Diabetes mellitus and risk of colorectal cancer in the Singapore Chinese Health Study.
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AbstractThe incidence of colorectal cancer is highest in populations that consume an energy-dense diet, have low intakes of vegetables and fruit, or lead a sedentary lifestyle. These factors may influence colorectal carcinogenesis via insulin pathways. We examined whether diabetes mellitus was associated with colorectal cancer in Singapore Chinese, whose body type and lifestyle profiles are distinct from those of Western populations. Between April 1993 and December 1998, 63,257 Singapore Chinese men and women aged 45 to 74 years were enrolled in a prospective study of diet and cancer. Each subject provided dietary, medical, and lifestyle information through an in-person interview. As of December 31, 2002, 636 incident colorectal cancer cases had been diagnosed. A history of physician-diagnosed diabetes was statistically significantly associated with colorectal cancer risk in both men (relative risk [RR] = 1.5, 95% confidence interval [CI] = 1.2 to 2.1) and women (RR = 1.4, 95% CI = 1.0 to 1.9). In stratified analyses, this association remained statistically significant among the subset of diabetics with high total calorie intake and low physical activity levels. Our results support the hypothesis that hyperinsulinemia may play a role in colorectal carcinogenesis, even in a relatively lean population.
CitationJ. Natl. Cancer Inst. 2006, 98 (2):135-138
DescriptionLifestyle modulation of cancer & cancer biomarkersLifestyle element evaluated: diabetes mellitusOutcome studied (cancer or cancer biomarker): colorectal cancerMethod of biomarker analysis:questionnairesStudy type (in vitro, animals, humans): humansStudy design (if human): prospectiveStudy size (if human): 6327 individualsDescription of cohort(s) studied (if human): Chinese men and women, aged 45 - 74 years, who belong to either the Hokkien or the Cantonese dialect groups and live in government housing estatesConfounders controlled for: sex, body mass index, total calorie intake and physical activityImpact on outcome: 636 subjects (284 women and 352 men) had developed colorectal cancer (391 colon and 245 rectal cancers), 97%histopathologically confirmed.Dose-response relationships observed: 50% higher among diabetics than among nondiabetics (relative risk [RR] = 1.5, 95% confidence interval [CI] = 1.2 to 1.9)Sex: men (RR = 1.5, 95% CI = 1.2 to 2.1) and women (RR = 1.4, 95% CI = 1.0 to 1.9).The relative risk estimates were similar for both colon cancer (RR =1.5, 95% CI =1.1 to 2.0) and rectal cancer (RR =1.5, 95% CI = 1.0 to 2.1) BMI between 20 and 24 kg/m 2 : Diabetics had a 70% higher risk of developing colorectal cancer ( P <.001) than nondiabetics among subjects with a Calorie intake: among subjects with higher total caloric intake (RR =1.8, 95% CI = 1.3 to 2.4; P interaction = .10).Physical activity: elevated risk of colorectal cancer dia - betics versus nondiabetics with lower levels of physical activity (RR = 1.5, 95% CI = 1.2 to 1.9; P interaction = .16. KEYWORDS CLASSIFICATION: Aged;complications;cancer epidemiology;China;Colorectal Neoplasms;Confidence Intervals;Diabetes Complications;dietary modulation of cancer & cancer biomarkers;epidemiology;ethnology;etiology;Energy Intake;Exertion;Family;Female;history;Humans;Hyperinsulinism;lifestyle modulation of cancer & cancer biomarkers;Male;Middle Aged;Odds Ratio;Prospective Studies;Questionnaires;Research;Risk Assessment;Risk Factors;Singapore.