The association of metabolic syndrome with the characteristics of colorectal adenomas

Dimitrije Damjanov; Željka Savić; Olgica Latinović Bošnjak; Žarko Krnetić; Vladimir Vračarić; Nebojša Janjić; Božidar Dejanović

doi:10.2298/VSP250117070D

Dimitrije Damjanov University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Željka Savić University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Olgica Latinović Bošnjak University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Žarko Krnetić University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Vladimir Vračarić University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Nebojša Janjić University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Božidar Dejanović University Clinical Center of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP250117070D

Keywords: adenoma;, colon;, colorectal neoplasms;, metabolic syndrome;, polyps;, risk factors

Abstract

Background/Aim. Metabolic syndrome (MetS) is associated with an increased risk of developing colorectal cancer (CRC). However, data on its relationship with colorectal adenomas (CRA), the primary precancerous lesions, remain unclear and limited in certain regions. The aim of this study was to examine the characteristics and distribution of CRA in patients with and without MetS. Methods. A cross-sectional study was conducted, including 80 patients with CRA, of whom 40 had MetS (MetS group), and 40 did not meet the criteria for MetS (control group). Demographic data, risk factors for CRC (smoking, alcohol consumption, and family history of CRC), protective factors (use of acetylsalicylic acid and nonsteroidal anti-inflammatory drugs, physical activity), and polyp characteristics (size, number, localization, and degree of advancement) were collected and compared between the two groups. The diagnosis of CRA was established by histological examination of polyp specimens retrieved during colonoscopy. The diagnosis of MetS was made if three or more of the following criteria were present: increased waist circumference (≥ 94 cm for males, or ≥ 80 cm for females); hypertriglyceridemia (≥ 1.7 mmol/L); reduced high-density lipoprotein cholesterol levels (< 1.0 mmol/L for males, or < 1.3 mmol/L for females); arterial hypertension (systolic blood pressure ≥ 130 mmHg, and/or diastolic blood pressure ≥ 85 mmHg); fasting hyperglycaemia (≥ 5.6 mmol/L). Results. The average age of the patients was 61 years. Males and females were equally present in both groups, as were all the common risk factors for CRA. There were no differences between the groups regarding adenoma size, number of detected adenomas, localization of adenomas, and the degree of histological advancement of the adenoma. Conclusion. No significant association was found between the presence of MetS and the characteristics and distribution of CRA in our study. Further studies with larger samples and biomarker analyses are needed to better understand the potential role of MetS-related factors in colorectal carcinogenesis.

References

Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer 2018; 119(7): 785–92.

Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. The Lancet 2019; 394(10207): 1467–80.

Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am 2022; 32(2): 177–94.

Kanth P, Inadomi JM. Screening and prevention of colorectal cancer. BMJ 2021; 374: n1855.

Nguyen LH, Goel A, Chung DC. Pathways of Colorectal Carcinogenesis. Gastroenterology 2020; 158(2): 291–302.

Kastrinos F, Kupfer SS, Gupta S. Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart? Gastroenterology 2023; 164(5): 812–27.

Sninsky JA, Shore BM, Lupu GV, Crockett SD. Risk Factors for Colorectal Polyps and Cancer. Gastrointest Endosc Clin N Am 2022; 32(2): 195–213.

Sawicki T, Ruszkowska M, Danielewicz A, Niedźwiedzka E, Arłukowicz T, Przybyłowicz KE. A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis. Cancers (Basel) 2021; 13(9): 2025.

Chen H, Zheng X, Zong X, Li Z, Li N, Hur J, et al. Metabolic syndrome, metabolic comorbid conditions and risk of early-onset colorectal cancer. Gut 2021; 70(6): 1147–54.

Shen X, Wang Y, Zhao R, Wan Q, Wu Y, Zhao L, et al. Metabolic syndrome and the risk of colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36(10): 2215–25.

Uzunlulu M, Telci Caklili O, Oguz A. Association between Metabolic Syndrome and Cancer. Ann Nutr Metab 2016; 68(3): 173–9.

Mili N, Paschou SA, Goulis DG, Dimopoulos MA, Lambrinoudaki I, Psaltopoulou T. Obesity, metabolic syndrome, and cancer: pathophysiological and therapeutic associations. Endocrine 2021; 74(3): 478–97.

