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Wong MCS, Leung EYM, Wang HHX, Huang J. Risk prediction of advanced colorectal neoplasia among diabetic patients: A derivation and validation study. JGH Open 2024; 8:e13062. [PMID: 38742181 PMCID: PMC11089280 DOI: 10.1002/jgh3.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
Background and Aim Colorectal cancer (CRC) is the third most common cancer in the world. This study devises and validates a clinical scoring system for risk prediction of advanced colorectal neoplasia (ACN) to guide colonoscopy evaluation among diabetic patients. Methods We identified 55 964 diabetic patients who received colonoscopies from a large database in a Chinese population (2008-2018). We recruited a derivation cohort based on random sampling. The risk factors of CRC evaluated by univariate analysis were examined for ACN, defined as advanced adenoma, CRC, or any combination thereof using binary logistic regression analysis. We used the adjusted odds ratios (aORs) for independent risk factors to devise a risk score, ranging from 0 to 6: 0-4 "average risk" (AR) and 5-6 "high risk" (HR). The other subjects acted as an independent validation cohort. Results The prevalence of ACN in both the derivation and validation cohorts was 2.0%. Using the scoring system constructed, 78.5% and 21.5% of patients in the validation cohort were classified as AR and HR, respectively. The prevalence of ACN in the AR and HR groups was 1.5% and 4.1%, respectively. Individuals in the HR group had a 2.78-fold increased prevalence of ACN than the AR group. The concordance (c-) statistics was 0.70, implying a good discriminatory capability of the risk score to stratify high-risk individuals who should consider colonoscopy. Conclusion The clinical risk scoring system based on age, gender, smoking, presence of hypertension, and use of aspirin is useful for ACN risk prediction among diabetic patients.
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Affiliation(s)
- Martin CS Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong Kong SARChina
- Centre for Health Education and Health Promotion, Faculty of MedicineChinese University of Hong KongHong Kong SARChina
- The School of Public HealthPeking UniversityBeijingChina
- The School of Public Health, The Chinese Academy of Medical Sciences and The Peking Union Medical CollegesBeijingChina
| | - Eman YM Leung
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong Kong SARChina
| | - Harry HX Wang
- School of Public HealthSun Yat‐Sen UniversityGuangzhouGuangdongChina
- Usher Institute, Deanery of Molecular, Genetic and Population Health SciencesThe University of EdinburghEdinburghUK
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of MedicineChinese University of Hong KongHong Kong SARChina
- Centre for Health Education and Health Promotion, Faculty of MedicineChinese University of Hong KongHong Kong SARChina
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2
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Szablewski L. Changes in Cells Associated with Insulin Resistance. Int J Mol Sci 2024; 25:2397. [PMID: 38397072 PMCID: PMC10889819 DOI: 10.3390/ijms25042397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Insulin is a polypeptide hormone synthesized and secreted by pancreatic β-cells. It plays an important role as a metabolic hormone. Insulin influences the metabolism of glucose, regulating plasma glucose levels and stimulating glucose storage in organs such as the liver, muscles and adipose tissue. It is involved in fat metabolism, increasing the storage of triglycerides and decreasing lipolysis. Ketone body metabolism also depends on insulin action, as insulin reduces ketone body concentrations and influences protein metabolism. It increases nitrogen retention, facilitates the transport of amino acids into cells and increases the synthesis of proteins. Insulin also inhibits protein breakdown and is involved in cellular growth and proliferation. On the other hand, defects in the intracellular signaling pathways of insulin may cause several disturbances in human metabolism, resulting in several chronic diseases. Insulin resistance, also known as impaired insulin sensitivity, is due to the decreased reaction of insulin signaling for glucose levels, seen when glucose use in response to an adequate concentration of insulin is impaired. Insulin resistance may cause, for example, increased plasma insulin levels. That state, called hyperinsulinemia, impairs metabolic processes and is observed in patients with type 2 diabetes mellitus and obesity. Hyperinsulinemia may increase the risk of initiation, progression and metastasis of several cancers and may cause poor cancer outcomes. Insulin resistance is a health problem worldwide; therefore, mechanisms of insulin resistance, causes and types of insulin resistance and strategies against insulin resistance are described in this review. Attention is also paid to factors that are associated with the development of insulin resistance, the main and characteristic symptoms of particular syndromes, plus other aspects of severe insulin resistance. This review mainly focuses on the description and analysis of changes in cells due to insulin resistance.
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Affiliation(s)
- Leszek Szablewski
- Chair and Department of General Biology and Parasitology, Medical University of Warsaw, Chałubińskiego Str. 5, 02-004 Warsaw, Poland
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3
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Li W, Liu T, Qian L, Wang Y, Ma X, Cao L, Zhang Q, Qu J. Insulin resistance and inflammation mediate the association of abdominal obesity with colorectal cancer risk. Front Endocrinol (Lausanne) 2022; 13:983160. [PMID: 36407320 PMCID: PMC9669084 DOI: 10.3389/fendo.2022.983160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The close association of abdominal obesity rather than general obesity with colorectal cancer (CRC) risk might be mediated by IR and inflammation, which has never been systematically explored in large-scale prospective studies. METHODS We prospectively examined the mediation effects of the fasting triglyceride-glucose (TyG) index and C-reactive protein (CRP) on the associations of obesity (general and abdominal) with CRC risk among 93,659 participants. We used the Cox proportional hazards regression models and subgroup analyses to evaluate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of CRC. The CAUSALMED procedure was used to perform the mediation analyses. RESULTS During 13.02 years of follow-up, a total of 586 CRC cases were verified. Male participants with general obesity and abdominal obesity had a 1.29-fold and a 1.28-fold increased risk of CRC. However, a significant association was only observed among female individuals with abdominal obesity. Both TyG index and CRP were associated with an elevated risk of CRC, and A significant interaction between the TyG index and CRP was found for the risk of CRC (P for interaction<0.05). CRP and the TyG index significantly mediated the positive association between abdominal obesity and CRC risk. CONCLUSION CRP and TyG index increased the risk of CRC independently and synergistically. Mediation effects of CRP and the TyG index were found for the association between abdominal obesity and CRC risk.
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Affiliation(s)
- Wenqiang Li
- Department of General Surgery, Aerospace Center Hospital, Beijing, China
| | - Tong Liu
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Liang Qian
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China
| | - Yiming Wang
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, China
| | - Xiangming Ma
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, China
| | - Liying Cao
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, China
| | - Qingsong Zhang
- Department of General Surgery, Kailuan General Hospital, Tangshan, China
- *Correspondence: Jun Qu, ; Qingsong Zhang,
| | - Jun Qu
- Department of General Surgery, Aerospace Center Hospital, Beijing, China
- *Correspondence: Jun Qu, ; Qingsong Zhang,
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Impact of Preoperative Total Proteins and Glycated Hemoglobin on Recurrences after Early Colorectal Cancer. Nutrients 2021; 13:nu13020711. [PMID: 33672318 PMCID: PMC7926911 DOI: 10.3390/nu13020711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The outcome of colorectal cancer is mostly based on TNM classification. There are several factors determining that patients with the same tumoral stage present different outcomes. The nutritional status has been related to the immunological response and may affect the oncologic results. The purpose of this study was to determine if preoperative nutritional parameters may predict the oncologic outcome in patients with early colorectal cancer. Methods: A prospective observational study of patients undergoing elective surgery for colorectal cancer was performed with stage I. Preoperative nutritional assessment included glycemic and lipid profiles, total proteins, and albumin levels. These parameters were correlated with tumoral recurrence during a follow-up of at least 24 months. Results: During the period of study, 744 patients were operated on and 228 (30.6%) followed the inclusion criteria for this study. Recurrence rate was 5.7% (13 patients). Patients with hypoproteinemia showed a 7.8-fold greater risk of recurrence during the first 24 months after surgery [OR 7.8 (CI95% 1.3–48), p = 0.012]. Patients with glycated hemoglobin levels (HbA1c) > 6.2% showed a 2.3 increased risk of recurrence [OR 2.3 (CI95% 1.1–4.7; p = 0.01]. Conclusions: Preoperative values of total proteins and HbA1c correlate with the recurrence rate in early colorectal cancer.
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Chae YC, Kim JY, Park JW, Kim KB, Oh H, Lee KH, Seo SB. FOXO1 degradation via G9a-mediated methylation promotes cell proliferation in colon cancer. Nucleic Acids Res 2019; 47:1692-1705. [PMID: 30535125 PMCID: PMC6393239 DOI: 10.1093/nar/gky1230] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
Posttranslational modifications of the Forkhead family transcription factor, FOXO1, have been known to have important regulatory implications in its diverse activities. Several types of modifications of FOXO1, including acetylation, phosphorylation, and ubiquitination, have been reported. However, lysine methylation of FOXO1 has not yet been identified. Here, we reported that FOXO1 is methylated by G9a at K273 residue in vitro and in vivo. Methylation of FOXO1 by G9a increased interaction between FOXO1 and a specific E3 ligase, SKP2, and decreased FOXO1 protein stability. In addition, G9a expression was increased by insulin and resulted in insulin-mediated FOXO1 degradation by K273 methylation. Tissue array analysis indicated that G9a was overexpressed and FOXO1 levels decreased in human colon cancer. Cell proliferation assays revealed that G9a-mediated FOXO1 methylation increased colon cancer cell proliferation. Fluorescence-activated cell sorting (FACS) analysis indicated that apoptosis rates were higher in the presence of FOXO1 than in FOXO1 knock-out cells. Furthermore, we found that G9a protein levels were elevated and FOXO1 protein levels were decreased in human colon cancer patients tissue samples. Here, we report that G9a specific inhibitor, BIX-01294, can regulate cell proliferation and apoptosis by inhibiting G9a-mediated FOXO1 methylation.
