Abstract
BackgroundCancer is a major cause of death in low- and middle-income countries. A large number of studies have shown that some of the metabolic risk factors (MRFs) tend to cluster in individuals. We examined the synergistic effects of multiple MRFs and cancer risk among Iranian adults.MethodsAmong 8593 (3929 men) participants aged ≥ 30 years, the self-organizing map (SOM) was applied to clustering of four MRFs including high fasting plasma glucose (HFPG), high total cholesterol (HTC), high systolic blood pressure (HSBP), and high body mass index (HBMI). The Cox proportional hazards model was used to investigate the association between clusters with cancer incidence during a median of 14.0 years of follow-up.ResultsDuring the study period, 265 new cases of cancer were identified among participants at risk. The incidence density rate was 2.5 per 1000 person years in total population. About 32 and 40% of men and women, respectively, had three or four MRFs. We identified seven clusters of MRFs in both men and women. In both genders, MRFs were clustered in those with older age. Further, inverse associations were found between current smoking in men, and education level and passive smoking in women and clustering of MRFs. In men, a cluster with 100% HSBP and HBMI had the highest risk for overall cancer. While, among women, a cluster with 100% HFPG and 93% HBMI yielded the highest risk for cancer. The risk was decreased when HBMI accompanied by HTC.ConclusionsClustering patterns may reflect underlying link between MRFs and cancer and could potentially facilitate tailored health promotion interventions.
Highlights
Cancer is a major cause of death in low- and middle-income countries
Box: 19395-4763, Tehran, Iran Full list of author information is available at the end of the article (MRFs) including high fasting plasma glucose (HFPG), high body mass index (HBMI), high systolic blood pressure (HSBP), and high total cholesterol (HTC) were the leading risk factors for non-communicable diseases; among them, HFPG and HBMI have been associated with increased risk of several of the more common cancers [5]
We found that co-occurrence of HBMI and HTC put men to a lower risk of cancer compared with the occurrence of the individual factors alone
Summary
A large number of studies have shown that some of the metabolic risk factors (MRFs) tend to cluster in individuals. Cancer is already a major cause of death in low- and middle-income countries [1, 2]. In 2010, cancer was the second main cause of death in Iran [4]. A large number of studies have repeatedly shown that some of the MRFs tend to cluster and co-occur in individuals [6, 7], and clusters of these factors may have synergistic properties, such that the combined effect of these factors is much worse than the sum of each risk factor in isolation [8].
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