Association of markers of insulin and glucose control with subsequent colorectal cancer risk.
Association of markers of insulin and glucose control with subsequent colorectal cancer risk.
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发表时间：
2003-05
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通讯作者：
S. Saydah;E. Platz;N. Rifai;M. Pollak;F. Brancati;K. Helzlsouer
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作者：
S. Saydah;E. Platz;N. Rifai;M. Pollak;F. Brancati;K. Helzlsouer
我们评估了血浆胰岛素和其他胰岛素和血糖控制标记物与随后的结直肠癌的相关性。在马里兰州华盛顿县社区队列的参与者中，发现了1989年至2000年基线期间发生的结肠癌(n=132)和直肠癌(n=41)癌症病例和匹配的对照组(n=346)。检测基线血样中胰岛素和血糖控制的循环标志物。在基线时自我报告体重指数(BMI)和治疗糖尿病的药物使用情况。条件Logistic回归用于估计匹配的优势比(ORs)。与最低的四分之一相比，胰岛素浓度处于最高的第四的参与者患结直肠癌的风险没有增加[OR，0.78；95%可信区间(CI)，0.45-1.35；P(趋势)=0.24]。同样，总胆固醇：高密度脂蛋白-胆固醇、甘油三酯和胰岛素样生长因子结合蛋白1的比率也没有相关性。然而，糖化血红蛋白(1c)水平最高的四分之一的人患结直肠癌的风险略有增加(OR，1.57；95%CI，0.94-2.60；P(趋势)=0.02)。BMI=30 kg/m(2)与25 kg/m(2)相比，结直肠癌的OR值为1.70(95%CI，1.01~2.86；P(趋势)=0.08)。使用药物治疗糖尿病时，结直肠癌的OR值为2.43(95%CI，1.10~5.38)。更高的HBA(1c)，更高的BMI，以及使用药物治疗糖尿病与结直肠癌的相关性支持了胰岛素和血糖控制的扰动可能影响结直肠癌发生的假设。HbA(1c)、BMI和使用药物治疗糖尿病，作为长期或严重的2型糖尿病的替代指标，可能比在非禁食人群中诊断前曾经测量的血浆标志物更好地作为高胰岛素血症和高血糖的时间平均指标。
We evaluated the association of plasma insulin and other markers of insulin and glucose control with subsequent colorectal cancer. Incident colon (n = 132) and rectal (n = 41) cancer cases and matched controls (n = 346) were identified between baseline in 1989 and 2000 among participants in a community-based cohort in Washington County, Maryland. Circulating markers of insulin and glucose control were measured in baseline blood samples. Body mass index (BMI) and use of medications to treat diabetes mellitus were self-reported at baseline. Conditional logistic regression was used to estimate matched odds ratios (ORs). Compared with the lowest fourth, participants with insulin concentrations in the highest fourth were not at an increased risk of colorectal cancer [OR, 0.78; 95% confidence interval (CI), 0.45-1.35; P(trend) = 0.24]. Similarly, no associations were observed for the ratio of total cholesterol:HDL-cholesterol, triglycerides, and insulin-like growth factor binding protein 1. However, those in the highest fourth of glycosylated hemoglobin (HbA(1c)) level had a slightly increased risk of colorectal cancer (OR, 1.57; 95% CI, 0.94-2.60; P(trend) = 0.02). The OR of colorectal cancer was 1.70 (95% CI, 1.01-2.86; P(trend) = 0.08) comparing BMI >/=30 kg/m(2) to <25 kg/m(2). The OR of colorectal cancer was 2.43 (95% CI, 1.10-5.38) for the use of medications to treat diabetes. The associations of higher HbA(1c), higher BMI, and the use of medications to treat diabetes, with colorectal cancer lend support to the hypothesis that perturbations in insulin and glucose control may influence colorectal carcinogenesis. It is possible that HbA(1c), BMI, and the use of medications to treat diabetes, as a surrogate for protracted or severe type 2 diabetes mellitus, may have been better time-averaged indicators of hyperinsulinemia and hyperglycemia than the plasma markers that were measured once prediagnostically in a nonfasting population.