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Affiliation(s)
- Yun-Cheol Chae
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
| | - Ji-Young Kim
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
| | - Jin Woo Park
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
| | - Kee-Beom Kim
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
| | - Hyein Oh
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
| | - Sang-Beom Seo
- Department of Life Science, College of Natural Sciences, Chung-Ang University, Seoul 156-756, South Korea
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Choi S, Snider AJ. Diet, lipids and colon cancer. CELLULAR NUTRIENT UTILIZATION AND CANCER 2019; 347:105-144. [DOI: 10.1016/bs.ircmb.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ortega LS, Bradbury KE, Cross AJ, Morris JS, Gunter MJ, Murphy N. A Prospective Investigation of Body Size, Body Fat Composition and Colorectal Cancer Risk in the UK Biobank. Sci Rep 2017; 7:17807. [PMID: 29259258 PMCID: PMC5736687 DOI: 10.1038/s41598-017-17997-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/04/2017] [Indexed: 12/26/2022] Open
Abstract
Obesity has been consistently associated with a greater colorectal cancer risk, but this relationship is weaker among women. In the UK Biobank, we investigated the associations between body size (body mass index [BMI], height, waist circumference, and waist-to-hip ratio) and body fat composition (total body fat percentage and trunk fat percentage) measurements with colorectal cancer risk among 472,526 men and women followed for 5.6 years on average. Multivariable hazard ratios (HRs) and 95% confidence intervals (95%CI) for developing colorectal cancer (2,636 incident cases) were estimated using Cox proportional hazards models. Among men, when the highest and lowest fifths were compared, BMI (HR = 1.35, 95%CI: 1.13-1.61; Ptrend < 0.0001), waist circumference (HR = 1.66, 95%CI: 1.39-1.99; Ptrend < 0.0001), waist-to-hip ratio (HR = 1.58, 95%CI: 1.31-1.91; Ptrend < 0.0001), total body fat percentage (HR = 1.27, 95%CI: 1.06-1.53; Ptrend = 0.002), and trunk fat percentage (HR = 1.31, 95%CI: 1.09-1.58; Ptrend = 0.002) were associated with greater colorectal cancer risk. For women, only waist-to-hip ratio (HR for highest versus lowest fifth = 1.33, 95%CI: 1.08-1.65; Ptrend = 0.005) was positively associated with colorectal cancer risk. Greater body size (overall and abdominal adiposity) was positively associated with colorectal cancer development in men. For women, abdominal adiposity, rather than overall body size, was associated with a greater colorectal cancer risk.
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Affiliation(s)
- Luisa Saldana Ortega
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn E Bradbury
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda J Cross
- School of Public Health, Imperial College London, London, UK
| | | | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
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8
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Li H, Yang G, Xiang YB, Zhang X, Zheng W, Gao YT, Shu XO. Body weight, fat distribution and colorectal cancer risk: a report from cohort studies of 134255 Chinese men and women. Int J Obes (Lond) 2016; 37:783-9. [PMID: 22986684 PMCID: PMC3541452 DOI: 10.1038/ijo.2012.152] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the association of body size and fat distribution with risk of colorectal cancer (CRC) in Chinese men and women. DESIGN Population-based, prospective cohort study. SUBJECTS The analysis included 134 255 Chinese adults enrolled in the Shanghai Women’s Health Study and the Shanghai Men’s Health Study, with an average follow-up of 11.0 and 5.5 years, respectively. MEASUREMENTS Waist circumference (WC), body mass index (BMI) and waist-to-hip ratio (WHR) were measured by trained interviewers at baseline. Multivariable Cox models were used to calculate adjusted hazard ratios (HRs) for incident CRC. RESULTS A total of 935 incident CRC cases were identified. Both measures of general adiposity (measured by BMI) and central adiposity (measured by WHR and WC) were significantly associated with increased risk of colon cancer in men but not in women. Multivariable adjusted HRs for colon cancer in men in the highest compared with the lowest quintiles were 2.15 (95% CI: 1.35-3.43; P for trend = 0.0006) for BMI, 1.97 (95% CI: 1.19-3.24; P for trend = 0.0004) for WHR and 2.00 (95% CI: 1.21-3.29; P for trend = 0.0002) for WC. The BMI-associated risk was attenuated in analyses stratified by WHR, while the WHR-associated risk remained significant in the high BMI stratum (HR for comparison of extreme tertiles of WHR: 3.38, 95% CI: 1.47-7.75; P for trend =0.0002). None of these anthropometric measures were significantly associated with rectal cancer. CONCLUSION Obesity, particularly central obesity, was associated with increased risk of colon cancer in men.
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Affiliation(s)
- H Li
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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9
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Ambe CM, Mahipal A, Fulp J, Chen L, Malafa MP. Effect of Metformin Use on Survival in Resectable Pancreatic Cancer: A Single-Institution Experience and Review of the Literature. PLoS One 2016; 11:e0151632. [PMID: 26967162 PMCID: PMC4788143 DOI: 10.1371/journal.pone.0151632] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/02/2016] [Indexed: 12/16/2022] Open
Abstract
Observational studies have demonstrated that metformin use in diabetic patients is associated with reduced cancer incidence and mortality. Here, we aimed to determine whether metformin use was associated with improved survival in patients with resected pancreatic cancer. All patients with diabetes who underwent resection for pancreatic adenocarcinoma between 12/1/1986 and 4/30/2013 at our institution were categorized by metformin use. Survival analysis was done using the Kaplan-Meier method, with log-rank test and Cox proportional hazards multivariable regression models. For analyses of our data and the only other published study, we used Meta-Analysis version 2.2. We identified 44 pancreatic cancer patients with diabetes who underwent resection of the primary tumor (19 with ongoing metformin use, 25 never used metformin). There were no significant differences in major clinical and demographic characteristics between metformin and non-metformin users. Metformin users had a better median survival than nonusers, but the difference was not statistically significant (35.3 versus 20.2 months; P = 0.3875). The estimated 2-, 3-, and 5-year survival rates for non-metformin users were 42%, 28%, and 14%, respectively. Metformin users fared better with corresponding rates of 68%, 34%, and 34%, respectively. In our literature review, which included 111 patients from the two studies (46 metformin users and 65 non-users), overall hazard ratio was 0.668 (95% CI 0.397–1.125), with P = 0.129. Metformin use was associated with improved survival outcomes in patients with resected pancreatic cancer, but the difference was not statistically significant. The potential benefit of metformin should be investigated in adequately powered prospective studies.
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Affiliation(s)
- Chenwi M. Ambe
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Amit Mahipal
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Jimmy Fulp
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Lu Chen
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Mokenge P. Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- * E-mail:
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Bu WJ, Song L, Zhao DY, Guo B, Liu J. Insulin therapy and the risk of colorectal cancer in patients with type 2 diabetes: a meta-analysis of observational studies. Br J Clin Pharmacol 2015; 78:301-9. [PMID: 25099257 DOI: 10.1111/bcp.12350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/09/2014] [Indexed: 12/19/2022] Open
Abstract
AIMS Several epidemiological studies have reported inconsistent associations between insulin therapy and the risk of colorectal cancer (CRC) in patients with type 2 diabetes mellitus. We performed this meta-analysis of observational studies to evaluate the effect of insulin therapy on the risk of CRC. METHODS We carried out a systematic search of PubMed, Embase and the Cochrane Library Central database between January 1966 and August 2013. Fixed-effects and random-effects models were used to estimate the pooled relative risk (RR) and corresponding 95% confidence interval (CI). RESULTS A total of 12 epidemiological studies were included in the present meta-analysis, involving a total of 7947 CRC cases and 491 384 participants. There was significant heterogeneity among the studies, but no publication bias. Insulin therapy significantly increased the risk of CRC [RR = 1.69, 95% CI (1.25, 2.27)]. When the various studies were stratified by study design, we found that insulin use was associated with a statistically significant 115% higher risk of CRC among case-control studies [RR = 2.15, 95% CI (1.41, 3.26)], but not among cohort studies [RR = 1.25, 95% CI (0.95, 1.65)]. Furthermore, a significant association was noted among studies conducted in USA [RR = 1.73, 95% CI (1.15, 2.60)] and Asia [RR = 2.55, 95% CI (2.14, 3.04)], but not in Europe [RR = 1.20, 95% CI (0.92, 1.57)]. CONCLUSIONS The present meta-analysis suggests that insulin therapy may increase the risk of CRC. More prospective cohort studies with longer follow-up durations are warranted to confirm this association. Furthermore, future studies should report results stratified by gender and race and should adjust the results by more confounders.
