Insulin, insulin-like growth factors and colon cancer: A review of the evidence
Insulin, insulin-like growth factors and colon cancer: A review of the evidence
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DOI：
10.1093/jn/131.11.3109s
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发表时间：
2001-11-01
影响因子：
4.2
通讯作者：
Giovannucci, E
中科院分区：
文献类型：
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作者：
Giovannucci, E
胰岛素和胰岛素样生长因子（IGF）轴是细胞增殖和细胞凋亡的主要决定因素，因此可能影响癌变。在各种动物模型中，通过各种方式调节胰岛素和IGF-1水平，包括直接输注、能量过剩或限制、遗传性肥胖、饮食质量（包括脂肪酸和蔗糖含量）、抑制正常胰岛素分泌和药物抑制IGF-1，都会影响结肠癌变。人类的证据也表明，高水平的胰岛素和IGF-1与结肠癌的风险增加有关。与高水平胰岛素（非胰岛素依赖型糖尿病和高甘油三酯血症）和IGF-1（肢端肥大症）相关的临床状况与结肠癌风险增加有关，而胰岛素和IGF-1循环浓度升高与结肠肿瘤风险增加有关。高胰岛素血症的决定因素和标志（缺乏运动、高体重指数、中枢性肥胖）和高IGF-1水平（身材高大）也与高风险相关。许多研究表明，刺激胰岛素抵抗或分泌的饮食模式，包括大量消耗蔗糖、各种来源的淀粉、高血糖指数和高饱和脂肪酸摄入，都与结肠癌的高风险有关。虽然其他环境和遗传因素也会影响结肠癌，但在技术进步导致久坐不动的生活方式和肥胖普遍存在，以及高度加工的碳水化合物和饱和脂肪酸的增加之前，这种恶性肿瘤的发病率一直很低。对抗这些模式的努力可能最有可能减少结肠癌、心血管疾病和糖尿病的发病率。
Insulin and insulin-like growth factor (IGF) axes are major determinants of proliferation and apoptosis and thus may influence carcinogenesis. In various animal models, modulation of insulin and IGF-1 levels through various means, including direct infusion, energy excess or restriction, genetically induced obesity, dietary quality including fatty acid and sucrose content, inhibition of normal insulin secretion and pharmacologic inhibition of IGF-1, influences colonic carcinogenesis. Human evidence also associates high levels of insulin and IGF-1 with increased risk of colon cancer. Clinical conditions associated with high levels of insulin (noninsulin-dependent diabetes mellitus and hypertriglyceridemia) and IGF-1 (acromegaly) are related to increased risk of colon cancer, and increased circulating concentrations of insulin and IGF-1 are related to a higher risk of colonic neoplasia. Determinants and markers of hyperinsulinemia (physical inactivity, high body mass index, central adiposity) and high IGF-1 levels (tall stature) are also related to higher risk. Many studies indicate that dietary patterns that stimulate insulin resistance or secretion, including high consumption of sucrose, various sources of starch, a high glycemic index and high saturated fatty acid intake, are associated with a higher risk of colon cancer. Although additional environmental and genetic factors affect colon cancer, the incidence of this malignancy was invariably low before the technological advances that rendered sedentary lifestyles and obesity common, and increased availability of highly processed carbohydrates and saturated fatty acids. Efforts to counter these patterns are likely to have the most potential to reduce colon cancer incidence, as well as cardiovascular disease and diabetes mellitus.