Abstract
BACKGROUND: Metabolic syndrome (MetS) is a worldwide pandemic and complex disorder associated with colorectal cancer (CRC). This study aims to identify the influence of number of MetS components on CRC incidence and mortality, using a national, longitudinal dataset of hospital care in Taiwan. METHODS: Patient data from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2008 were extracted. Individuals with at least one inpatient diagnosis or 2 outpatient visits with any MetS component found within one year were identified and included. Subjects died within 12 months after the presence of MetS components or had any prior cancer were excluded. The study cohort were then divided into two groups: subjects who had more (i.e., 3 to 4) MetS components and those who had fewer (i.e., 1 to 2) MetS components. An 2:1 propensity score (PS) matching were performed to balance the baseline characteristics between the groups. Cox regression analyses were conducted to compare the CRC incidence and all-cause mortality at follow-up between subjects with more MetS components versus fewer components. RESULTS: After matching, a total of 119,843 subjects (78,274 with 1-2 and 41,569 with 3-4 MetS components) were analyzed. After adjusting for confounders, subjects with 3-4 MetS components had a significantly higher risk of CRC [adjusted hazard ratio (aHR), 1.28; 95% confidence interval (CI), 1.15-1.43, p < 0.001) and all-cause mortality (aHR, 1.13; 95% CI, 1.08-1.17, p < 0.001) than those with only 1-2 MetS components. In stratified analyses, the greatest increased risk of CRC incidence that 3-4 MetS components posed as compared to 1-2 MetS components was seen in subjects without CHD history (aHR, 1.41, 95% CI, 1.23-1.62, p < 0.001). In addition, 3-4 MetS components (vs. 1-2) led to greater all-cause mortality among the subjects < 65y, both genders, with or without CHD, subjects without CKD hisotry, both aspirin users and non-users, users of nonsteroidal anti-inflammatory drugs (NSAIDs), and users of statin. CONCLUSION: Compared with 1-2 components, subjects with 3-4 MetS components are at greater risk of CRC and death at follow-up. This study also demonstrates the risks for CRC and all-cause mortality in certain subgroups of individuals with 3-4 MetS components compared to 1-2 components. These findings may help clinicians on the CRC risk stratification according to individuals' characteristics, as well as to optimize the strategy of MetS surveillance and control in order to prevent CRC.