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Affiliation(s)
- Wu-jie Bu
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Kim EH, Kim H, Bae SJ, Chang H, Park HW, Do MY, Kim K, Jung CH, Lee WJ, Park J, Choe J. Fasting serum insulin levels and insulin resistance are associated with colorectal adenoma in Koreans. J Diabetes Investig 2014; 5:297-304. [PMID: 24843778 PMCID: PMC4020334 DOI: 10.1111/jdi.12178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/24/2013] [Accepted: 08/22/2013] [Indexed: 12/13/2022] Open
Abstract
AIMS/INTRODUCTION Insulin has been associated with the risk of colorectal cancer (CRC). However, few studies have evaluated the association between insulin and colorectal adenoma. We investigated the relationship between fasting serum insulin levels or homeostasis model assessment of insulin resistance (HOMA-IR) and colorectal adenoma. MATERIALS AND METHODS We retrospectively enrolled 15,427 participants who underwent both fasting serum insulin measurement and colonoscopy for a routine health examination at Asan Medical Center from January 2007 to December 2008. Participants with a history of any cancer, previous colectomy or polypectomy, those taking antidiabetic medications, and inflammatory bowel disease, non-specific colitis, non-adenomatous polyps only or CRC on colonoscopic findings were excluded. Finally, 3,606 participants with histologically confirmed colorectal adenoma and 6,019 controls with no abnormal findings on colonoscopy were included. Participants were categorized into quartiles (Q) based on fasting serum insulin levels and HOMA-IR. RESULTS Fasting serum insulin and HOMA-IR were significantly higher in participants with colorectal adenomas compared with controls. Multivariate regression analysis adjusting for age, sex, smoking habits, drinking habits and family history of CRC showed that participants with higher quartiles of fasting serum insulin levels (odd ratio [OR] 1.17 for 2nd Q, 1.19 for 3rd Q, and 1.42 for 4th Q, P < 0.05) or HOMA-IR (OR 1.18 for 2nd Q and 1.45 for 4th Q, P < 0.05) showed significantly increased ORs of colorectal adenoma compared with the lowest quartiles. CONCLUSIONS These findings showed that increased serum insulin levels and insulin resistance were significantly associated with the presence of colorectal adenoma.
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Affiliation(s)
- Eun Hee Kim
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Hong‐Kyu Kim
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Sung Jin Bae
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Hye‐Sook Chang
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Hye Won Park
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Mi Young Do
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
| | - Kyung‐Jo Kim
- Division of GastroenterologyDepartment of Internal MedicineUniversity of Ulsan College of MedicineSeoulKorea
| | - Chang Hee Jung
- Division of Endocrinology & MetabolismDepartment of Internal MedicineUniversity of Ulsan College of MedicineSeoulKorea
| | - Woo Je Lee
- Division of Endocrinology & MetabolismDepartment of Internal MedicineUniversity of Ulsan College of MedicineSeoulKorea
| | - Joong‐Yeol Park
- Division of Endocrinology & MetabolismDepartment of Internal MedicineUniversity of Ulsan College of MedicineSeoulKorea
| | - Jaewon Choe
- Health Screening and Promotion CenterAsan Medical CenterSeoulKorea
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Ito K, Ishigamori R, Mutoh M, Ohta T, Imai T, Takahashi M. Ay allele promotes azoxymethane-induced colorectal carcinogenesis by macrophage migration in hyperlipidemic/diabetic KK mice. Cancer Sci 2013; 104:835-43. [PMID: 23551905 PMCID: PMC7657178 DOI: 10.1111/cas.12162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 01/17/2023] Open
Abstract
The incidence of colorectal cancer has been increasing and is associated with obesity and diabetes. We have found that type 2 diabetes model KK-Ay/TaJcl (KK-Ay) mice develop tumors within a short period after treatment with azoxymethane (AOM). However, factors that contribute to the promotion of carcinogenesis have not been clarified. Therefore, we looked at the genetic background of KK-Ay, including two genetic characteristics of KK/TaJcl (KK) mice and C57BL/6J-Ham-Ay/+ (Ay) mice, compared with other non-obese and non-diabetic mouse strains C57BL/6J and ICR, and induced colorectal premalignant lesions, aberrant crypt foci (ACF), and tumors using AOM (150 μg/mouse/week for 4 weeks and 200 μg/mouse/week for 6 weeks, respectively). The mice with a diabetes feature, KK-Ay and KK, developed significantly more ACF, 67 and 61 per mouse, respectively, whereas ICR, Ay, and C57BL/6J mice developed 42, 24, and 18 ACF/mouse, respectively, at 17 weeks of age. Serum insulin and triglyceride levels in KK-Ay and KK mice were quite high compared with other non-diabetic mouse strains. Interestingly, KK-Ay mice developed more colorectal tumors (2.7 ± 2.3 tumor/mouse) than KK mice (1.2 ± 1.1 tumor/mouse) at 25 weeks of age, in spite of similar diabetic conditions. The colon cancers that developed in both KK-Ay and KK mice showed similar activation of β-catenin signaling. However, mRNA levels of inflammatory factors related to the activation of macrophages were significantly higher in colorectal cancer of KK-Ay mice than in KK. These data indicate that factors such as insulin resistance and dyslipidemia observed in obese and diabetic patients could be involved in susceptibility to colorectal carcinogenesis. In addition, increase of tumor-associated macrophages may play important roles in the stages of promotion of colorectal cancer.
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Affiliation(s)
- Kumiko Ito
- Division of Cancer Prevention Research, National Cancer Center Research Institute, Tokyo, Japan
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13
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Femia AP, Raimondi L, Maglieri G, Lodovici M, Mannucci E, Caderni G. Long-term treatment with Sitagliptin, a dipeptidyl peptidase-4 inhibitor, reduces colon carcinogenesis and reactive oxygen species in 1,2-dimethylhydrazine-induced rats. Int J Cancer 2013; 133:2498-503. [DOI: 10.1002/ijc.28260] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/26/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Angelo Pietro Femia
- Section of Pharmacology and Toxicology; NEUROFARBA Department, University of Florence; Florence; Italy
| | - Laura Raimondi
- Section of Pharmacology and Toxicology; NEUROFARBA Department, University of Florence; Florence; Italy
| | - Giulia Maglieri
- Section of Pharmacology and Toxicology; NEUROFARBA Department, University of Florence; Florence; Italy
| | - Maura Lodovici
- Section of Pharmacology and Toxicology; NEUROFARBA Department, University of Florence; Florence; Italy
| | | | - Giovanna Caderni
- Section of Pharmacology and Toxicology; NEUROFARBA Department, University of Florence; Florence; Italy
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Tsai CJ, Giovannucci EL. Hyperinsulinemia, insulin resistance, vitamin D, and colorectal cancer among whites and African Americans. Dig Dis Sci 2012; 57:2497-503. [PMID: 22562539 DOI: 10.1007/s10620-012-2198-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/14/2012] [Indexed: 12/11/2022]
Abstract
African Americans have the highest incidence and mortality rates of colorectal cancer among all US racial and ethnic groups. Dietary factors, lifestyle factors, obesity, variability in screening rates, socioeconomic differences, barriers to screening, and differences in access to health care may be contributory factors to racial and ethnic disparities. African Americans are more likely to demonstrate microsatellite instability in their colorectal tumors leading to malignancy. However, these differences do not completely explain all the variances. Ample evidence implicates insulin resistance and its associated conditions, including elevated insulin and insulin-like growth factor-1 (IGF-1), in colorectal carcinogenesis. African Americans have a high risk for and a high prevalence of insulin resistance and subsequent overt type 2 diabetes. Recent clinical studies revealed that ethnic differences between whites and African Americans in early diabetes-related conditions including hyperinsulinemia already exist during childhood. African Americans have a much higher prevalence of vitamin D deficiency than whites throughout their life spans. Vitamin D deficiency has been associated with higher rates of diabetes and colorectal cancer, particularly in individuals with high serum insulin and IGF-1 levels. Moreover, African Americans have lower insulin sensitivity in tissues, independent of obesity, fat distribution, and inflammation. Further development of measures of biomarkers of tumor biology and host susceptibility may provide further insight on risk stratification in African Americans.
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Affiliation(s)
- Chung-Jyi Tsai
- Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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15
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Wong P, Weiner MG, Hwang WT, Yang YX. Insulin therapy and colorectal adenomas in patients with diabetes mellitus. Cancer Epidemiol Biomarkers Prev 2012; 21:1833-40. [PMID: 22879206 DOI: 10.1158/1055-9965.epi-12-0771] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (DM) are at increased risk for colorectal adenomas and cancer because of endogenous hyperinsulinemia. Exogenous insulin therapy has been associated with higher colorectal cancer incidence. The aim of this study was to evaluate the association between exogenous insulin therapy and adenoma formation, accounting for duration of therapy and location and stage of the adenoma. METHODS We conducted a cross-sectional study of patients with type 2 diabetes between the ages of 50 and 80 years who completed full colonoscopies. Cases were patients with any adenoma on index colonoscopy. Patients without any adenoma composed the control group. Multivariable logistic regression was used to calculate odds ratios (OR) and associated confidence intervals (CI). RESULTS Compared with the controls, case patients (n = 196) did not have a significantly increased odds of insulin exposure, when exposure was defined as 12 months or more of insulin use compared with no insulin. However, the odds of insulin exposure among the cases was significantly increased when exposure was defined as 18 months or more (OR 1.6, 95% CI 1.1-2.5), 24 months or more (OR 1.7, CI 1.1-2.6), and 36 months or more (OR 2.0, 95% CI 1.2-3.4) of insulin use (test for trend P = 0.05). A similar trend in insulin exposure was seen among type 2 diabetics with advanced adenomas. Adenoma location was not significantly affected by insulin therapy. CONCLUSIONS Chronic insulin therapy is associated with increased risk of colorectal adenomas in patients with type 2 diabetes. IMPACT Diabetes patients receiving insulin may need more stringent colon cancer screening.
