ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet2017224-32ometendo-8178Research ArticleНаучные исследованияOriginal studiesМетаболический синдром как фактор риска колоректального ракаThe metabolic syndrome as a risk factor for colorectal cancerНикитенкоТатьяна МихайловнаNikitenkoTatiana M.

к.м.н., старший научный сотрудник  лаборатории клинико-популяционных и профилактических исследований терапевтических и эндокринных заболеваний

MD

t_nikitenko_72@mail.ruЩербаковаЛилия ВалерьевнаShcherbakovaLilia V.

старший научный сотрудник лаборатории клинико- популяционных и профилактических исследований терапевтических и эндокринных заболеваний

MD

9584792@mail.ruМалютинаСофья КонстантиновнаMalyutinaSofia K.

д.м.н., профессор, заведующая лабораторией этиопатогенеза и клиники внутренних заболеваний

ScD, prof.

smalyutina@hotmail.comМустафинаСветлана ВладимировнаMustafinaSvetlana V.

к.м.н, старший научный сотрудник лаборатории клинико-популяционных и профилактических исследований терапевтических и эндокринных заболеваний, заведующая центром лечебного и профилактического питания.

PhD

svetlana3548@gmail.comВеревкинЕвгений ГеоргиевичVerevkinEugene G.

к.б.н., ведущий научный сотрудник группы математического моде­лирования биомедицинских систем (ММ БМС)

MD

ewer@ngs.ruРагиноЮлия ИгоревнаRaginoYuliya I.

д.м.н., профессор РАН, зам. директора по научной  работе ФГБНУ «Научно-исследовательский институт терапии и профилактической медицины», заведующая лабораторией клинических биохимических и гормональных исследований терапевтических заболеваний

ScD, prof

ragino@mail.ruВойцицкийВладимир ЕвгеньевичVoytsitskyVladimir E.

Главный врач ГБУЗ Новосибирской области "Новосибирский областной клинический онкологический диспансер"; Главный онколог Новосибирской области.  Заведующий кафедрой онкологии НГМУ,  д.м.н., профессор

ScD, prof.

nood-nso@mail.ruПятибратоваАнна ВладимировнаPyatibratovaAnna V.

заведующая отделом организационно-методической работы

 

MD

onkolog1@mail.ruРымарОксана ДмитриевнаRymarOksana D.

д.м.н., профессор, заведующая лабораторией клинико-популяционных и профилактических исследований терапевтических и эндокринных заболеваний

ScD, prof.

orymar23@gmail.com<p>ФГБНУ &laquo;Научно-исследовательский институт терапии и профилактической медицины&raquo;</p>Россия<p>&lsquo;&lsquo;Institution of Internal and Preventive Medicine&rdquo;</p>Russian Federation<p>ФГБНУ &laquo;Научно-исследовательский институт терапии и профилактической медицины; ФГБНУ &laquo;Научно-исследовательский институт молекулярной биологии и биофизики&raquo;</p>Россия<p>&laquo;Institution of Internal and Preventive Medicine&raquo;; The Institute of Molecular Biology and Biophysics</p>Russian Federation<p>ФГБНУ &laquo;Научно-исследовательский институт терапии и профилактической медицины&raquo;</p>Россия<p>&laquo;Institution of Internal and Preventive Medicine&raquo;</p>Russian Federation<p>ГБУЗ Новосибирской области &laquo;Новосибирский областной клинический онкологический диспансер&raquo;</p>Россия<p>&laquo;Novosibirsk Regional Clinical Oncology Center&raquo;</p>Russian Federation<p>ГБУЗ Новосибирской области "Новосибирский областной клинический онкологический диспансер"</p>Россия<p>&laquo;Novosibirsk Regional Clinical Oncology Center&raquo;</p>Russian Federation2017150920171422432Copyright &#x00A9; Никитенко Т.М., Щербакова Л.В., Малютина С.К., Мустафина С.В., Веревкин Е.Г., Рагино Ю.И., Войцицкий В.Е., Пятибратова А.В., Рымар О.Д., 20172017Никитенко Т.М., Щербакова Л.В., Малютина С.К., Мустафина С.В., Веревкин Е.Г., Рагино Ю.И., Войцицкий В.Е., Пятибратова А.В., Рымар О.Д.Nikitenko T.M., Shcherbakova L.V., Malyutina S.K., Mustafina S.V., Verevkin E.G., Ragino Y.I., Voytsitsky V.E., Pyatibratova A.V., Rymar O.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/8178Цель работы

Цель работы. Оценить прогностическую значимость метаболического синдрома (МС) в развитии колоректального рака (КРР) в популяции г. Новосибирска с учетом применения различных критериев МС.

