Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr 25;11(1):21.
doi: 10.1186/s13293-020-00296-6.

Sex-specific clustering of metabolic risk factors and cancer risk: a longitudinal study in Iran

Azra Ramezankhani  1 , Fereidoun Azizi  2 , Farzad Hadaegh  3
Affiliations

Sex-specific clustering of metabolic risk factors and cancer risk: a longitudinal study in Iran

Azra Ramezankhani et al. Biol Sex Differ. .

Abstract

Background: Cancer 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.

Methods: Among 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.

Results: During 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.

Conclusions: Clustering patterns may reflect underlying link between MRFs and cancer and could potentially facilitate tailored health promotion interventions.

Keywords: Cancer; Cluster; Metabolic; Risk factor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study participant selection. Tehran Lipid and Glucose Study (1999–2014)
Fig. 2
Fig. 2
The relationship between four MRFs in the study population. a Male. b Female. First columns show the total number of population in each row, and the next columns show the number (percentage) of each MRF in each row. For easy interpretation, the table is colored: green, < 20%; blue, 20–40%; yellow, 40–60%; and red, > 60% prevalence. MRFs: metabolic risk factors; HBMI: high body mass index; HFPG: high fasting plasma glucose; HTC: high total cholesterol
Fig. 3
Fig. 3
a Overall clusters identified by SOM in men with size of 7 × 1. Each circle represents one cluster. Each cluster contains 400–800 subjects who are extremely similar to each other regarding to four MRFs. b The silhouette width of each cluster and average silhouette width of all clusters. SOM: self-organizing maps; MRFs: metabolic risk factors
Fig. 4
Fig. 4
a Overall clusters identified by SOM in women with size of 7 × 1. Each circle represents one cluster. Each cluster contains 300–900 subjects who are extremely similar to each other regarding to four MRFs. b The silhouette width of each cluster and average silhouette width of all clusters. SOM: self-organizing maps; MRFs: metabolic risk factors
See this image and copyright information in PMC

References

    1. Hadaegh F, Asgari S, Hashemi P, Baghbani-Oskouei A, Eskandari F, Azizi F, et al. All-cancer incidence in Tehranian adults: more than a decade of follow-up-results from the Tehran Lipid and Glucose Study. Public Health. 2020;181:189–195. doi: 10.1016/j.puhe.2020.01.003. - DOI - PubMed
    1. Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: Disease Control Priorities, 3rd edn. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2015. - PubMed
    1. Atun R, Knaul FM, Gospodarowicz M. Networks in global cancer-potential synergies and opportunities. Lancet Glob Health. 2018;6:S21–S22. doi: 10.1016/S2214-109X(18)30093-7. - DOI
    1. Shabestari AN, Moghaddam SS, Sharifi F, Fadayevatan R, Nabavizadeh F, Delavari A, et al. The most prevalent causes of deaths, DALYs, and geriatric syndromes in Iranian elderly people between 1990 and 2010: findings from the Global Burden of Disease study 2010. Arch Iran Med. 2015;18(8):462–479. - PubMed
    1. Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1345–1422. doi: 10.1016/S0140-6736(17)32366-8. - DOI - PMC - PubMed

Publication types