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Affiliation(s)
- Patricia Wong
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, USA
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16
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Sun L, Yu S. Diabetes mellitus is an independent risk factor for colorectal cancer. Dig Dis Sci 2012; 57:1586-97. [PMID: 22302244 DOI: 10.1007/s10620-012-2059-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 01/07/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological studies have suggested positive associations between diabetes and colorectal cancer. However, the findings were inconsistent, especially regarding specific sex or cancer subsite. AIMS To conduct a systematic review with meta-analysis to examine the association of diabetes mellitus with risk of colorectal cancer and to investigate whether the association is dependent on sex, cancer subsite, race/ethnicity, or duration of diabetes. METHODS Relevant studies were identified by searching Pubmed to May 12, 2011. The reference lists of identified articles were also reviewed. Two authors independently selected the studies and extracted relevant data. The study quality was assessed. RESULTS Thirty-nine studies (28 cohort studies and 11 case-control studies) were included in the final analysis. Compared with non-diabetic subjects, the pooled risk estimate of colorectal cancer for diabetic subjects was 1.29 (95% CI = 1.23-1.35). The subgroup analyses revealed that the risk was significantly increased for both genders, for every cancer subsite, and for both short duration and long duration of diabetes. Exposure to diabetes increased the risk of colorectal cancer for White and Asian, whereas there was no evidence of such an association either among Black or native Hawaiians. CONCLUSIONS Our results confirmed that subjects with diabetes are at modestly increased risk of developing colorectal cancer.
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Affiliation(s)
- Lei Sun
- Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wu Han, China.
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17
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Insulin glargine and NPH insulin increase to a similar degree epithelial cell proliferation and aberrant crypt foci formation in colons of diabetic mice. Discov Oncol 2011; 1:320-30. [PMID: 21761363 DOI: 10.1007/s12672-010-0020-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The insulin analog glargine has a higher binding affinity than regular insulin for the insulin-like growth factor 1 receptor in vitro, raising questions about increased mitogenicity in vivo. Observational studies in humans have recently reported a potential differential association between insulin glargine and malignancies, but available evidence remains inconclusive. We directly compared glargine vs. neutral protamine Hagedorn (NPH) insulin's effects on cell proliferation in colonic mucosa and on formation of aberrant crypt foci in diabetic mice, i.e., early stages of colorectal cancer development. Mice (BKS.Cg-+Lepr(db)/+Lepr(db)/OlaHsd) were treated with insulin glargine (G), NPH insulin (NPH), or saline (NaCl). We assessed epithelial proliferation after long-term insulin treatment (18 weeks) by 5-bromo-2'-deoxyuridine and Ki67 staining and analyzed the formation of aberrant crypt foci (ACF) in mice treated with insulin glargine or NPH insulin or 10 weeks after initiation with 1,2-dimethylhydrazine. Insulin glargine treatment did not result in significantly different epithelial colonic proliferation compared to NPH insulin (G, 137 ± 22; NPH, 136 ± 15; NaCl, 100 ± 20 (relative proliferation index)), but both insulin-treated groups of mice had a higher proliferation index compared to the NaCl control group (p<0.001). Similarly, we observed no difference in ACF formation between glargine- and NPH-insulin-treated mice (G, 132 ± 12; NPH, 138 ± 9; NaCl, 100 ± 7 (relative number of ACF)), but ACF formation was significantly higher in insulin-treated mice than in NaCl-treated control mice (p=0.001). Chronic insulin treatment results in higher colonic epithelial proliferation and ACF formation, but the use of insulin glargine vs. NPH insulin is not associated with increased risk.
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Lipoprotein lipase as a candidate target for cancer prevention/therapy. Biochem Res Int 2011; 2012:398697. [PMID: 22028972 PMCID: PMC3199119 DOI: 10.1155/2012/398697] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022] Open
Abstract
Epidemiological studies have shown that serum triglyceride (TG) levels are linked with risk of development of cancer, including colorectal and pancreatic cancers, and their precancerous lesions. Thus, it is assumed that serum TG plays an important role in carcinogenesis, and the key enzyme lipoprotein lipase (LPL), which catalyzes the hydrolysis of plasma TG, may therefore be involved. Dysregulation of LPL has been reported to contribute to many human diseases, such as atherosclerosis, chylomicronaemia, obesity, and type 2 diabetes. Recently, it has been reported that LPL gene deficiency, such as due to chromosome 8p22 loss, LPL gene polymorphism, and epigenetic changes in its promoter region gene, increases cancer risk, especially in the prostate. In animal experiments, high serum TG levels seem to promote sporadic/carcinogen-induced genesis of colorectal and pancreatic cancers. Interestingly, tumor suppressive effects of LPL inducers, such as PPAR ligands, NO-1886, and indomethacin, have been demonstrated in animal models. Moreover, recent evidence that LPL plays important roles in inflammation and obesity implies that it is an appropriate general target for chemopreventive and chemotherapeutic agents.
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Ortiz AP, Thompson CL, Chak A, Berger NA, Li L. Insulin resistance, central obesity, and risk of colorectal adenomas. Cancer 2011; 118:1774-81. [PMID: 22009143 DOI: 10.1002/cncr.26454] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/13/2011] [Accepted: 06/22/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increasing evidence supports insulin resistance (IR) as the underpinning of the obesity-colorectal neoplasia link. The homeostasis model assessment-IR (HOMA-IR) is a widely accepted index of evolving hyperinsulinemia and early IR. Studies of the relation between HOMA-IR and colorectal adenomas are limited. Therefore, the authors sought to determine the associations of HOMA-IR and central obesity (waist to hip ratio [WHR]) with risk of colorectal adenomas in a screening colonoscopy-based study. METHODS The authors collected lifestyle information and fasting blood samples from 1222 participants (320 incident adenoma cases and 902 without adenomas) before their screening colonoscopies. Unconditional logistic regression models were used to assess risk associations. RESULTS In multivariate analysis of participants (n = 1093) reporting no antidiabetic medication use, those in the top quartile of WHR were twice as likely (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.33-3.57; P-trend = .003) and those in the top quartile of HOMA-IR were 63% more likely (OR, 1.63; 95% CI, 1.09-2.44; P-trend = .01) to have adenomas compared with those in the bottom quartiles. Stratified analysis revealed a statistically significant interaction between HOMA-IR and sex (P-interaction = .04), with the association largely limited to men; compared with those in the bottom tertile, men in the top tertile of HOMA-IR were twice more likely to have adenomas (OR, 2.11; 95% CI, 1.18-3.78; P-trend = .01). CONCLUSIONS The results support central obesity and insulin resistance, particularly in men, as important risk factors for the development of early colorectal neoplasia.
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Affiliation(s)
- Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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20
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Jimenez B, Palekar N, Schneider A. Issues related to colorectal cancer and colorectal cancer screening practices in women. Gastroenterol Clin North Am 2011; 40:415-26, ix. [PMID: 21601788 DOI: 10.1016/j.gtc.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Studies have shown that colorectal cancer (CRC) incidence is equal between men and women. However, several studies have demonstrated lower adenoma detection rates in women than in men. Many questions arise about differences in adenomas, CRC, and screening practices between men and women: should screening be the same for both sexes, are there differences in risk factors in the formation of colon cancer, should special groups of women be screened differently from the general population, are colonoscopies tolerated differently in women and why, and what determines if a woman will undergo colonoscopy? This article reviews these issues.
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Affiliation(s)
- Brenda Jimenez
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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21
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Polymorphisms affecting micro-RNA regulation and associated with the risk of dietary-related cancers: a review from the literature and new evidence for a functional role of rs17281995 (CD86) and rs1051690 (INSR), previously associated with colorectal cancer. Mutat Res 2010; 717:109-15. [PMID: 20971123 DOI: 10.1016/j.mrfmmm.2010.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/08/2010] [Accepted: 10/14/2010] [Indexed: 12/16/2022]
Abstract
In this review, we focus on the genetic variations (single nucleotide polymorphisms, SNPs) known to occur in microRNAs and in their binding sites and the susceptibility to cancers of the gastro-intestinal (GI) tract in humans. Since the sequence complementarity and the thermodynamics of binding play an essential role in the interaction of miRNA with its target mRNA, sequence variations in the miRNA-binding seed regions or in miRNA genes (either within pre-, pri-, or mature miRNA regions) should reinforce, weaken, or disrupt the miRNA-mRNA interaction and affect the expression of mRNA targets. Indirect evidences supporting these hypotheses are reported in the literature, essentially coming from case-control association studies. Several studies have been published on the association between miR-SNPs or SNPs within their binding sites and the risk of oesophageal, gastric, or colorectal cancer. Unfortunately, functional studies are lacking. Besides reviewing the available literature, we present here for the first time two SNPs (rs17281995 in CD86 and rs1051690 in INSR) previously associated with the risk of CRC in a Czech population are also associated with the risk in a Spanish population. Moreover, we show for the first time that both these alleles regulate differentially the amount of a reporter gene (luciferase) in an in vitro assay on HeLa cells. These findings suggest that both these SNPs may have a functional role in regulating the expression of CD-86 and INSR proteins acting at the level of the 3'UTR. More functional studies are needed in order to better understand the role of polymorphic regulatory sequences at the 3'UTR of genes.
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Jalving M, Gietema JA, Lefrandt JD, de Jong S, Reyners AKL, Gans ROB, de Vries EGE. Metformin: taking away the candy for cancer? Eur J Cancer 2010; 46:2369-80. [PMID: 20656475 DOI: 10.1016/j.ejca.2010.06.012] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 06/07/2010] [Indexed: 12/16/2022]
Abstract
Metformin is widely used in the treatment of diabetes mellitus type 2 where it reduces insulin resistance and diabetes-related morbidity and mortality. Population-based studies show that metformin treatment is associated with a dose-dependent reduction in cancer risk. The metformin treatment also increases complete pathological tumour response rates following neoadjuvant chemotherapy for breast cancer, suggesting a potential role as an anti-cancer drug. Diabetes mellitus type 2 is associated with insulin resistance, elevated insulin levels and an increased risk of cancer and cancer-related mortality. This increased risk may be explained by activation of the insulin- and insulin-like growth factor (IGF) signalling pathways and increased signalling through the oestrogen receptor. Reversal of these processes through reduction of insulin resistance by the oral anti-diabetic drug metformin is an attractive anti-cancer strategy. Metformin is an activator of AMP-activated protein kinase (AMPK) which inhibits protein synthesis and gluconeogenesis during cellular stress. The main downstream effect of AMPK activation is the inhibition of mammalian target of rapamycin (mTOR), a downstream effector of growth factor signalling. mTOR is frequently activated in malignant cells and is associated with resistance to anticancer drugs. Furthermore, metformin can induce cell cycle arrest and apoptosis and can reduce growth factor signalling. This review discusses the role of diabetes mellitus type 2 and insulin resistance in carcinogenesis, the preclinical rationale and potential mechanisms of metformin's anti-cancer effect and the current and future clinical developments of metformin as a novel anti-cancer drug.
