Metabolic health is a determining factor for incident colorectal cancer in the obese population: A nationwide population‐based cohort study

Abstract

Background The association of the risk of colorectal cancer (CRC) with obesity or obesity‐induced metabolic disturbances remains controversial. We assessed the association of metabolic health status with incident CRC among subjects with obesity. Methods This study included 319,397 subjects from the Korean National Health Insurance Service‐National Health Screening Cohort. Transitions in metabolic health status and obesity were examined during 2009–2010 and 2011–2012. We categorized subjects with obesity into four separate groups according to their dynamic metabolic health status: metabolically healthy obesity (MHO), MHO to metabolically unhealthy obesity (MUO), MUO to MHO, and stable MUO. Subjects were followed up from 2009 to 2015 for incident CRC. Results The stable MHO group showed no increased risk of incident CRC (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.83–1.14). However, the MHO to MUO group had a higher risk of incident CRC than the stable metabolically healthy nonobese (MHNO) group (HR, 1.34; 95% CI, 1.15–1.57). Among patients with MUO at baseline, those in the subgroup who transitioned to MHO group were not at increased risk of CRC (HR, 1.06; 95% CI, 0.91–1.25), whereas those who remained in the stable MUO group had a higher risk of incident CRC than those in the stable MHNO group (HR, 1.29; 95% CI, 1.19–1.41). Conclusions The transition of metabolic health was a determining factor for CRC among subjects with obesity. Hence, maintenance or recovery of metabolic health should be addressed to prevent CRC in individuals with obesity.

Association between cardiovascular risk factors and colorectal cancer: A systematic review and meta-analysis of prospective cohort studies

“…Although obesity has been an established risk factor for CRC, it often coexists with other metabolic abnormalities such hyperglycemia, dyslipidemia and hypertension, which may mediate this association between obesity and CRC risk [34][35][36] . Recent studies found that obese individuals without metabolic abnormalities which were referred to "metabolically health obesity (MHO) " had no increased risk of incident CRC whereas those with "metabolically unhealthy obesity (MUO)" showed a higher risk of CRC, raising special concern of MUO [35] . Consistent with these findings, our study included obese individuals with at least one of metabolic abnormalities and did observe a 31% greater risk of CRC.…”

Metabolic phenotypes and risk of colorectal cancer: a systematic review and meta-analysis of cohort studies

“…1. Finally, 7 cohort studies [13,[20][21][22][23][24][25], with a total sample size of 759,066 participants met eligibility criteria to be included in this meta-analysis. The studies had been published between 2014 and 2020.…”

“…The outcome was colorectal cancer in all studies except for the study by Moore et al [23], which assessed specifically colon cancer. Data for the risk of colorectal cancer for individuals with MUHNW, MHO, and MUHO, compared with subjects with MHNW, were reported in 7 studies with 9 data sets [13,[20][21][22][23][24][25] and 6 studies with 8 data sets [13,20,21,[23][24][25]. The definition of metabolically unhealthy phenotype was according to the presence of metabolic syndrome [13,[20][21][22], and having elevated blood glucose (> 125 mg/dL) [23],…”

The Adipokine Component in the Molecular Regulation of Cancer Cell Survival, Proliferation and Metastasis

“…It is recently reported that the increasing bulk of fat in obesity is not the independent contributor to cancer pathogenesis. A cohort study on 319,397 Korean subjects has suggested that the people with obesity derived metabolic derangements are at relatively higher risk of colorectal cancer [ 18 ]. Despite of the high body mass index, the risk of colorectal cancers and cardiovascular ailments was remarkably minimum in a sub-population of obese subjects who did not show metabolic dysregulations such as high blood pressure, hyperinsulinemia, dyslipidemia, and insulin resistance.…”