Материалы и методы

Материалы и методы. Исследование выполнено по дизайну гнездовой «случай-контроль». Популяционная когорта (9360 мужчин и женщин 45–69 лет) была обследована в проекте HAPIEE и наблюдалась в течение 11 лет. В группу «случай» включены все лица, перенесшие КРР в течение 11 лет наблюдения, по данным Регистра онкологических заболеваний (n=99, м. 52, ж. 47). Парный контроль (2/1) также селектирован из участников когорты HAPIEE (n=198, м. 104, ж. 94). Проспективное исследование КРР поддержано Российским научным фондом (РНФ). Критерии МС были определены согласно ВНОК (2009), IDF (2005), NCEP ATP III (2001). Использован статистический пакет SPSS v.11.0. Для оценки связи МС и КРР был использован метод логистической регрессии.

Результаты

Результаты. У женщин с уровнем глюкозы ≥6,1 ммоль/л 11-летний риск развития КРР увеличивается в 3 раза по сравнению c уровнем <6,1 ммоль/л (OR=3,11; 95% CI: 1,23–7,87 по ВНОК, 2009 и OR=3,20; 95% CI: 1,27–8,08 по NCEP ATP III, 2001). Уровень артериального давления (АД) ≥130/85 мм рт. ст. ассоциировался со снижением риска КРР у женщин и у лиц обоего пола, но значимость связи не сохранялась при учете гипотензивной терапии. Другие компоненты МС достоверно не были связаны с риском развития КРР.

Выводы

Выводы. В изученной выборке 11-летний риск развития КРР достоверно увеличивается у женщин с повышенным уровнем глюкозы. У женщин и лиц обоего пола негативная связь АД с риском КРР нивелируется при учете гипотензивной терапии, что нуждается в дальнейшем изучении.

 

 

Objective

Objective. To evaluate the prognostic significance of metabolic syndrome (MS) in the development of colorectal cancer (CRC) using various MS criteria in Novosibirsk population.

Materials and Methods

Materials and Methods. The study was designed as nested «case-control». Baseline population cohort (9360 men, women aged 45–69) was examined in the HAPIEE project and followed-up during 11 years. The “cases” included all subjects, who had CRC during 11-year follow-up according to the Register of Cancer (n=99, M-52, M-47). The matched control group (2/1) was selected from HAPIEE cohort (n=198, m-104, w-94). The prospective study of CRC was supported by RSF. MS criteria were determined in accordance to VNOK (2009), IDF (2005), NCEP ATP III (2001). Statistical package SPSS v.11.0 was used. Logistic regression was used to estimate the association between MS and risk of CRC.

Results

Results. Women with glucose levels ≥6.1 mmol/l had 3 times higher 11-year risk of CRC then those with glucose <6.1 mmol/l (OR=3.11;

95%CI

95%CI:1.23–7.87, VNOK, 2009; OR=3.20; 95%CI:1.27–8.08, NCEP ATP III, 2001). Blood pressure (BP) ≥130/85 mmHg was associated with decreased risk of CRC in women and in both sexes, but the relationship became insignificant after controlling for antihypertensive treatment. Other components of the MS were not significantly associated with CRC risk.

Conclusions

Conclusions. In studied sample the 11-year risk of developing CRC was significantly increased in women with elevated glucose levels. The negative relationship between elevated BP and the risk of CRC in women and both sexes became insignificant when adjusted for antihypertensive treatment; this finding requires further exploration.

