Open Access Research article

Metabolic syndrome biomarkers and early breast cancer in Saudi women: evidence for the presence of a systemic stress response and/or a pre-existing metabolic syndrome-related neoplasia risk?

Majed S Alokail12, Nasser Al-Daghri127*, Amal Abdulkareem3, Hossam M Draz14, Sobhy M Yakout1, Abdullah M Alnaami1, Shaun Sabico1, Amal M Alenad5 and George P Chrousos16

Author Affiliations

1 Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia (KSA

2 Center of Excellence in Biotechnology, King Saud University, Riyadh, 11451, KSA

3 Department of Surgery, College of Medicine, King Saud University, Riyadh, 11472, KSA

4 Department of Biochemistry, National Research Centre, Cairo, 12311, Egypt

5 School of Biological Sciences, Life Science Building 85, University of Southampton, Southampton, SO17 1BJ, UK

6 First Department of Pediatrics, Athens University Medical School, Athens, 11527, Greece

7 Department of Biochemistry, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Kingdom of Saudi Arabia

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BMC Cancer 2013, 13:54  doi:10.1186/1471-2407-13-54

Published: 4 February 2013



Obesity has been linked to many adverse health consequences, including breast cancer. This study aims to determine adipocytokine and other biological changes in recently diagnosed breast cancer patients before therapy is started.


A total of 109 female Saudi subjects [56 newly diagnosed, treatment-naïve, histologically-confirmed breast cancer cases and 53 age- and BMI-matched controls] were enrolled in this study. Anthropometric data were collected. Serum insulin, adipocytokines and plasminogen activator inhibitor-1 (PAI-1) concentrations were measured using a customized multiplex Luminex assay. Hypersensitive C-Reactive Protein (CRP), tumor necrosis factor-alpha (TNF-α), and angiotensin II (ANG II) were measured using ELISA.


A few days in the diagnosis, breast cancer subjects had significantly higher systolic blood pressure (p = 0.03), glucose (p = 0.01), triglycerides (p = 0.001), leptin (p = 0.044), resistin (p = 0.04), ANG II (p = 0.02), TNF-α (p = 0.045), and CRP (p = 0.04) than the controls. On the other hand, HDL (p = 0.01) and adiponectin (p = 0.02) were significantly lower in cancer subjects than controls. A significant association was found between elevated triglycerides (TG) and breast cancer [OR (95% CI), 6.1(1.8, 15.6), p = 0.004], as well as elevated ANG II [OR (95% CI), 5.2(1.2, 14.3), p = 0.03]. On the other hand, aPAI and HDL correlated negatively with breast cancer [OR (95% CI), 0.076(0.01, 0.34), p = 0.001; 0.30(0.09, 0.95), p 0.04, respectively].


Circulating ANGII and triglycerides were positively associated with early breast cancer. In contrast, HDL-cholesterol correlated negatively with ANG II and aPAI in these patients. This suggests that patients with recently diagnosed breast cancer have biochemical changes consistent with an activated stress response and/or that patients with metabolic syndrome manifestations have a higher risk of developing this disease.

Breast cancer; Saudi women; Adiponectin; Leptin; HDL