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Affiliation(s)
- Mathilde Jalving
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands.
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23
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Yamamoto S, Nakagawa T, Matsushita Y, Kusano S, Hayashi T, Irokawa M, Aoki T, Korogi Y, Mizoue T. Visceral fat area and markers of insulin resistance in relation to colorectal neoplasia. Diabetes Care 2010; 33:184-9. [PMID: 19837793 PMCID: PMC2797970 DOI: 10.2337/dc09-1197] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although abdominal obesity and related metabolic abnormalities are hypothesized to promote colorectal carcinogenesis, direct confirmation of this effect is required. Here, we examined the relation of early-stage colorectal neoplasia to visceral fat area and markers of insulin resistance. RESEARCH DESIGN AND METHODS Subjects were participants in a comprehensive health screening conducted at the Hitachi Health Care Center, Ibaraki, Japan. During a 3-year period (2004-2007), a total of 108 patients with early-stage colorectal neoplasia, including 22 with early cancer, were identified among individuals who received both colorectal cancer screening and abdominal computed tomography scanning. Three control subjects matched to each case subject were randomly selected from those whose screening results were negative. Conditional logistic regression analysis was used to examine the association of measures of obesity and markers of insulin resistance with colorectal neoplasia, with adjustment for smoking and alcohol drinking. RESULTS Visceral fat area, but not subcutaneous fat area, was significantly positively associated with colorectal cancer, with odds ratios (95% CI) for the lowest to highest tertile of visceral fat area of 1 (reference), 2.17 (0.45-10.46), and 5.92 (1.22-28.65), respectively (P(trend) = 0.02). Markers of insulin resistance, particularly fasting glucose, were also positively associated with colorectal cancer risk. In contrast, no associations were observed for colorectal adenomas. CONCLUSIONS These results suggest that visceral adipose tissue accumulation and insulin resistance may promote the development of early-stage cancer but not adenoma in the colorectum.
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Abstract
Experimental, epidemiological and clinical evidence implicates insulin resistance and its accompanying hyperinsulinaemia in the development of cancer, but the relative importance of these disturbances in cancer remains unclear. There are, however, theoretical mechanisms by which hyperinsulinaemia could amplify such growth-promoting effects as insulin may have, as well as the growth-promoting effects of other, more potent, growth factors. Hyperinsulinaemia may also induce other changes, particularly in the IGF (insulin-like growth factor) system, that could promote cell proliferation and survival. Several factors can independently modify both cancer risk and insulin resistance, including subclinical inflammation and obesity. The possibility that some of the effects of hyperinsulinaemia might then augment pro-carcinogenic changes associated with disturbances in these factors emphasizes how, rather than being a single causative factor, insulin resistance may be most usefully viewed as one strand in a network of interacting disturbances that promote the development and progression of cancer.
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Jaggers JR, Sui X, Hooker SP, LaMonte MJ, Matthews CE, Hand GA, Blair SN. Metabolic syndrome and risk of cancer mortality in men. Eur J Cancer 2009; 45:1831-8. [PMID: 19250819 DOI: 10.1016/j.ejca.2009.01.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 01/22/2009] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) has been linked with an increased risk of developing cancer; however, the association between MetS and cancer mortality remains less clear. Little research has focused on pre-cancer risk factors that may affect the outcome of treatment. The purpose of this study was to examine the association between MetS and all-cancer mortality in men. METHODS The participants included 33,230 men aged 20-88 years who were enrolled in the Aerobics Centre Longitudinal Study and who were free of known cancer at the baseline. RESULTS At baseline 28% of all the participants had MetS. During an average of 14 years follow-up, there were a total of 685 deaths due to cancer. MetS at baseline was associated with a 56% greater age-adjusted risk in cancer mortality. CONCLUSION These data show that MetS is associated with an increased risk of all-cause cancer mortality in men. Based on these findings, it is evident that successful interventions should be identified to attenuate the negative effects of MetS.
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Affiliation(s)
- Jason R Jaggers
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States.
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26
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Swede H, Rohan TE, Yu H, Anderson JC, Stevens RG, Brokaw J, Levine J, Brenner BM, Malchoff CD, Duffy VB, Pleau DC, Rosenberg DW. Number of aberrant crypt foci associated with adiposity and IGF1 bioavailability. Cancer Causes Control 2008; 20:653-61. [PMID: 19067190 DOI: 10.1007/s10552-008-9278-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 11/21/2008] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dysregulation of the insulin-like growth factor (IGF) system, a common consequence of adiposity-induced insulin resistance, may be a key underlying mechanism linking excess body weight with colon cancer. Evidence has been derived from studies of cancer and polyps. Supporting data about aberrant crypt foci (ACF), putative pre-polyp changes, have been generated only from animal studies to date. METHODS We randomly selected 26 patients with sex-specific elevated waist-hip-ratio (WHR) and 26 with normal values from a series of 150 patients seeking routine colonoscopy at the University of Connecticut Health Center. Cross-sectional analyses were performed of ACF number (<5, > or = 5) in relation to total IGF1, IGF-binding protein-3 (IGFBP3), insulin, body mass index (BMI), WHR and waist circumference (WC). Visualized ACF in the 20 cm of the distal colon were counted using advanced endoscopic imaging. RESULTS Patients with > or = 5 ACF had higher BMI, WHR, and WC compared with patients with >5 ACF (p = 0.04, p = 0.03, and p = 0.01, respectively). IGFBP3 was reduced (p = 0.02) and IGF1:IGFBP3 molar ratio was greater (p = 0.03) in patients with > or = 5 ACF. We did not observe significant associations between ACF number and insulin or total IGF1. CONCLUSIONS Our study provides the first report in humans of a possible association of ACF prevalence and IGF1 bioavailability as characterized by IGF1:IGFBP3 molar ratio and IGFBP3 level. More research is needed to determine whether this relationship is varied by ACF features (e.g., size, dysplasia, molecular changes), synchronous cancer and polyps, and is modified by colon cancer risk factors.
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Affiliation(s)
- Helen Swede
- Colon Cancer Prevention Program, Neag Comprehensive Cancer Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6325, USA.
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Ealey KN, Lu S, Archer MC. Development of aberrant crypt foci in the colons of ob/ob and db/db mice: evidence that leptin is not a promoter. Mol Carcinog 2008; 47:667-77. [PMID: 18240295 DOI: 10.1002/mc.20419] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Leptin is elevated in obesity and has been suggested to increase the risk of colorectal cancer (CRC), although the evidence is conflicting. The objective of this study was to compare the susceptibility to colon carcinogenesis of db/db mice that have highly elevated circulating leptin and leptin-deficient ob/ob mice, both of which are obese. Seven-week-old male ob/ob, db/db, and WT mice received 4 weekly i.p. injections of 5 mg/kg azoxymethane (AOM) and were killed 14 wk later for the analysis of putative preneoplastic aberrant crypt foci (ACF). There were no differences in ACF number or multiplicity between ob/ob and db/db mice. Leptin has been shown to induce CYP2E1, the main enzyme that activates AOM, but we observed no differences in hepatic CYP2E1 activity or colonic CYP2E1 protein levels between ob/ob and db/db mice. We also induced ACF with 2 oral doses 3 d apart of 30 mg/kg methylnitrosourea (MNU), a direct-acting carcinogen. There were no differences in ACF number or multiplicity between the two groups of obese animals 5 wk following the last dose of MNU. The colonic mucosa of db/db mice expressed significantly lower mRNA levels of ObRa, the predominant short form of the leptin receptor, compared to ob/ob mice, and following i.p. injection with 1 mg/kg recombinant mouse leptin, exhibited significantly reduced p44/42 pMAPK compared to saline-treated controls. These results show that ObRa is functionally active in the colons of db/db mice. We conclude that leptin does not play a significant role in ACF development.
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Affiliation(s)
- Kafi N Ealey
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
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Why diabetes patients are more prone to the development of colon cancer? Med Hypotheses 2008; 71:241-4. [PMID: 18456417 DOI: 10.1016/j.mehy.2008.03.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 03/09/2008] [Accepted: 03/12/2008] [Indexed: 12/23/2022]
Abstract
Type II diabetes mellitus (T2D) develops as the consequence of relative insulin insufficiency. The onset of T2D is characterized by insulin resistance, and in most cases, with hyperinsulinemia for compensation. Extensive basic and clinical examinations have identified a large profile of T2D susceptibility genes and multiple risk factors, including obesity and sedentary life style, which are shared by colon cancer development. The intestinal endocrine L cells produce an incretin hormone, namely glucagon-like peptide-1 (GLP-1), which stimulates insulin secretion in blood glucose dependent manner, pancreatic beta cell proliferation and neogenesis. It has been shown that in T2D patients, postprandial GLP-1 secretion level is reduced. I hypothesize that during the development of insulin resistance, intestinal endocrine L cells produce more GLP-1 for compensation. This compensatory response involves the activation of Wnt signaling pathway and the cross-talk between Wnt and insulin signaling pathways. A pathological consequence of this compensation will be the stimulated expression of proto-oncogenes, including c-Myc.