метаболический синдромколоректальный раккомпоненты метаболического синдромарак ободочной и прямой кишки.metabolic syndromecolorectal cancerthe components of the metabolic syndromecolon and rectum cancerReferencesСимонова ГИ, Мустафина СВ, Печенкина ЕА. Распространенность метаболического синдрома в Сибири: популяционное исследование в г. Новосибирске. Бюллетень СО РАМН. 2011;(5):100-106 Симонова Г.И., Мустафина С.В., Печенкина Е.А. Распространенность метаболического синдрома в Сибири: популяционное исследование в г. Новосибирске //Сибирский научный медицинский журнал. – 2011. – Т. 31. – №. 5. – C. 100-106/ [Simonova GA, Mustafina SV, Pechenkina EA. Rasprostranennost’ metabolicheskogo sindroma v Sibiri: populyatsionnoe issledovanie v g. Novosibirske. Sibirskiy nauchnyy meditsinskiy zhurnal. 2011;31(5):100-106. (In Russ.)].Симонова ГИ, Мустафина СВ, Печенкина ЕА. Распространенность метаболического синдрома в Сибири: популяционное исследование в г. Новосибирске. Бюллетень СО РАМН. 2011;(5):100-106 Симонова Г.И., Мустафина С.В., Печенкина Е.А. Распространенность метаболического синдрома в Сибири: популяционное исследование в г. Новосибирске //Сибирский научный медицинский журнал. – 2011. – Т. 31. – №. 5. – C. 100-106/ [Simonova GA, Mustafina SV, Pechenkina EA. Rasprostranennost’ metabolicheskogo sindroma v Sibiri: populyatsionnoe issledovanie v g. Novosibirske. Sibirskiy nauchnyy meditsinskiy zhurnal. 2011;31(5):100-106. (In Russ.)].Mozumdar A, Liguori G. Persistent Increase of Prevalence of Metabolic Syndrome Among U.S. Adults: NHANES III to NHANES 1999-2006. Diabetes Care. 2010;34(1):216-219. doi: 10.2337/dc10-0879.Mozumdar A, Liguori G. Persistent Increase of Prevalence of Metabolic Syndrome Among U.S. Adults: NHANES III to NHANES 1999-2006. Diabetes Care. 2010;34(1):216-219. doi: 10.2337/dc10-0879.Alegría E, Cordero A, Laclaustra M, et al. Prevalence of Metabolic Syndrome in the Spanish Working Population: MESYAS Registry. Revista Española de Cardiología (English Edition). 2005;58(7):797-806. doi: 10.1016/s1885-5857(06)60508-2.Alegría E, Cordero A, Laclaustra M, et al. Prevalence of Metabolic Syndrome in the Spanish Working Population: MESYAS Registry. Revista Española de Cardiología (English Edition). 2005;58(7):797-806. doi: 10.1016/s1885-5857(06)60508-2.Hildrum B, Mykletun A, Hole T, et al. Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study. BMC Public Health. 2007;7(1). doi: 10.1186/1471-2458-7-220.Hildrum B, Mykletun A, Hole T, et al. Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study. BMC Public Health. 2007;7(1). doi: 10.1186/1471-2458-7-220.Bhowmik B, Afsana F, Siddiquee T, et al. Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and Inte. Journal of Diabetes Investigation. 2015;6(3):280-288. doi: 10.1111/jdi.12268.Bhowmik B, Afsana F, Siddiquee T, et al. Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and Inte. Journal of Diabetes Investigation. 2015;6(3):280-288. doi: 10.1111/jdi.12268.Khoo CM, Liew CF, Chew SK, Tai ES. The Impact of Central Obesity as a Prerequisite for the Diagnosis of Metabolic Syndrome*. Obesity. 2007;15(1):262-269. doi: 10.1038/oby.2007.559.Khoo CM, Liew CF, Chew SK, Tai ES. The Impact of Central Obesity as a Prerequisite for the Diagnosis of Metabolic Syndrome*. Obesity. 2007;15(1):262-269. doi: 10.1038/oby.2007.559.Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. Journal of Cardiovascular Disease Research. 2012;3(3):204-211. doi: 10.4103/0975-3583.98895.Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. Journal of Cardiovascular Disease Research. 