Raised glucose concentrations and diabetes are associated with cancer
http://www.100md.com
《英国医生杂志》
High fasting serum glucose concentrations and diabetes are associated with increased risk of death from several cancers, according to a Korean follow up study of more than one million people ( JAMA 2005;293: 194-202).
The Korean cancer prevention study included all of the 829 770 men and 468 615 women aged 30 to 95 years receiving health insurance from the National Health Insurance Corporation who had had a health check every two years during 1992-5. Fasting serum glucose measurements were taken during these health checks. For the follow up study the researchers collected cancer mortality and cancer incidence data from the national cancer registry and hospital records.
Overall, 20 566 men and 5907 women died from cancer in the 10 years of follow up, which was measured from the time of the first recorded serum glucose measurement. People in the group with the highest fasting serum glucose value (7.8 mmol/l) had higher death rates from all cancers combined (29% (95% confidence interval 22% to 37%) higher for men; 23% (9% to 39%) higher for women) than those with the lowest concentration (<5.0 mmol/l), after smoking and alcohol use were controlled for.
Cancer incidence reflected a similar pattern. Risks for cancer incidence and mortality were generally greater in people with diabetes than in those without.
Results showed the strongest association between raised glucose concentrations and cancer for pancreatic cancer. Men with the highest glucose concentrations had a relative risk of 1.91 (1.52 to 2.41) compared with men with the lowest. For women with the highest concentrations, the relative risk was 2.05 (1.43 to 2.93) compared with those with the lowest.
Significant associations were also found for cancers of the oesophagus, liver, and colon or rectum in men and of the liver and cervix in women, and there were significant trends with glucose concentration for cancers of the oesophagus, colon or rectum, liver, pancreas, and bile duct in men and of the liver and pancreas in women.
Dr Sun Ha Jee, from the Graduate School of Public Health, Yonsei University, Seoul, South Korea, said, "We have shown that fasting serum glucose level and diabetes are associated with cancer risk in a population far leaner than the Western populations in other studies. These associations do not reflect confounding by obesity, suggesting that the mechanism of increased cancer risk reflects the consequences of hyperinsulinaemia." Insulin is known to affect cell growth, and both diabetes and the metabolic syndrome are associated with systemic inflammation, which could explain the increased cancer risk.
An accompanying editorial from Kathleen Cooney and Stephen Gruber from the University of Michigan Medical School, Ann Arbor, noted that the relative risks of raised glucose or diabetes on cancer were modest and so the fraction of cancers attributable to raised fasting glucose in the Korean population was small, although this was partly because of the relatively low prevalence of diabetes. The impact of the association might be greater in countries with higher rates of diabetes. The editorial's authors hoped that some of the cancer deaths may be preventable, concluding, "Further studies will be required to demonstrate that reductions in hyperglycemia and diabetes will lead to declines in cancer mortality" ( JAMA 2005;293: 235-6).(Susan Mayor)
The Korean cancer prevention study included all of the 829 770 men and 468 615 women aged 30 to 95 years receiving health insurance from the National Health Insurance Corporation who had had a health check every two years during 1992-5. Fasting serum glucose measurements were taken during these health checks. For the follow up study the researchers collected cancer mortality and cancer incidence data from the national cancer registry and hospital records.
Overall, 20 566 men and 5907 women died from cancer in the 10 years of follow up, which was measured from the time of the first recorded serum glucose measurement. People in the group with the highest fasting serum glucose value (7.8 mmol/l) had higher death rates from all cancers combined (29% (95% confidence interval 22% to 37%) higher for men; 23% (9% to 39%) higher for women) than those with the lowest concentration (<5.0 mmol/l), after smoking and alcohol use were controlled for.
Cancer incidence reflected a similar pattern. Risks for cancer incidence and mortality were generally greater in people with diabetes than in those without.
Results showed the strongest association between raised glucose concentrations and cancer for pancreatic cancer. Men with the highest glucose concentrations had a relative risk of 1.91 (1.52 to 2.41) compared with men with the lowest. For women with the highest concentrations, the relative risk was 2.05 (1.43 to 2.93) compared with those with the lowest.
Significant associations were also found for cancers of the oesophagus, liver, and colon or rectum in men and of the liver and cervix in women, and there were significant trends with glucose concentration for cancers of the oesophagus, colon or rectum, liver, pancreas, and bile duct in men and of the liver and pancreas in women.
Dr Sun Ha Jee, from the Graduate School of Public Health, Yonsei University, Seoul, South Korea, said, "We have shown that fasting serum glucose level and diabetes are associated with cancer risk in a population far leaner than the Western populations in other studies. These associations do not reflect confounding by obesity, suggesting that the mechanism of increased cancer risk reflects the consequences of hyperinsulinaemia." Insulin is known to affect cell growth, and both diabetes and the metabolic syndrome are associated with systemic inflammation, which could explain the increased cancer risk.
An accompanying editorial from Kathleen Cooney and Stephen Gruber from the University of Michigan Medical School, Ann Arbor, noted that the relative risks of raised glucose or diabetes on cancer were modest and so the fraction of cancers attributable to raised fasting glucose in the Korean population was small, although this was partly because of the relatively low prevalence of diabetes. The impact of the association might be greater in countries with higher rates of diabetes. The editorial's authors hoped that some of the cancer deaths may be preventable, concluding, "Further studies will be required to demonstrate that reductions in hyperglycemia and diabetes will lead to declines in cancer mortality" ( JAMA 2005;293: 235-6).(Susan Mayor)