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Perry Glauert H. Influence of Dietary Fat on the Development of Cancer. FOOD SCIENCE AND TECHNOLOGY 2008. [DOI: 10.1201/9781420046649.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Colorectal cancer occurs more frequently in patients with type 2 diabetes mellitus. The hyperinsulinemia-hypothesis suggests that elevated levels of insulin and free IGF-1 promote proliferation of colon cells and lead to a survival benefit of transformed cells, ultimately resulting in colorectal cancer. In patients with type 2 diabetes mellitus, epidemiological studies show an increased risk for colorectal cancer and an even higher risk if patients are treated with sulphonylureas or insulin. Moreover, tumour progression at hyperinsulinemia is more rapid and tumour-associated mortality is increased. Colorectal cancer can be avoided by screening. Recommendations for colorectal cancer screening should employ the recent epidemiologic evidence. All patients with type 2 diabetes mellitus should be recommended to undergo colonoscopy before starting insulin therapy, and screening intervals should not exceed 5 years. For this concept, a review of the evidence is presented, and a screening algorithm for colorectal cancer in patients with type 2 diabetes mellitus is proposed.
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Affiliation(s)
- Jutta M Berster
- Medizinische Klinik und Poliklinik II, Klinikum Grosshadern, LMU Munich, Marchioninistrasse 15, Munich, Germany
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Early DS, Fontana L, Davidson NO. Translational approaches to addressing complex genetic pathways in colorectal cancer. Transl Res 2008; 151:10-6. [PMID: 18061123 PMCID: PMC2195933 DOI: 10.1016/j.trsl.2007.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/30/2007] [Accepted: 09/04/2007] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is among the most prevalent cancers worldwide and represents a major public health challenge in the developed world. From the perspective of translational investigation, scientists have enormous opportunity to elucidate the molecular genetic mechanisms that contribute to CRC pathogenesis because most cancers develop from adenomatous precursor lesions. The process of adenoma growth and transformation is accompanied by cumulative mutations in dominant genetic pathways that confer a growth advantage. Although this developmental process permits interrogation of informative pathways before the development of cancer, only a few adenomas progress to CRC. Accordingly, a major challenge for clinical translational investigators is to identify the molecular signatures that indicate increased likelihood for adenoma progression. By corollary, these molecular signatures include mutations in high penetrance alleles, which include the Adenomatous Polyposis Coli (APC) gene as well as other alleles in the Wnt/beta-catenin signaling pathway that specify increased genetic susceptibility to CRC. Interactions between these high penetrance alleles and other modifier genes as well as with environmental factors are of particular importance to understand the complex network of events that lead to CRC. This brief review will highlight 3 areas where important questions concerning genetic and environmental risk factors have fueled translational investigation into possible pathways that lead to CRC.
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Affiliation(s)
- Dayna S Early
- Gastroenterology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Mo 63110, USA
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Sun J, Jin T. Both Wnt and mTOR signaling pathways are involved in insulin-stimulated proto-oncogene expression in intestinal cells. Cell Signal 2008; 20:219-29. [DOI: 10.1016/j.cellsig.2007.10.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 10/07/2007] [Indexed: 01/10/2023]
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Abstract
The association between diet and colorectal cancer has been studied in depth for many decades, with equivocal results. It has been hypothesized that cancers arising in the distal and proximal colon have different pathologies, and therefore different risk factors. As such, it is possible that diet-related factors might influence colorectal neoplasia differently depending on the subsite. Recent evidence indicates that women may be more likely to develop proximal cancers than men. Additionally, the link between certain dietary factors and colorectal neoplasia in women seems to vary by menopausal status. Given these observations, women may be affected differently than men by diet-related factors. The objective of this article was therefore to review the data for diet and colorectal adenomas and cancer, and then attempt to address the potential differences in the association of diet-related factors and colorectal neoplasia in men and women. For total energy intake, selenium, and fiber, it seems that there may be slightly stronger effects in men as compared with women, whereas calcium and folate seem to affect both sexes similarly. With regard to vitamin D and colorectal cancer, women may exhibit stronger associations than men. Perhaps the most evidence for a sex-specific effect is observed for obesity, where more substantial direct relationships between body size and colorectal neoplasia have been reported for men than for women. However, this observation may be influenced by the differential effects in women by menopausal status. Further research on sex-specific dietary effects is warranted.
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Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman Arizona College of Public Health, Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA.
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Shonka NA, Anderson JR, Panwalkar AW, Reed EC, Steen PD, Ganti AK. Effect of diabetes mellitus on the epidemiology and outcomes of colon cancer. Med Oncol 2007; 23:515-9. [PMID: 17303910 DOI: 10.1385/mo:23:4:515] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 11/30/1999] [Accepted: 04/22/2006] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To assess the effect of diabetes mellitus (DM) on the pathogenesis and outcomes from colon cancer. METHODS A retrospective chart review was conducted on 1853 patients with colon cancer. RESULTS A higher percentage of males than females with colon cancer had DM (16.2% vs 11.3%; p < 0.01). Males had a slightly lower risk of dying from colon cancer (RR - 0.88; p=0.08). There was no difference in the median age of diagnosis of colon cancer in patients with and without DM, but a larger proportion of patients with diabetes mellitus were >or=70 yr at diagnosis (50% vs 43%) (p=0.0004). No significant relationship was noted between stage of colon cancer or survival and presence of DM. CONCLUSIONS DM did not affect either the stage at diagnosis, or outcomes from colon cancer. More males with colon cancer tended to have DM and a larger proportion of patients with DM were >or=70 yr at the time of diagnosis.
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Affiliation(s)
- Nicole Annette Shonka
- Department of Internal Medicine, Section of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA
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Shonka NA, Anderson JR, Panwalkar AW, Reed EC, Steen PD, Ganti AK, Davis TE. Effect of diabetes mellitus on the epidemiology and outcomes of colon cancer. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2007. [PMID: 17303910 DOI: 10.1385/mo:] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the effect of diabetes mellitus (DM) on the pathogenesis and outcomes from colon cancer. METHODS A retrospective chart review was conducted on 1853 patients with colon cancer. RESULTS A higher percentage of males than females with colon cancer had DM (16.2% vs 11.3%; p < 0.01). Males had a slightly lower risk of dying from colon cancer (RR - 0.88; p=0.08). There was no difference in the median age of diagnosis of colon cancer in patients with and without DM, but a larger proportion of patients with diabetes mellitus were >or=70 yr at diagnosis (50% vs 43%) (p=0.0004). No significant relationship was noted between stage of colon cancer or survival and presence of DM. CONCLUSIONS DM did not affect either the stage at diagnosis, or outcomes from colon cancer. More males with colon cancer tended to have DM and a larger proportion of patients with DM were >or=70 yr at the time of diagnosis.
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Affiliation(s)
- Nicole Annette Shonka
- Department of Internal Medicine, Section of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA
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Otani T, Iwasaki M, Ikeda S, Kozu T, Saito H, Mutoh M, Wakabayashi K, Tsugane S. Serum triglycerides and colorectal adenoma in a case-control study among cancer screening examinees (Japan). Cancer Causes Control 2007; 17:1245-52. [PMID: 17111255 DOI: 10.1007/s10552-006-0065-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Most epidemiologic studies have shown serum triglycerides to be associated with colorectal adenoma. However, whether the association can be modified by smoking is unknown. We cross-sectionally investigated the association of serum triglycerides with the risk of adenoma by smoking status. METHODS We identified 782 newly diagnosed adenoma cases from the examinees of a colorectal cancer screening program. All cases were diagnosed by a magnifying colonoscopy with dye spreading. We determined 738 controls without present illness or past history of adenoma from among the examinees. They provided their lifestyle information and fasting blood samples to measure their serum triglycerides. We calculated odds ratios (OR) and 95% confidence intervals (CI) of colorectal adenoma for serum triglycerides. RESULTS High serum triglycerides were associated with colorectal adenoma (OR 1.5; 95% CI 1.1-2.0 for the highest versus the lowest quartile, P (trend, )0.030). A stronger association was observed between three or more adenoma cases and study controls (OR 2.3; 95% CI 1.3-4.2, P (trend,) < 0.0010). After classifying the study subjects by smoking status, a significant linear risk trend was found in ever-smokers (P (trend), 0.0018) but not in never-smokers (P (trend), 0.94; P (interaction), 0.067). CONCLUSIONS Our results suggested that a higher serum triglyceride level may be related to a larger number of adenomas. Adenoma development involving an elevated serum triglyceride level may be modified by smoking.