2012;3(3):204-211. doi: 10.4103/0975-3583.98895.Wang G-R, Li L, Pan Y-H, et al. Prevalence of metabolic syndrome among urban community residents in China. BMC Public Health. 2013;13(1). doi: 10.1186/1471-2458-13-599.Wang G-R, Li L, Pan Y-H, et al. Prevalence of metabolic syndrome among urban community residents in China. BMC Public Health. 2013;13(1). doi: 10.1186/1471-2458-13-599.Ninomiya JK. Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2003;109(1):42-46. doi: 10.1161/01.cir.0000108926.04022.0c.Ninomiya JK. Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2003;109(1):42-46. doi: 10.1161/01.cir.0000108926.04022.0c.Shin J-A, Lee J-H, Lim S-Y, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. Journal of Diabetes Investigation. 2013;4(4):334-343. doi: 10.1111/jdi.12075.Shin J-A, Lee J-H, Lim S-Y, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. Journal of Diabetes Investigation. 2013;4(4):334-343. doi: 10.1111/jdi.12075.Ahmed RL, Schmitz KH, Anderson KE, et al. The metabolic syndrome and risk of incident colorectal cancer. Cancer. 2006;107(1):28-36. doi: 10.1002/cncr.21950.Ahmed RL, Schmitz KH, Anderson KE, et al. The metabolic syndrome and risk of incident colorectal cancer. Cancer. 2006;107(1):28-36. doi: 10.1002/cncr.21950.Chiu HM, Lin JT, Shun CT, et al. Association of Metabolic Syndrome With Proximal and Synchronous Colorectal Neoplasm. Clinical Gastroenterology and Hepatology. 2007;5(2):221-229. doi: 10.1016/j.cgh.2006.06.022.Chiu HM, Lin JT, Shun CT, et al. Association of Metabolic Syndrome With Proximal and Synchronous Colorectal Neoplasm. Clinical Gastroenterology and Hepatology. 2007;5(2):221-229. doi: 10.1016/j.cgh.2006.06.022.Furberg AS, Veierod MB, Wilsgaard T, et al. Serum High-Density Lipoprotein Cholesterol, Metabolic Profile, and Breast Cancer Risk. JNCI Journal of the National Cancer Institute. 2004;96(15):1152-1160. doi: 10.1093/jnci/djh216.Furberg AS, Veierod MB, Wilsgaard T, et al. Serum High-Density Lipoprotein Cholesterol, Metabolic Profile, and Breast Cancer Risk. JNCI Journal of the National Cancer Institute. 2004;96(15):1152-1160. doi: 10.1093/jnci/djh216.Pollak MN. Insulin, insulin-like growth factors, insulin resistance, and neoplasia. The American Journal of Clinical Nutrition. 2007;86(3):820S-821S.Pollak MN. Insulin, insulin-like growth factors, insulin resistance, and neoplasia. The American Journal of Clinical Nutrition. 2007;86(3):820S-821S.Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные образования в России в 2013 году (заболеваемость и смертность) // М.: МНИОИ им. ПА Герцена–филиал ФГБУ «ФМИЦ им. ПА Герцена» Министерства здравоохранения РФ. – 2015. [Kaprin AD, Starinskiy VV, Petrova GV. Zlokachestvennye obrazovaniya v Rossii v 2013 godu (zabolevaemost’ i smertnost’). Moscow: MNIOI im. PA Gertsena–filial FGBU «FMITs im. PA Gertsena» Ministerstva zdravookhraneniya RF. 2015 (In Russ.)]Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные образования в России в 2013 году (заболеваемость и смертность) // М.: МНИОИ им. ПА Герцена–филиал ФГБУ «ФМИЦ им. ПА Герцена» Министерства здравоохранения РФ. – 2015. [Kaprin AD, Starinskiy VV, Petrova GV. Zlokachestvennye obrazovaniya v Rossii v 2013 godu (zabolevaemost’ i smertnost’). Moscow: MNIOI im. PA Gertsena–filial FGBU «FMITs im. PA Gertsena» Ministerstva zdravookhraneniya RF. 2015 (In Russ.)]GLOBOCAN estimated cancer incidence, mortality and prevalence worldwide in 2012; available at http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx ссылка активна на 01.03.2017GLOBOCAN estimated cancer incidence, mortality and prevalence worldwide in 2012; available at http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx ссылка активна на 01.03.2017Давыдов М. И., Аксель Е. М. Статистика злокачественных новообразований в России и странах СНГ в 2009 г //Вестник РОНц им. НН Блохина РАМН. – 2009. – Т. 20. – №. 