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Systematic review and meta-analysis: Associations between metabolic syndrome and colorectal neoplasia outcomes

Lookup NU author(s): Dr Liya Lu, Dr Sara Koo, Professor Stuart McPhersonORCiD, Professor Colin Rees, Professor Linda Sharp


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© 2022 The Association of Coloproctology of Great Britain and Ireland. Aim: Metabolic syndrome (MetS) is a cluster of factors including obesity, hypertension, diabetes, hypercholesterolemia and hyperlipidaemia. It has been associated with an increased risk of colorectal neoplasia. This systematic review and meta-analysis assessed the association between MetS and (i) recurrence of adenomas or occurrence of CRC in patients with prior adenomas, and (ii) survival in patients with CRC. Method: MEDLINE, Embase, Scopus and Web of Science were searched up to 22 November 2019. Two authors independently conducted title and abstract screening; full text of eligible studies was evaluated. Where ≥3 studies reported effect measures for a specific outcome, meta-analysis using random effects model was conducted. I2 was used to assess between-study heterogeneity. Quality appraisal was undertaken with the Newcastle-Ottawa Score. Results: The search identified 1,764 articles, 55 underwent full text screening, resulting in a total of 15 eligible studies. Five studies reported on metachronous neoplasia, with differing outcomes precluded a meta-analysis. No consistent relationship between MetS and metachronous neoplasia was found. Ten studies reported on survival outcomes. MetS was associated with poorer CRC-specific survival (HR = 1.8, 95% CI: 1.04–3.12, I2 = 92.7%, n = 3). Progression-free survival was also worse but this did not reach statistical significance (HR = 1.12, 95% CI: 0.89–1.42, I2 = 85.6%, n = 3). There was no association with overall survival (HR = 1.04, 95% CI: 0.94–1.15, I2 = 43.7%, n = 7). Significant heterogeneity was present but subgroup analysis did not account for this. Conclusion: MetS is associated with poorer CRC-specific survival, but evidence is inconsistent on metachronous neoplasia. Further research is warranted to better understand the impact of MetS on the adenoma-carcinoma pathway.

Publication metadata

Author(s): Lu L, Koo S, McPherson S, Hull MA, Rees CJ, Sharp L

Publication type: Review

Publication status: Published

Journal: Colorectal Disease

Year: 2022

Volume: 24

Issue: 6

Pages: 681-694

Print publication date: 28/06/2022

Online publication date: 13/02/2022

Acceptance date: 12/01/2022

ISSN (print): 1462-8910

ISSN (electronic): 1463-1318

Publisher: John Wiley and Sons Inc


DOI: 10.1111/codi.16092

PubMed id: 35156283