The metabolic syndrome and cancer: Is the metabolic syndrome useful for predicting cancer risk above and beyond its individual components?

Aims. - The metabolic syndrome (MetS) is a risk factor for cancer. However, it is not known if the MetS confers a greater cancer risk than thesum of its individual components, which components drive the association, or if the MetS predicts future cancer risk.Materials and methods. - We linked 20,648 participants from the Australian and New Zealand Diabetes and Cancer Collaboration with completedata on the MetS to national cancer registries and used Cox proportional hazards models to estimate associations of the MetS, the number ofpositive MetS components, and each of the five MetS components separately with the risk for overall, colorectal, prostate and breast cancer. Hazardratios (HR) and 95% confidence intervals (95%CI) are reported. We assessed predictive ability of the MetS using Harrell's c-statistic.Results. - The MetS was inversely associated with prostate cancer (HR 0.85; 95% CI 0.72-0.99). We found no evidence of an association betweenthe MetS overall, colorectal and breast cancers. For those with five positive MetS components the HR was 1.12 (1.02-1.48) and 2.07 (1.26-3.39) foroverall, and colorectal cancer, respectively, compared with those with zero positive MetS components. Greater waist circumference (WC) (1.38;1.13-1.70) and elevated blood pressure (1.29; 1.01-1.64) were associated with colorectal cancer. Elevated WC and triglycerides were (inversely)associated with prostate cancer. MetS models were only poor to moderate discriminators for all cancer outcomes. Conclusions. - We show that the MetS is (inversely) associated with prostate cancer, but is not associated with overall, colorectal or breast cancer. Although, persons with five positive components of the MetS are at a 1.2 and 2.1 increased risk for overall and colorectal cancer, respectively, andthese associations appear to be driven, largely, by elevated WC and BP. We also demonstrate that the MetS is only a moderate discriminator ofcancer risk