3. – С. 1-158. [Davydov M, Aksel’ E. Statistika zlokachestvennykh novoobrazovaniy v Rossii i stranakh SNG v 2009 g. JOURNAL of N. N. Blokhin Russian Cancer Research Center RAMS. 2009;20(3):1-158. (In Russ.)].Давыдов М. И., Аксель Е. М. Статистика злокачественных новообразований в России и странах СНГ в 2009 г //Вестник РОНц им. НН Блохина РАМН. – 2009. – Т. 20. – №. 3. – С. 1-158. [Davydov M, Aksel’ E. Statistika zlokachestvennykh novoobrazovaniy v Rossii i stranakh SNG v 2009 g. JOURNAL of N. N. Blokhin Russian Cancer Research Center RAMS. 2009;20(3):1-158. (In Russ.)].Moghaddam AA, Woodward M, Huxley R. Obesity and Risk of Colorectal Cancer: A Meta-analysis of 31 Studies with 70,000 Events. Cancer Epidemiology Biomarkers & Prevention. 2007;16(12):2533-2547. doi: 10.1158/1055-9965.epi-07-0708.Moghaddam AA, Woodward M, Huxley R. Obesity and Risk of Colorectal Cancer: A Meta-analysis of 31 Studies with 70,000 Events. Cancer Epidemiology Biomarkers & Prevention. 2007;16(12):2533-2547. doi: 10.1158/1055-9965.epi-07-0708.Aleksandrova K, Boeing H, Jenab M, et al. Metabolic Syndrome and Risks of Colon and Rectal Cancer: The European Prospective Investigation into Cancer and Nutrition Study. Cancer Prevention Research. 2011;4(11):1873-1883. doi: 10.1158/1940-6207.capr-11-0218.Aleksandrova K, Boeing H, Jenab M, et al. Metabolic Syndrome and Risks of Colon and Rectal Cancer: The European Prospective Investigation into Cancer and Nutrition Study. Cancer Prevention Research. 2011;4(11):1873-1883. doi: 10.1158/1940-6207.capr-11-0218.Kim JH, Lim YJ, Kim YH, et al. Is Metabolic Syndrome A Risk Factor for Colorectal Adenoma? Cancer Epidemiology Biomarkers &amp; Prevention. 2007;16(8):1543-1546. doi: 10.1158/1055-9965.epi-07-0199.Kim JH, Lim YJ, Kim YH, et al. Is Metabolic Syndrome A Risk Factor for Colorectal Adenoma? Cancer Epidemiology Biomarkers &amp; Prevention. 2007;16(8):1543-1546. doi: 10.1158/1055-9965.epi-07-0199.Trabulo D. Metabolic syndrome and colorectal neoplasms: An ominous association. World Journal of Gastroenterology. 2015;21(17):5320. doi: 10.3748/wjg.v21.i17.5320.Trabulo D. Metabolic syndrome and colorectal neoplasms: An ominous association. World Journal of Gastroenterology. 2015;21(17):5320. doi: 10.3748/wjg.v21.i17.5320.Keimling M, Renehan AG, Behrens G, et al. Comparison of Associations of Body Mass Index, Abdominal Adiposity, and Risk of Colorectal Cancer in a Large Prospective Cohort Study. Cancer Epidemiology Biomarkers & Prevention. 2013;22(8):1383-1394. doi: 10.1158/1055-9965.epi-13-0353.Keimling M, Renehan AG, Behrens G, et al. Comparison of Associations of Body Mass Index, Abdominal Adiposity, and Risk of Colorectal Cancer in a Large Prospective Cohort Study. Cancer Epidemiology Biomarkers & Prevention. 2013;22(8):1383-1394. doi: 10.1158/1055-9965.epi-13-0353.Pischon T, Lahmann PH, Boeing H, et al. Body Size and Risk of Colon and Rectal Cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). JNCI Journal of the National Cancer Institute. 2006;98(13):920-931. doi: 10.1093/jnci/djj246.Pischon T, Lahmann PH, Boeing H, et al. Body Size and Risk of Colon and Rectal Cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). JNCI Journal of the National Cancer Institute. 2006;98(13):920-931. doi: 10.1093/jnci/djj246.Forootan M, Tabatabaeefar M, Yahyaei M, Maghsoodi N. Metabolic Syndrome and Colorectal Cancer: A Cross-Sectional Survey. Asian Pacific Journal of Cancer Prevention. 