Kim BC, Shin A, Hong CW, Sohn DK, Han KS, Ryu KH, et al. Association of colorectal adenoma with components of metabolic syndrome. Cancer Causes Control 2012; 23(5): 727–35.

Trabulo D, Ribeiro S, Martins C, Teixeira C, Cardoso C, Mangualde J, et al. Metabolic syndrome and colorectal neoplasms: An ominous association. World J Gastroenterol 2015; 21(17): 5320–7.

Milano A, Bianco MA, Buri L, Cipolletta L, Grossi E, Rotondano G, et al. Metabolic syndrome is a risk factor for colorectal adenoma and cancer: a study in a White population using the harmonized criteria. Therap Adv Gastroenterol 2019; 12: 1756284819867839.

Damjanov D, Ičin T, Savić Ž, Janjić N, Nikolić S, Bošnjak OL, et al. Visceral Fat Thickness, Serum Adiponectin, and Metabolic Syndrome in Patients with Colorectal Adenomas. J Pers Med 2024; 14(9): 1008.

Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2020; 115(3): 415–34.

World Health Organization. Waist Circumference and Waist-Hip Ratio [Internet]. Geneva: WHO; 2008 [cited 2023 Aug 26; accessed 2025 Aug 26]. Available from: https://iris.who.int/bitstream/handle/10665/44583/9789241501491_eng.pdf

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16): 1640–5.

Institute of Public Health of Vojvodina. The state of health of the inhabitants of Vojvodina in 2019 [Internet]. Novi Sad: IZJZV; 2020 [cited 2023 Sep 7; accessed 2025 Aug 26]. Available from: http://www.izjzv.org.rs/?lng=lat&cir=0&link

=4-21 (Serbian)

Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74(3): 229–63.

Institute of Public Health of Serbia “Dr Milan Jovanović Batut”. Malignant tumours in Republic of Serbia [Internet]. Beograd; 2022 [cited 2023 Sep 3; accessed 2025 Aug 26]. Available from: https://www.batut.org.rs/download/publikacije/Mali

gniTumoriuRepubliciSrbiji2020.pdf (Serbian)

Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol 2019; 16(12): 713–32.

Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology 2019; 156(1): 254–72.e11.

Corley DA, Jensen CD, Marks AR, Zhao WK, de Boer J, Levin TR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol 2013; 11(2): 172–80.

Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7(12): 1272–8.

O’Brien MJ, Winawer SJ, Zauber AG, Gottlieb LS, Sternberg SS, Diaz B, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 1990; 98(2): 371–9.

Hirode G, Wong RJ. Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016. JAMA 2020; 323(24): 2526–8.

McCashland TM, Brand R, Lyden E, de Garmo P; CORI Research Project. Gender differences in colorectal polyps and tumors. Am J Gastroenterol 2001; 96(3): 882–6.

Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355(18): 1863–72.

Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty BM, et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110(1): 72–90.

Wu H, Zhang J, Zhou B. Metabolic syndrome and colorectal adenoma risk: A systematic review and meta analysis. Clin Res Hepatol Gastroenterol 2021; 45(5): 101749.

Mendonça FM, de Sousa FR, Barbosa AL, Martins SC, Araújo RL, Soares R, et al. Metabolic syndrome and risk of cancer: Which link? Metabolism. 2015; 64(2): 182–9.

Keum N, Lee DH, Kim R, Greenwood DC, Giovannucci EL. Visceral adiposity and colorectal adenomas: dose-response meta-analysis of observational studies. Ann Oncol 2015; 26(6): 1101–9.

Chiu HM, Lin JT, Shun CT, Liang JT, Lee YC, Huang SP, et al. Association of metabolic syndrome with proximal and synchronous colorectal neoplasm. Clin Gastroenterol Hepatol 2007; 5(2): 221–9.

Kim JH, Lim YJ, Kim YH, Sung IK, Shim SG, Oh SO, et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol Biomarkers Prev 2007; 16(8): 1543–6.

Morita T, Tabata S, Mineshita M, Mizoue T, Moore MA, Kono S. The metabolic syndrome is associated with increased risk of colorectal adenoma development: the Self-Defense Forces health study. Asian Pac J Cancer Prev 2005; 6(4): 485–9.