Metabolic health is a determining factor for incident colorectal cancer in the obese population: A nationwide population‐based cohort study

• Published in: Cancer medicine (Malden, MA) Vol. 10; no. 1; pp. 220 - 229
• Main Authors: Cho, Yun Kyung, Lee, Jiwoo, Kim, Hwi Seung, Park, Joong‐Yeol, Lee, Woo Je, Kim, Ye‐Jee, Jung, Chang Hee
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2021; John Wiley and Sons Inc
• Subjects: Antihypertensives; Body mass index; Clinical Cancer Research; Codes; Cohort analysis; Colorectal cancer; Colorectal carcinoma; Diabetes; Disease; Health insurance; Hypertension; Inflammatory bowel disease; Medical screening; metabolic syndrome; Metabolism; Mortality; nationwide cohort study; Obesity; Original Research; phenotypic transition; Polyps; Population; Population studies; Population-based studies; Risk factors; metabolic syndrome; colorectal cancer; nationwide cohort study; obesity; phenotypic transition
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3607

ABSTRACT Background The association of the risk of colorectal cancer (CRC) with obesity or obesity‐induced metabolic disturbances remains controversial. We assessed the association of metabolic health status with incident CRC among subjects with obesity. Methods This study included 319,397 subjects from the Korean National Health Insurance Service‐National Health Screening Cohort. Transitions in metabolic health status and obesity were examined during 2009–2010 and 2011–2012. We categorized subjects with obesity into four separate groups according to their dynamic metabolic health status: metabolically healthy obesity (MHO), MHO to metabolically unhealthy obesity (MUO), MUO to MHO, and stable MUO. Subjects were followed up from 2009 to 2015 for incident CRC. Results The stable MHO group showed no increased risk of incident CRC (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.83–1.14). However, the MHO to MUO group had a higher risk of incident CRC than the stable metabolically healthy nonobese (MHNO) group (HR, 1.34; 95% CI, 1.15–1.57). Among patients with MUO at baseline, those in the subgroup who transitioned to MHO group were not at increased risk of CRC (HR, 1.06; 95% CI, 0.91–1.25), whereas those who remained in the stable MUO group had a higher risk of incident CRC than those in the stable MHNO group (HR, 1.29; 95% CI, 1.19–1.41). Conclusions The transition of metabolic health was a determining factor for CRC among subjects with obesity. Hence, maintenance or recovery of metabolic health should be addressed to prevent CRC in individuals with obesity. The presence of metabolic unhealthiness significantly increased the risk of incident colorectal cancer in the obese population. Physicians should consider the metabolic health status of obese patients and counsel them on the importance of metabolic fitness.