2012;13(10):4999-5002. doi: 10.7314/apjcp.2012.13.10.4999.Forootan M, Tabatabaeefar M, Yahyaei M, Maghsoodi N. Metabolic Syndrome and Colorectal Cancer: A Cross-Sectional Survey. Asian Pacific Journal of Cancer Prevention. 2012;13(10):4999-5002. doi: 10.7314/apjcp.2012.13.10.4999.Amirkalali B, Fakhrzadeh H, Sharifi F, et al. Prevalence of Metabolic Syndrome and Its Components in the Iranian Adult Population: A Systematic Review and Meta-Analysis. Iranian Red Crescent Medical Journal. 2015;17(12). doi: 10.5812/ircmj.24723.Amirkalali B, Fakhrzadeh H, Sharifi F, et al. Prevalence of Metabolic Syndrome and Its Components in the Iranian Adult Population: A Systematic Review and Meta-Analysis. Iranian Red Crescent Medical Journal. 2015;17(12). doi: 10.5812/ircmj.24723.Ulaganathan V, Kandiah M, Zalilah MS, et al. Colorectal Cancer and its Association with the Metabolic Syndrome: a Malaysian Multi-Centric Case-Control Study. Asian Pacific Journal of Cancer Prevention. 2012;13(8):3873-3877. doi: 10.7314/apjcp.2012.13.8.3873.Ulaganathan V, Kandiah M, Zalilah MS, et al. Colorectal Cancer and its Association with the Metabolic Syndrome: a Malaysian Multi-Centric Case-Control Study. Asian Pacific Journal of Cancer Prevention. 2012;13(8):3873-3877. doi: 10.7314/apjcp.2012.13.8.3873.Aguilar M, Bhuket T, Torres S, et al. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. Jama. 2015;313(19):1973. doi: 10.1001/jama.2015.4260.Aguilar M, Bhuket T, Torres S, et al. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. Jama. 2015;313(19):1973. doi: 10.1001/jama.2015.4260.Jinjuvadia R, Lohia P, Jinjuvadia C, et al. The Association Between Metabolic Syndrome and Colorectal Neoplasm. Journal of Clinical Gastroenterology. 2013;47(1):33-44. doi: 10.1097/MCG.0b013e3182688c15.Jinjuvadia R, Lohia P, Jinjuvadia C, et al. The Association Between Metabolic Syndrome and Colorectal Neoplasm. Journal of Clinical Gastroenterology. 2013;47(1):33-44. doi: 10.1097/MCG.0b013e3182688c15.Alfa-Wali M, Boniface S, Sharma A, et al. Metabolic Syndrome (Mets) and Risk of Colorectal Cancer (CRC): A Systematic Review and Meta-Analysis. World Journal of Surgical Medical and Radiation Oncology. 2015;4(7) :41-52.Alfa-Wali M, Boniface S, Sharma A, et al. Metabolic Syndrome (Mets) and Risk of Colorectal Cancer (CRC): A Systematic Review and Meta-Analysis. World Journal of Surgical Medical and Radiation Oncology. 2015;4(7) :41-52.Esposito K, Chiodini P, Capuano A, et al. Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine. 2013;44(3):634-647. doi: 10.1007/s12020-013-9939-5.Esposito K, Chiodini P, Capuano A, et al. Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine. 2013;44(3):634-647. doi: 10.1007/s12020-013-9939-5.Stocks T, Lukanova A, Bjørge T, et al. Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me-Can). Cancer. 2011;117(11):2398-2407. doi: 10.1002/cncr.25772.Stocks T, Lukanova A, Bjørge T, et al. Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me-Can). Cancer. 2011;117(11):2398-2407. doi: 10.1002/cncr.25772.Inoue M, Noda M, Kurahashi N, et al. Impact of metabolic factors on subsequent cancer risk: results from a large-scale population-based cohort study in Japan. European Journal of Cancer Prevention. 2009;18(3):240-247. doi: 10.1097/CEJ.0b013e3283240460.Inoue M, Noda M, Kurahashi N, et al. Impact of metabolic factors on subsequent cancer risk: results from a large-scale population-based cohort study in Japan. European Journal of Cancer Prevention. 