{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T11:02:43Z","timestamp":1775905363763,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Screening colonoscopy prevents colorectal cancer (CRC) by detecting and removing premalignant lesions. Metabolic syndrome (MetS) has been proposed as an additional risk marker to refine risk stratification beyond age\u2010based screening, but its independent association with advanced colorectal neoplasia remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross\u2010sectional analysis of asymptomatic adults undergoing screening colonoscopy in the Salzburg Colon Cancer Prevention Initiative. Analyses were limited to participants with complete\u2010case data for the Adult Treatment Panel III (ATP III) MetS definition (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20094891). The primary endpoint was advanced colorectal lesions, defined as advanced adenoma and\/or\n                      <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>\n                      . We estimated incidence rate ratios (\n                      <jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>\n                      ) using Poisson regression with robust variance in unadjusted, age\/sex\u2010adjusted and fully adjusted models (demographic and lifestyle covariates). Sensitivity analyses applied the International Diabetes Federation (\n                      <jats:styled-content style=\"fixed-case\">IDF<\/jats:styled-content>\n                      )\n                      <jats:styled-content style=\"fixed-case\">MetS<\/jats:styled-content>\n                      definition and insulin resistance (\n                      <jats:styled-content style=\"fixed-case\">HOMA<\/jats:styled-content>\n                      \u2010\n                      <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content>\n                      ; binary and per doubling). In an exploratory subsample, leptin (per doubling) was evaluated, including joint models with\n                      <jats:styled-content style=\"fixed-case\">MetS<\/jats:styled-content>\n                      . Bayesian models (non\u2010informative, pessimistic, sceptical priors) quantified posterior effect distributions and equivalence probabilities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Advanced lesions occurred in 389\/4891 participants (7.95%) and were more frequent in ATP III MetS (9.66% vs. 6.97%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). In frequentist analyses, ATP III MetS was associated with advanced lesions in unadjusted models (IRR: 1.39; 95% CI, 1.15\u20131.68) but not after age\/sex adjustment (IRR: 1.09; 95% CI, 0.90\u20131.32) or full adjustment (IRR: 1.06; 95% CI, 0.83\u20131.36). Age was the dominant predictor (fully adjusted IRR: 1.73 per decade; 95% CI, 1.53\u20131.95), while female sex was protective (IRR: 0.57; 95% CI, 0.44\u20130.73). Findings were concordant using the IDF definition (unadjusted IRR: 1.39; age\/sex\u2010adjusted 1.09; fully adjusted 1.07) and for HOMA\u2010IR (binary: no association; per doubling: unadjusted IRR: 1.10,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.052; adjusted null). In the leptin subsample (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009602), leptin was not independently associated with advanced lesions (per doubling IRR: 0.85 unadjusted; 0.96 age\/sex\u2010adjusted; 0.95 fully adjusted) and did not materially alter MetS estimates. Bayesian analyses mirrored attenuation with adjustment; in fully adjusted models, sceptical priors yielded a posterior median IRR of 1.01 (95% CrI: 0.91\u20131.12) with a 92.9% probability that the MetS effect lay within \u00b110% of no effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The apparent excess risk of advanced colorectal lesions in MetS is explained by age and sex. Across MetS definitions, HOMA\u2010IR, leptin and Bayesian sensitivity analyses, MetS does not provide independent incremental information for CRC screening risk stratification beyond established demographic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70424","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T04:22:58Z","timestamp":1773980578000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic syndrome and risk of advanced colorectal adenomas in a screening population: Frequentist and Bayesian analyses"],"prefix":"10.1111","volume":"28","author":[{"given":"Franz","family":"Singhartinger","sequence":"first","affiliation":[{"name":"Department of Surgery Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0411-166X","authenticated-orcid":false,"given":"Georg","family":"Semmler","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Paar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8403-3931","authenticated-orcid":false,"given":"Michael","family":"Lichtenauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"V\u00f6lkerer","sequence":"additional","affiliation":[{"name":"Hospital Oberndorf  Oberndorf Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Holzinger","sequence":"additional","affiliation":[{"name":"Department of Surgery Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3353-8702","authenticated-orcid":false,"given":"Mathias","family":"Ausserwinkler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1 Paracelsus Medical University  Salzburg Austria"},{"name":"Department of Internal Medicine Elisabethinen Hospital Klagenfurt  Klagenfurt Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Flamm","sequence":"additional","affiliation":[{"name":"Institute of General Practice Family Medicine and Preventive Medicine, Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elmar","family":"Aigner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1 Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Datz","sequence":"additional","affiliation":[{"name":"Hospital Oberndorf  Oberndorf Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Wernly","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1 Paracelsus Medical University  Salzburg Austria"},{"name":"Institute of General Practice Family Medicine and Preventive Medicine, Paracelsus Medical University  Salzburg 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