between insulin resistance and the development of colorectal malignancies, it is worthwhile to investigate whether metabolic syndrome (MS) is correlated to an increased number of colorectal neoplasms. However, few studies have been performed regarding the relationship between MS, colorectal adenomatous polyps, and cancer in European countries. With this study, we aimed to investigate the association between MS and colorectal neoplasms, as well as obesity, smoking and alcohol consumption, in a Portuguese population. In our patients, MS was positively associated with colorectal cancer and adenomas.