title: Metabolic syndrome and esophageal and gastric cancer.
abstract: BACKGROUND
  The role of the metabolic syndrome in the etiology of esophageal and gastric cancer is unclear.
  
  
  METHODS
  This was a large nationwide cohort study based on data from 11 prospective population-based cohorts in Norway with long-term follow-up, the Cohort of Norway (CONOR) and the third Nord-Trøndelag Health Study (HUNT3). The metabolic syndrome was assessed by objective anthropometric and metabolic biochemical measures and was defined by the presence of at least three of the following five factors: increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension and high glucose. Newly diagnosed cases of esophageal adenocarcinoma, esophageal squamous-cell carcinoma and gastric adenocarcinoma were identified from the Norwegian Cancer Registry. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with adjustment for potential confounders.
  
  
  RESULTS
  Among 192,903 participants followed up for an average of 10.6 years, 62 developed esophageal adenocarcinoma, 64 had esophageal squamous-cell carcinoma and 373 had gastric adenocarcinoma. The metabolic syndrome was significantly associated with an increased risk of gastric adenocarcinoma (HR 1.44, 95% CI 1.14-1.82), but not associated with esophageal adenocarcinoma (HR 1.32, 95% CI 0.77-2.26) or esophageal squamous-cell carcinoma (HR 1.08, 95% CI 0.64-1.83). Increased waist circumference was associated with an increased HR of esophageal adenocarcinoma (HR 2.48, 95% CI 1.27-4.85). No significant association was found between any single component of the metabolic syndrome and risk of esophageal squamous-cell carcinoma. High waist circumference (HR 1.71, 95% CI 1.05-2.80), hypertension (HR 2.41, 95% CI 1.44-4.03) and non-fasting glucose (HR 1.74, 95% CI 1.18-2.56) were also related to an increased risk of gastric adenocarcinoma in women, but not in men.
  
  
  CONCLUSIONS
  Metabolic syndrome was associated with an increased risk of gastric adenocarcinoma in women. Of the individual components of the metabolic syndrome, high waist circumference was positively associated with risk of esophageal adenocarcinoma. Positive associations were also observed for women between high waist circumference, hypertension, high non-fasting glucose and risk of gastric adenocarcinoma. However, further evidence is warranted due to the limited number of cases and the inability to effectively identify gastric cardia adenocarcinoma.
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.|European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Yulan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.|HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Ness-Jensen
authors.affiliation: HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hveem
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.|Division of Cancer Studies, King's College London, London, UK.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden. Yunxia.lu@ki.se.|Department of Epidemiology and Biostatistics, Imperial College London, London, UK. Yunxia.lu@ki.se.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Lu
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology*; D055105:Waist Circumference / Q000502:physiology; D055815:Young Adult
keywords: Esophagus; Hypertension; Metabolic syndrome; Neoplasm; Serum lipid; Stomach