© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 13, 1147-1154,
July 7, 1999
© 1999 Oxford University Press
REPORTS |
Increased Blood Glucose and Insulin, Body Size, and Incident Colorectal Cancer
Affiliations of authors: R. E. Schoen (Departments of Medicine and Epidemiology), L. H. Kuller (Department of Epidemiology), University of Pittsburgh, PA; C. M. Tangen, Department of Biostatistics, University of Washington, Seattle; G. L. Burke, Department of Public Health and Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; M. Cushman (Departments of Medicine and Pathology), R. P. Tracy (Departments of Medicine, Pathology, and Biochemistry), University of Vermont, Burlington; A. Dobs, Department of Medicine, The Johns Hopkins University, Baltimore, MD; P. J. Savage, National Heart, Lung, and Blood Institute, Bethesda, MD.
Correspondence to: Robert E. Schoen, M.D., M.P.H., Division of Gastroenterology and Hepatology, Mezzanine Level, C Wing, PUH, 200 Lothrop St., Pittsburgh, PA 15213-2582.
BACKGROUND: Abdominal obesity—an elevated level of visceral adipose tissue—has been linked to colorectal cancer. Furthermore, elevated levels of visceral adipose tissue have been associated with hyperinsulinemia, and insulin is a growth factor in the colon. We assessed whether waist circumference, a surrogate measure of visceral adipose tissue, and metabolic parameters associated with visceral adipose tissue were related to colorectal cancer. METHODS: In the Cardiovascular Health Study cohort, we examined the relationship of baseline measurements of body size, glucose, insulin, and lipoproteins to incident colorectal cancer. All P values are two-sided. RESULTS: Among 5849 participants, 102 incident cases of colorectal cancer were identified. Individuals in the highest quartile of fasting glucose had a nearly twofold increased risk of colorectal cancer (relative risk [RR] = 1.8; 95% confidence interval [CI] = 1.0-3.1), and the linear trend RR (LT RR = 1.2; 95% CI = 1.0-1.5) for fasting glucose level was statistically significant (P = .02). Glucose and insulin levels 2 hours after oral glucose challenge also exhibited statistically significant associations with colorectal cancer (2-hour glucose levels: RR = 2.4 [95% CI = 1.2-4.7]/LT RR = 1.3 [95% CI = 1.0-1.6; P = .02]; 2-hour insulin levels: RR = 2.0 [95% CI = 1.0-3.8]/LT RR = 1.2 [95% CI = 1.0-1.5; P = .04]). Analysis of fasting insulin levels suggested a threshold effect, with values above the median associated with colorectal cancer (RR = 1.6; 95% CI = 1.1-2.4; P = .02). Higher levels of waist circumference were also statistically significantly associated with colorectal cancer (RR = 1.9; 95% CI = 1.1-3.3; P = .02). CONCLUSIONS: These data provide, to our knowledge, the first direct evidence of an association between elevated visceral adipose tissue level, its associated metabolic effects, and colorectal cancer.
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