Impact of metabolic syndrome on the risk of endometrial cancer and the role of lifestyle in prevention

Abstract

Endometrial cancer is the second gynecological cancer with the highest global incidence. Among many associated risk factors, Among the risk factors, metabolic syndrome is an important and preventable one. It comprises a group of conditions that often occur together: central adiposity, hyperglycemia, arterial hypertension, and atherogenic dyslipidemia. This review aimed to describe the epidemiological and biological relationship between metabolic syndrome and endometrial cancer, focusing on the role of lifestyle in prevention. A literature search was carried out in the PubMed database. 4824 publications were screened, and 123 were included for this review. The association between metabolic syndrome and endometrial cancer has been described. Chronic adipose tissue inflammation and insulin resistance are involved in the development of obesity, particularly visceral adiposity. These changes promote the ideal environment for the development of endometrial cancer. Strategies based on lifestyle modifications may be effective for the prevention of metabolic syndrome and consequently endometrial cancer. Some of these modifications include adopting a diet rich in fruits, vegetables, whole grains, and legumes, depending to the accessibility of these foods for each region. Avoiding ultra-processed foods and increasing daily physical activity were also some suggested modifications. We propose that women be screened for metabolic syndrome to establish early treatment and to possibly prevent endometrial cancer. Clinical trials designed to prove the effect of lifestyle modifications on the prevention of endometrial cancer are needed.

Association of a Healthy Lifestyle with All-Cause, Cause-Specific Mortality and Incident Cancer among Individuals with Metabolic Syndrome: A Prospective Cohort Study in UK Biobank

“…However, previous studies have mainly targeted limited lifestyle management, such as smoking, alcohol consumption, and exercise, and rarely considered emerging factors such as diet, sleep, social support, and sedentary behaviour [ 13 , 14 ]. Additionally, most studies on lifestyle management involving individuals with MetS have focused on CVD-related diseases [ 15 ] or site-specific cancers, such as endometrial cancer [ 16 ]. Research on all-cause and cause-specific mortality and the overall incidence of cancer are limited.…”

Metabolic Syndrome and Survival Outcomes in Endometrial Cancer

“…Numerous factors are at the very core of the development of EC (in particular endometrioid subtype), including obesity, early menarche, late menopause, nulliparity, unopposed estrogen therapy, and chronic anovulation. A temporal pattern association has been described and coincides with a parallel increase in obesity and the prevalence of metabolic syndrome (MetS) observed in the general population [1,2].…”

“…Studies show a significantly higher prevalence of metabolic disorders following surgical menopause compared to natural menopause. This association is linked to the sudden decline in estrogen levels caused by surgery, which can lead to endothelial dysfunction, dyslipidemia [1,[26][27][28][29], and increased risk of cardiovascular events [30][31][32][33][34]. Research suggests a 1.5-fold to 9.7-fold increased risk of MetS in women who undergo surgical menopause compared to natural menopause [1,[35][36][37][38][39].…”

Prognostic impact of metabolic syndrome in patients with primary endometrial cancer: a retrospective bicentric study

“…Metabolic diseases, including obesity (body mass index (BMI) > 30 kg/m 2 ), and diabetes mellitus (DM), belong to the most important contributing factors for the rising rates (Raglan et al 2019 ). Although unopposed estrogen exposure is considered a major driver of endometrial carcinogenesis, other additional factors such as chronic inflammation, insulin resistance, and hyperinsulinemia are allied to substantial risk factors for EC (Perez-Martin et al 2022 ; Siegel et al 2021 ). Previous epidemiological studies revealed that obesity, DM, and metabolic syndrome (MetS) are each linked to an increase in EC incidence, but their separate and combined influence on survival remains unclear (Raglan et al 2019 ; Perez-Martin et al 2022 ; Romanos-Nanclares et al 2023 ; Morice et al 2016 ).…”

“…Although unopposed estrogen exposure is considered a major driver of endometrial carcinogenesis, other additional factors such as chronic inflammation, insulin resistance, and hyperinsulinemia are allied to substantial risk factors for EC (Perez-Martin et al 2022 ; Siegel et al 2021 ). Previous epidemiological studies revealed that obesity, DM, and metabolic syndrome (MetS) are each linked to an increase in EC incidence, but their separate and combined influence on survival remains unclear (Raglan et al 2019 ; Perez-Martin et al 2022 ; Romanos-Nanclares et al 2023 ; Morice et al 2016 ). Conversely, Tang et al described in a meta-analysis the perceived protective effects of metformin intake leading to a decrease in incidence rates and an improvement in OS in EC Patients.…”