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Changes in Metabolic Syndrome Status are Associated With Altered Risk of Pancreatic Cancer: A Nationwide Cohort Study

  • Author Footnotes
    ∗ Authors share co-first authorship.
    Joo-Hyun Park
    Footnotes
    ∗ Authors share co-first authorship.
    Affiliations
    Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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  • Author Footnotes
    ∗ Authors share co-first authorship.
    Kyungdo Han
    Footnotes
    ∗ Authors share co-first authorship.
    Affiliations
    Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
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  • Jung Yong Hong
    Affiliations
    Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Young Suk Park
    Correspondence
    Jung Yong Hong, MD, PhD, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
    Affiliations
    Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Kyu Yeon Hur
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Gunseog Kang
    Affiliations
    Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
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  • Joon Oh Park
    Correspondence
    Correspondence Address correspondence to: Joon Oh Park, MD, PhD, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
    Affiliations
    Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Author Footnotes
    ∗ Authors share co-first authorship.
Published:October 12, 2021DOI:https://doi.org/10.1053/j.gastro.2021.09.070

      Background and Aims

      Metabolic syndrome (MetS) is reversible; however, the effect of changes in MetS status on pancreatic cancer risk is unknown. We aimed to investigate the effects of changes and persistence in MetS status on pancreatic cancer risk.

      Methods

      This nationwide cohort study included 8,203,492 adults without cancer who underwent 2 consecutive biennial health screenings provided by the Korean National Health Insurance System between 2009 and 2012 and were followed up until 2017. MetS was defined as the presence of 3 of its 5 components, which were evaluated at 2 consecutive biennial health screenings. Participants were categorized into the MetS-free, MetS-recovered, MetS-developed, or MetS-persistent group. Multivariable Cox proportional hazards regression models were used.

      Results

      During the 40,464,586 person-years of follow-up (median, 5.1 years), 8010 individuals developed pancreatic cancer. Compared with the MetS-free group, the MetS-persistent group had the highest risk of pancreatic cancer (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.23–1.37), followed by the MetS-developed group (HR, 1.17; 95% CI, 1.09–1.25) and the MetS-recovered group (HR, 1.12; 95% CI, 1.04–1.21) after adjusting for potential confounders (P for trend <.001). The MetS-recovered group was associated with a lower risk of pancreatic cancer than that in the MetS-persistent group (P < .001). The association between changes in MetS status and pancreatic cancer risk did not differ according to sex or obesity (all P for interactions >.05).

      Conclusions

      In this study, recovering from MetS was associated with a reduced risk of pancreatic cancer compared with persistent MetS, suggesting that pancreatic cancer risk can be altered by changes in MetS.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      AHA (American Heart Association), aHR (▪▪▪), BMI (body mass index), CI (confidence intervals), HDL-C (high-density lipoprotein cholesterol), HR (hazard ratio), ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification), IDF (International Diabetes Federation), MetS (metabolic syndrome), NHIS (National Health Insurance Service), NHLBI (National Heart, Lung, and Blood Institute), S1 (first screening date), S2 (second screening date), S3 (third screening date)
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