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Affiliation(s)
- Tetsuya Otani
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
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Abstract
OBJECTIVES Increased risk for colorectal cancer (CRC) has been associated with type 2 diabetes. Despite several studies linking insulin resistance to increased CRC risk, there are limited data on colorectal adenoma risk in diabetic women. We hypothesized that diabetic women would have increased rates of colorectal adenomas relative to a group of nondiabetic women. METHODS Colorectal adenoma rates were determined in 100 estrogen-negative women with type 2 diabetes mellitus and compared with 500 nondiabetic, estrogen-negative controls. Adenomas were defined as any adenoma or advanced adenoma (villous or tubulovillous features, size >1 cm or high-grade dysplasia). A multivariate model including age, race, diabetes, hypertension, hypercholesterolemia, body mass index, and nonsteroidal anti-inflammatory drug status was used to determine the independent effects of diabetes on colorectal adenoma incidence. RESULTS Diabetics as compared with nondiabetics had greater rates of any adenoma (37%vs 24%, p= 0.009) and advanced adenomas (14%vs 6%, p= 0.009). Two hundred forty-five obese subjects compared with 355 nonobese subjects had a higher rate of any adenoma (32%vs 22%, p= 0.001). Obese diabetics compared with nonobese, nondiabetics had greater rates of any adenoma (42%vs 23%, p< or = 0.001) and advanced adenomas (19%vs 7%, p< or = 0.001). Multivariate analysis showed that adenomas and advanced adenomas were independently predicted by diabetes (p < 0.05) and adenomas by age. DISCUSSION Women with type 2 diabetes mellitus had higher rates of colorectal adenomas as compared with lean and nondiabetic women. This finding adds to the evidence that type 2 diabetes is an important factor in the progression of the adenoma-carcinoma sequence.
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Affiliation(s)
- Jill E Elwing
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Johnson KT, Harmsen WS, Limburg PJ, Carston MJ, Johnson CD. Visceral fat analysis at CT colonography. Acad Radiol 2006; 13:963-8. [PMID: 16843848 DOI: 10.1016/j.acra.2006.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Revised: 04/19/2006] [Accepted: 04/22/2006] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES Obesity is associated with increased risks for colorectal neoplasia. Few studies have examined quantitative body fat measurements as predictors of colorectal polyps. The objective is to determine whether visceral fat is associated with colorectal polyps at computed tomography (CT) colonography. MATERIALS AND METHODS Case (n = 25) and control (n = 25) subjects with proven large (>1 cm) colorectal adenomas or normal colons respectively were randomly selected from among an established CT colonography research study cohort. Using supine CT colonography data, the body wall was traced at three levels: top of the right kidney, iliac crest, and superior acetabulum. Total area from the three slices and each slice area were determined within the visceral fat range (-170 to -45 Hounsfield units) and recorded within the selected region. Visceral fat measures were compared between patient groups with and without polyps. RESULTS None of the single slice visceral fat area measures or summed measures predicted case or control status. The most informative visceral fat measure was obtained at the top of the right kidney with a maximum area under the received operator characteristic curve of 0.77 (0.05 SE). For a selected sensitivity of 75%, the maximum specificity for a large (>or=1 cm) polyp was 64%. CONCLUSION In this pilot study, visceral fat measures at CT colonography were not significantly associated with the presence of large colorectal adenomas. However, odd ratios were elevated by a factor of 2. This suggests that a larger study may be justified.
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Wei EK, Ma J, Pollak MN, Rifai N, Fuchs CS, Hankinson SE, Giovannucci E. C-Peptide, Insulin-like Growth Factor Binding Protein-1, Glycosylated Hemoglobin, and the Risk of Distal Colorectal Adenoma in Women. Cancer Epidemiol Biomarkers Prev 2006; 15:750-5. [PMID: 16614119 DOI: 10.1158/1055-9965.epi-05-0820] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Determinants of insulin secretion and insulin-like growth factors (IGF) have been directly associated with risk for colorectal cancer. However, few studies have evaluated whether these factors are also associated with risk of colorectal adenoma, the main precursor lesion to colorectal cancer. METHODS We identified 380 distal colorectal adenoma cases diagnosed between 1989 and 1998 and 380 controls among nondiabetic women from the cohort of 32,826 women, nested in the Nurses' Health Study, who provided blood samples in 1989 to 1990. Cases and controls were individually matched on year of birth, time period of and indication(s) for endoscopy, and date of blood draw. RESULTS High concentrations of C-peptide, an indicator of insulin secretion, were statistically significantly associated with risk of distal colorectal adenoma [multivariable relative risk (MVRR) top versus bottom quartile, 1.63; 95% confidence interval (95% CI), 1.01-2.66; P = 0.01], even after including body mass index and physical activity in the statistical model. Fasting IGF binding protein-1 (IGFBP-1) concentrations did not show any clear association with risk for adenoma (MVRR top versus bottom quartile, 1.08; 95% CI, 0.56-2.07). These associations did not differ significantly by size/stage of adenoma. Glycosylated hemoglobin (HbA1c) was associated with a nonstatistically significant increased risk of colorectal adenoma (MVRR top versus bottom quartile, 1.47; 95% CI, 0.89-2.44). CONCLUSIONS High HbA1c and low IGFBP-1 were not clearly associated with increased risk of distal colorectal adenoma. However, our current results and previous associations between C-peptide and colorectal cancer suggest that hyperinsulinemia may play a role throughout the development of colorectal neoplasia.
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Affiliation(s)
- Esther K Wei
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Insulin-like growth factor-I and insulin are associated with the presence and advancement of adenomatous polyps. Gastroenterology 2005. [PMID: 16083703 DOI: 10.1053/j.gastro.2005.05.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND & AIMS Insulin and insulin-like growth factor-I (IGF-I) affect proliferation, differentiation, and apoptosis and are potential risk factors for colorectal cancer (CRC). Visceral obesity, possibly via hyperinsulinemia, has also been linked to CRC risk. We evaluated the relationship of insulin, IGF-I, insulin-like growth factor binding protein (IGFBP) 3, and visceral adipose tissue (VAT) in subjects with adenomatous polyps, the precursor lesion of colorectal cancer. METHODS Participants were asymptomatic subjects who underwent screening flexible sigmoidoscopy (FSG) within the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Subjects underwent single-slice, computerized tomography scanning to measure VAT and serum fasting insulin, IGF-I, and IGFBP-3 measurements. RESULTS Four hundred fifty-eight subjects were enrolled, of which 202 subjects had an adenoma, 70 of which were an advanced adenoma. IGF-I (P = .02), IGF-I/IGFBP-3 ratio (P = .003), and insulin (P = .02) were significantly increased in subjects with adenomas compared with controls. In an unadjusted logistic regression analysis using sex-specific quartile cut points, subjects in quartile 4 in comparison with quartile 1 of IGF-I (odds ratio [OR] = 1.7; [95% CI: 1.0-2.9], Ptrend = .03), IGF-I/IGFBP-3 ratio (OR = 1.9 [95% CI: 1.1-3.3], Ptrend = .01), and insulin (OR = 2.1 [95% CI: 1.2-3.6], Ptrend = .04) were at increased risk of adenoma. When limiting the case group to advanced adenomas, the effect was more pronounced: IGF-I (OR = 2.8 [95% CI: 1.3-6.2], Ptrend = .006), IGF-I/IGFBP-3 ratio (OR = 2.3, [95% CI: 1.0-5.2], Ptrend = .04), and insulin (OR = 2.3 [95% CI: 1.1-4.9], Ptrend = .14). Visceral adipose tissue was not associated with adenoma risk. CONCLUSIONS Levels of IGF-I, ratio of IGF-I/IGFBP-3, and insulin are associated with adenomas and even more so with advanced adenomas. These data support the hypothesis that insulin and IGF-I may contribute to the development and advancement of adenomatous polyps.
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Biesalski HK. Meat as a component of a healthy diet - are there any risks or benefits if meat is avoided in the diet? Meat Sci 2005; 70:509-24. [PMID: 22063749 DOI: 10.1016/j.meatsci.2004.07.017] [Citation(s) in RCA: 208] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 07/15/2004] [Accepted: 07/15/2004] [Indexed: 01/10/2023]
Abstract
Meat is frequently associated with a "negative" health image due to its "high" fat content and in the case of red meat is seen as a cancer-promoting food. Therefore, a low meat intake, especially red meat is recommended to avoid the risk of cancer, obesity and metabolic syndrome. However, this discussion overlooks the fact, that meat is an important source for some of micronutrients such as iron, selenium, vitamins A, B12 and folic acid. These micronutrients are either not present in plant derived food or have poor bioavailability. In addition, meat as a protein rich and carbohydrate "low" product contributes to a low glycemic index which is assumed to be "beneficial" with respect to overweight, the development of diabetes and cancer (insulin resistance hypothesis). Taken together meat is an important nutrient for human health and development. As an essential part of a mixed diet, meat ensures adequate delivery of essential micronutrients and amino acids and is involved in regulatory processes of energy metabolism.
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Affiliation(s)
- H-K Biesalski
- Universität Hohenheim, Institut für Biologische Chemie und Ernährungswissenschaft, Garbenstrasse 30 70593 Stuttgart, Germany
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Abstract
BACKGROUND & AIMS Endogenous hyperinsulinemia in the context of type 2 diabetes mellitus is potentially associated with an increased risk of colorectal cancer. We aimed to determine whether insulin therapy might increase the risk of colorectal cancer among type 2 diabetes mellitus patients. METHODS We conducted a retrospective cohort study among all patients with a diagnosis of type 2 diabetes mellitus in the General Practice Research Database from the United Kingdom. We excluded patients with <3 years of colorectal cancer-free database follow-up after the diabetes diagnosis as well as those insulin users who developed colorectal cancer after <1 year of insulin therapy. The remaining insulin users and the noninsulin-using type 2 diabetic patients were followed for the occurrence of colorectal cancer. Hazard ratios (HR) were determined in Cox proportional hazard analysis. A nested case-control study was conducted to perform multivariable analysis and to determine a duration-response effect. RESULTS The incidence of colorectal cancer in insulin users (n = 3160) was 197 per 100,000 person-years, compared with 124 per 100,000 person-years in type 2 diabetes mellitus patients not receiving insulin (n = 21,758). The age- and sex-adjusted HR of colorectal cancer associated with > or =1 year of insulin use was 2.1 (95% CI: 1.2-3.4, P = 0.005). The positive association strengthened after adjusting for potential confounders. The multivariable odds ratio associated with each incremental year of insulin therapy was 1.21 (95% CI: 1.03-1.42, P = 0.02). CONCLUSIONS Chronic insulin therapy significantly increases the risk of colorectal cancer among type 2 diabetes mellitus patients.