2009;18(3):240-247. doi: 10.1097/CEJ.0b013e3283240460.Tsilidis KK, Brancati FL, Pollak MN, et al. Metabolic syndrome components and colorectal adenoma in the CLUE II cohort. Cancer Causes & Control. 2009;21(1):1-10. doi: 10.1007/s10552-009-9428-6.Tsilidis KK, Brancati FL, Pollak MN, et al. Metabolic syndrome components and colorectal adenoma in the CLUE II cohort. Cancer Causes & Control. 2009;21(1):1-10. doi: 10.1007/s10552-009-9428-6.Moore LL, Bradlee ML, Singer MR, et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. International Journal of Obesity. 2004;28(4):559-567. doi: 10.1038/sj.ijo.0802606.Moore LL, Bradlee ML, Singer MR, et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. International Journal of Obesity. 2004;28(4):559-567. doi: 10.1038/sj.ijo.0802606.Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. The American Journal of Clinical Nutrition. 2007;86(3):556-565.Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. The American Journal of Clinical Nutrition. 2007;86(3):556-565.Karahalios A, Simpson JA, Baglietto L, et al. Change in weight and waist circumference and risk of colorectal cancer: results from the Melbourne Collaborative Cohort Study. BMC Cancer. 2016;16(1). doi: 10.1186/s12885-016-2144-1.Karahalios A, Simpson JA, Baglietto L, et al. Change in weight and waist circumference and risk of colorectal cancer: results from the Melbourne Collaborative Cohort Study. BMC Cancer. 2016;16(1). doi: 10.1186/s12885-016-2144-1.Yao X, Tian Z. Dyslipidemia and colorectal cancer risk: a meta-analysis of prospective studies. Cancer Causes & Control. 2014;26(2):257-268. doi: 10.1007/s10552-014-0507-y.Yao X, Tian Z. Dyslipidemia and colorectal cancer risk: a meta-analysis of prospective studies. Cancer Causes & Control. 2014;26(2):257-268. doi: 10.1007/s10552-014-0507-y.Tabuchi M, Kitayama J, Nagawa H. Hyperglycemia and hypertriglyceridemia may associate with the adenoma–carcinoma transition in colorectal epithelial cells. Journal of Gastroenterology and Hepatology. 2008;23(6):985-987. doi: 10.1111/j.1440-1746.2007.05072.x.Tabuchi M, Kitayama J, Nagawa H. Hyperglycemia and hypertriglyceridemia may associate with the adenoma–carcinoma transition in colorectal epithelial cells. Journal of Gastroenterology and Hepatology. 2008;23(6):985-987. doi: 10.1111/j.1440-1746.2007.05072.x.Schoen RE, Tangen CM, Kuller LH, et al. Increased Blood Glucose and Insulin, Body Size, and Incident Colorectal Cancer. JNCI Journal of the National Cancer Institute. 1999;91(13):1147-1154. doi: 10.1093/jnci/91.13.1147.Schoen RE, Tangen CM, Kuller LH, et al. Increased Blood Glucose and Insulin, Body Size, and Incident Colorectal Cancer. JNCI Journal of the National Cancer Institute. 1999;91(13):1147-1154. doi: 10.1093/jnci/91.13.1147.Oh S-W, Kim Y-H, Choi YS, et al. The Comparison of the Risk Factors and Clinical Manifestations of Proximal and Distal Colorectal Cancer. Diseases of the Colon & Rectum. 2008;51(1):56-61. doi: 10.1007/s10350-007-9083-5.Oh S-W, Kim Y-H, Choi YS, et al. The Comparison of the Risk Factors and Clinical Manifestations of Proximal and Distal Colorectal Cancer. Diseases of the Colon & Rectum. 2008;51(1):56-61. doi: 10.1007/s10350-007-9083-5.Yang Y, Hennessy S, Lewis J. Type 2 Diabetes Mellitus and the Risk of Colorectal Cancer. Clinical Gastroenterology and Hepatology. 2005;3(6):587-594. doi: 10.1016/s1542-3565(05)00152-7.Yang Y, Hennessy S, Lewis J. Type 2 Diabetes Mellitus and the Risk of Colorectal Cancer. Clinical Gastroenterology and Hepatology. 2005;3(6):587-594. doi: 10.1016/s1542-3565(05)00152-7.

The authors declare that there are no conflicts of interest present.