Metabolic syndrome in adult cancer survivors: A meta-analysis

https://doi.org/10.1016/j.diabres.2011.08.029Get rights and content

Abstract

Background

Cross-sectional studies have reported inconsistent findings on whether the risk of metabolic syndrome is high among cancer survivors. We conducted a meta-analysis of cross-sectional studies.

Methods

We searched MEDLINE (PubMed) and EMBASE in April 2010. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria.

Results

Out of 257 articles meeting our initial criteria, 9 cross-sectional studies, which involved 6763 participants (1762 cases and 5001 controls) were included in the final analysis. Compared with the healthy control groups, the cancer survivors were at an increased risk of metabolic syndrome, in the random-effects meta-analysis of all 9 cross-sectional studies (OR = 1.84; 95% CI = 1.14–2.97; I2 = 80.5). In the subgroup meta-analysis by cancer type, a significant positive association was observed for hematologic malignancies, including ALL (acute lymphoblastic leukemia), AML (acute myelogenous leukemia), NHL (non-Hodgkin's lymphoma), and CML (chronic myelogenous leukemia) (OR = 1.94; 95% CI = 1.06–3.55; I2 = 68.1%), whereas no significant association was found for non-hematologic malignancies, including testicular tumor, prostate cancer, sarcoma, and epithelial ovarian cancer.

Conclusions

Our meta-analyses of cross-sectional studies found that adult cancer survivors with hematologic malignancies were at an increased risk of metabolic syndrome.

Introduction

Since the survival rates of cancer have been improved [1], the long-term effects of cancer treatment have gained more concern. As cancer treatment can induce direct cardiovascular damage or promote atherosclerosis by aggravating cardiovascular risk factor profiles, cardiovascular disease has been recognized as one of the common disabling complications in cancer survivors [2], [3]. In this regard, it is important to identify an unfavorable risk profile of cardiovascular disease in cancer survivor. Several previous studies found a tendency of clustering of these risk factors in cancer survivors, and it has been called metabolic syndrome, a constellation of cardiovascular risk factors such as central obesity, insulin resistance, hyperglycemia, hypertension, high plasma triglyceride levels, and low plasma HDL cholesterol levels [4], [5].

During the last decade, metabolic syndrome has received attention because it has been found to increase the risk of future cardiovascular disease in the general population [6]. Metabolic syndrome is also expected to play a role in the development of cardiovascular disease in cancer survivors as well as in general population. In the meantime, recent comparative studies found that the predictive value of metabolic syndrome for future cardiovascular disease was not better than the previous risk score model, the Framingham risk score [7]. Nonetheless, regarding the significant association between metabolic syndrome and cardiovascular disease, determination of the risk of metabolic syndrome in cancer survivors might be noteworthy to explain the prevalence of cardiovascular disease in cancer survivors. Currently, there are inconsistent reports on whether the risk of metabolic syndrome is high among cancer survivors [8], [9], [10], [11], [12], [13], [14], [15], [16]. Even though several systematic review studies have reported an association between metabolic syndrome and cancer survivors [17], [18], no meta-analysis has been reported so far.

The current study aimed to assess the risk of metabolic syndrome among adult cancer survivors by performing a meta-analysis of the results of cross-sectional studies.

Section snippets

Literature search

We searched MEDLINE (PubMed) and EMBASE to April 26, 2010, using common keywords related to metabolic syndrome and cancer survivors, i.e., “cancer survivors,” “leukemia survivors,” “lymphoma survivors” or “hematopoietic cell transplantation,” and “metabolic syndrome”. The language of the publication was not restricted.

Selection criteria

We included epidemiologic studies that met all of the following criteria: (1) epidemiologic studies with a control group; (2) investigated the associations between adult cancer

Identification of relevant studies

Fig. 1 shows a flow diagram for identification of relevant studies. We identified 257 articles by searching PubMed and EMBASE. We excluded 20 duplicate articles and other 221 articles that did not satisfy the selection criteria. We reviewed the full texts of the remaining 16 articles. Among these, 7 were excluded because the studies did not include a control group (n = 2), included adolescents or children (n = 4), or they were review articles (n = 1). The remaining 9 cross-sectional studies were

Discussion

We found that adult cancer survivors were at an increased risk of metabolic syndrome as compared to healthy individuals. In particular, a significant positive association was observed for hematologic malignancies, including ALL, AML, NHL, and CML. In contrast, subgroup meta-analysis by the individual components of metabolic syndrome identified no significant association between cancer survivors and individual component of the criteria for metabolic syndrome. These findings have an important

Conflict of interest

There are no conflicts of interest.

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