Metabolic syndrome may be linked to pancreatic cancer risk

A nationwide cohort study in Korea found that risk for pancreatic cancer decreased in patients whose metabolic syndrome improved versus persisted over time.

Improvement in components of the metabolic syndrome (MetS) was associated with decreased risk for pancreatic cancer, a recent study found.

Researchers performed a nationwide cohort study of adults without cancer who had two consecutive biennial health screenings from the Korean National Health Insurance System between 2009 and 2012 and were followed until 2017. Patients were considered to have MetS if they had three of its five components: elevated waist circumference, elevated triglyceride levels or use of a relevant drug, reduced high-density lipoprotein cholesterol levels or use of a relevant drug, elevated blood pressure or use of antihypertensive medications, and elevated fasting plasma glucose levels or use of an antidiabetic drug. The goal of the study was to examine the effects of changes in and persistence of MetS on pancreatic cancer risk, with development of pancreatic cancer as the primary outcome. Results were published Oct. 12 by Gastroenterology.

The study involved 8,203,492 patients and more than 40 million person-years of follow-up, with a median follow-up duration of 5.1 years. Mean age was 49.8 years, and 56.7% of patients were men. Patients were categorized as MetS-free if they did not meet MetS criteria at either screening, MetS-recovered if they met criteria at the first screening but not the second, MetS-developed if they did not meet criteria at the first screening but did at the second, or MetS-persistent if they met criteria at both screenings. Over two years, 18.1% of the study population had a change in MetS status; of the 2,017,735 patients who had MetS at the first screening, 31.6% had recovered at the second screening, while 13.6% of the 6,185,757 people without MetS at the first screening had developed it by the second.

During follow-up, 8,010 patients developed pancreatic cancer. After adjustment for potential confounders, compared with the MetS-free group, those in the MetS-persistent group were at highest risk for pancreatic cancer (hazard ratio [HR], 1.30; 95% CI, 1.23 to 1.37), followed by the MetS-developed group (HR, 1.17; 95% CI, 1.09 to 1.25) and the MetS-recovered group (HR, 1.12; 95% CI, 1.04 to 1.21) (P<0.001 for trend). Patient sex or presence of obesity did not appear to affect the association between changes in MetS status and pancreatic cancer risk (P>0.05 for all interactions). Patients who had all five components of MetS at baseline had a 57% higher risk for pancreatic cancer than those who did not (HR, 1.57; 95% CI, 1.39 to 1.76).

Selection bias was possible, the results may not be generalizable to other populations, and the analysis did not consider type of pancreatic cancer, among other limitations, the authors noted. They concluded that MetS was independently associated with increased risk for pancreatic cancer, that persistent MetS appeared to confer the highest risk, and that recovering from MetS was associated with decreased risk. “Our findings suggest that MetS may be a modifiable risk factor for pancreatic cancer and that efforts to remain free of MetS or recover from MetS may lower the risk of pancreatic cancer development,” the authors wrote. “Future studies are warranted to investigate whether reversing MetS can reduce the risk of developing pancreatic cancer in other ethnic groups.”