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Affiliation(s)
- Yu-Xiao Yang
- Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA.
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Sass DA, Schoen RE, Weissfeld JL, Weissfeld L, Thaete FL, Kuller LH, McAdams M, Lanza E, Schatzkin A. Relationship of visceral adipose tissue to recurrence of adenomatous polyps. Am J Gastroenterol 2004; 99:687-93. [PMID: 15089903 DOI: 10.1111/j.1572-0241.2004.04136.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Insulin is a growth factor for colorectal cancer. Visceral adipose tissue (VAT) is strongly associated with insulin levels, and insulin and visceral obesity have been associated in cohort studies with colorectal cancer. The aim of this investigation was to determine whether VAT is associated with recurrence of adenomatous polyps, the precursor to colorectal cancer. METHODS As an ancillary study to the Polyp Prevention Trial, a randomized clinical trial that evaluated the effect of a low-fat, high-fiber, high vegetable and fruit diet on adenomatous polyp recurrence, subjects at one clinical center underwent measurement of VAT with a single-slice CT scan through the L4-L5 interspace. The scan was performed around the time of the subject's year 4 colonoscopy that determined adenoma recurrence. RESULTS Of 119 subjects, 44 of 84 men (52%) and 16 of 35 women (46%) had a recurrent adenoma (p= 0.51). Body mass index (BMI) and weight at baseline and at year 4 colonoscopy were unrelated to adenoma recurrence. In a multivariate model including visceral fat quartile, remote history of polyps, gender, age, and randomization group, only remote history of polyps was statistically significantly associated with recurrent adenoma with a relative risk of 4.6 (95% CI 1.7, 12.4, p= 0.001). There was no consistent monotonic trend of increased or decreased risk of recurrence as one ascended quartiles of adipose tissue for visceral, subcutaneous, or total abdominal fat. CONCLUSION In this study, no association between visceral adipose tissue and adenomatous polyp recurrence was observed. Further study and exploration of the role of VAT in adenoma progression is required.
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Affiliation(s)
- David A Sass
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Abstract
Obesity has recently been linked to mortality from the majority of cancers. The insulin/insulin-like growth factor (IGF) system may partly explain this effect. The metabolic syndrome, associated with hyperinsulinemia, may modulate this effect. Recent evidence supports the role of insulin and IGF-1 as important growth factors, acting through the tyrosine kinase growth factor cascade in enhancing tumor cell proliferation. In addition, the metabolic syndrome associated with a chronic inflammatory state and accompanying cytokine abnormalities may also contribute to tumor progression. Growing links between insulin and the etiology as well as prognosis in colon, prostate, pancreatic, and, particularly, breast cancer are reviewed. Of particular concern is the evidence that elevated IGF-1 may interfere with cancer therapy, adversely affecting prognosis. The role of insulin is of concern because of the increasing levels of obesity and the associated metabolic syndrome. Weight gain, through typical Western diet; limited levels of activity; and, more recently, stress-related changes in neuroendocrine function may lead to insulin resistance and hyperinsulinemia. The opportunity for a multidisciplinary approach involving nutrition, exercise, and stress reduction in an integrative setting may be crucial to limiting the insulin-resistant state and improving cancer outcomes.
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Komninou D, Ayonote A, Richie JP, Rigas B. Insulin resistance and its contribution to colon carcinogenesis. Exp Biol Med (Maywood) 2003; 228:396-405. [PMID: 12671184 DOI: 10.1177/153537020322800410] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The insulin resistance-colon cancer hypothesis, stating that insulin resistance may be associated with the development of colorectal cancer, represents a significant advance in colon cancer, as it emphasizes the potential for this cancer to become a modifiable disease. The fact that the incidence of insulin resistance has been increasing in the United States and much of the rest of the Western world where colon cancer remains the second leading cause of cancer death makes the exploration of the interrelationship of these conditions a subject of high priority. Here, we review the salient features of insulin resistance, defined as impaired biological response to the action of insulin. Recent epidemiological studies, evaluating potential associations between colon cancer risk and diabetes mellitus, dietary intake and metabolic factors, and IGF levels in several clinical settings, provide strong support of the insulin resistance-colon cancer hypothesis (without establishing causality). Mechanistically, insulin resistance has been associated with hyperinsulinemia, increased levels of growth factors including IGF-1, and alterations in NF-kappaB and peroxisome proliferator-activated receptor signaling, which may promote colon cancer through their effects on colonocyte kinetics. It is a reasonable expectation that in the not too distant future, critical interventions to the already mapped molecular sequence of events, which link two apparently disparate entities, combined with lifestyle changes could abrogate the development of colon cancer.
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Affiliation(s)
- Despina Komninou
- American Health Foundation, New York Medical College, Valhalla, New York 10595, USA
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Roncucci L, Pedroni M, Vaccina F, Benatti P, Marzona L, De Pol A. Aberrant crypt foci in colorectal carcinogenesis. Cell and crypt dynamics. Cell Prolif 2001; 33:1-18. [PMID: 10741640 PMCID: PMC6496032 DOI: 10.1046/j.1365-2184.2000.00159.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aberrant crypt foci (ACF) have been identified on the colonic mucosal surface of rodents treated with colon carcinogens and of humans after methylene-blue staining and observation under a light microscope. Several lines of evidence strongly suggest that ACF with certain morphological, histological, cell kinetics, and genetic features are precursor lesions of colon cancer both in rodents and in humans. Thus, ACF represent the earliest step in colorectal carcinogenesis. This paper has the main purpose of reviewing the evidence supporting this view, with particular emphasis on cell and crypt dynamics in ACF. ACF have been used as intermediate biomarkers of cancer development in animal studies aimed at the identification of colon carcinogens and chemopreventive agents. Recently, evidence has also shown that ACF can be effectively employed in chemopreventive studies also in humans.
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Affiliation(s)
- L Roncucci
- Department of Internal Medicine, University of Modena, Italy
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Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr 2001; 131:3109S-20S. [PMID: 11694656 DOI: 10.1093/jn/131.11.3109s] [Citation(s) in RCA: 646] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- E Giovannucci
- Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.
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Ealey K, El-Sohemy A, Archer M. Conjugated Linoleic Acid Does Not Inhibit Development of Aberrant Crypt Foci in Colons of Male Sprague-Dawley Rats. Nutr Cancer 2001. [DOI: 10.1207/s15327914nc41-1&2_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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49
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Bruce WR, Wolever TM, Giacca A. Mechanisms linking diet and colorectal cancer: the possible role of insulin resistance. Nutr Cancer 2001; 37:19-26. [PMID: 10965515 DOI: 10.1207/s15327914nc3701_2] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Diet is clearly implicated in the origin of colorectal cancer, with risk factors for the disease including reduced consumption of vegetables, fiber, and starch and increased consumption of red meat and animal fat. Several hypotheses have been developed to explain these associations. Most recently, McKeown-Eyssen and Giovannucci noted the similarity of the risk factors for colorectal cancer and those for insulin resistance and suggested that insulin resistance leads to colorectal cancer through the growth-promoting effect of elevated levels of insulin, glucose, or triglycerides. We briefly review the evidence from observational, epidemiological, and experimental animal studies linking diet with insulin resistance and colorectal cancer. The evidence suggests that diets high in energy and saturated fat and with high glycemic index carbohydrate and low levels of fiber and n-3 fatty acids lead to insulin resistance with hyperinsulinemia, hyperglycemia, and hypertriglyceridemia. We then consider how insulin, the related insulin-like growth factors, triglycerides, and nonesterified fatty acids could lead to increased growth of colon cancer precursor lesions and the development of colorectal cancer. Finally, we consider the implications of this scheme on possible future research directions, including studies of satiety and clinical tests of the importance of insulin resistance in the colon carcinogenesis process.
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Affiliation(s)
- W R Bruce
- Department of Nutritional Sciences, University of Toronto, ON, Canada.
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Strickler HD, Wylie-Rosett J, Rohan T, Hoover DR, Smoller S, Burk RD, Yu H. The relation of type 2 diabetes and cancer. Diabetes Technol Ther 2001; 3:263-74. [PMID: 11478333 DOI: 10.1089/152091501300209633] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Increasing evidence indicates that individuals with type 2 diabetes (diabetes) are at elevated risk for several common human malignancies, including cancers of the colon, breast, endometrium, pancreas, and liver. In particular, the consistent positive results reported by prospective investigations make it unlikely that methodologic issues, occult tumors, or chance results could explain the findings. Since diabetes and impaired fasting glucose together affect >25% of Americans above age 50, even a moderate etiologic association (e.g., relative risk = 1.5) would explain >10% of involved malignancies. Laboratory studies have suggested biologically plausible mechanisms. Insulin, for example, is typically at high levels during the development and early stages of diabetes. Activation of the insulin receptor by its ligand, or cross-activation of the insulin-like growth factor-I receptor, has been shown to be mitogenic and promote tumorigenesis in various model systems. A "unifying concept," in fact, holds that hyperinsulinemia may underlie the cancer associations of several additional risk factors, including high waist circumference, visceral fat, waist-to-hip ratio, body mass index, sedentary lifestyle, and energy intake. In this review, we assess current evidence regarding the relation of type 2 diabetes with cancer, and evaluate the findings in terms of well-accepted criteria for establishing causality.
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Affiliation(s)
- H D Strickler
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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