High blood glucose increases stomach cancer
risk
| Fumie Ikeda, Yasufumi Doi, Koji
Yonemoto, et al. Hyperglycemia Increases Risk
of Gastric Cancer Posed by Helicobacter pylori
Infection: A Population-Based Cohort Study.
Gastroenterol 2009;
136: 1234-1241.
ABSTRACT
Background & Aims
Although diabetes mellitus and hyperglycemia
are considered to be possible risk factors for
various types of malignancy, the epidemiologic
evidence concerning gastric cancer is scarce.
The aim of this study was to evaluate the
impact of hemoglobin A1c (HbA1c) levels on
gastric cancer occurrence and their interaction
with Helicobacter pylori infection.
Methods
A total of 2603 Japanese subjects aged
≥40 years were stratified into 4 groups
according to baseline HbA1c levels
(≤4.9%, 5.0%–5.9%,
6.0%–6.9%, and ≥7.0%) and
followed up prospectively for 14 years.
Results
During the follow-up, 97 subjects developed
gastric cancer. The age- and sex-adjusted
incidence of gastric cancer significantly
increased in the 6.0%–6.9% (5.1 per 1000
person-years; P < .05) and ≥7.0%
groups (5.5 per 1000 person-years; P < .05)
compared with the 5.0%–5.9% group (2.5
per 1000 person-years), whereas it was slightly
but not significantly high in the ≤4.9%
group (3.6 per 1000 person-years). This
association remained substantially unchanged
even after adjusting for the confounding
factors including Helicobacter pylori
seropositivity, (multivariate-adjusted hazard
ratio [HR], 2.13; 95% confidence interval [CI]:
1.30–3.47 for the 6.0%–6.9% group
and HR, 2.69; 95% CI: 1.24–5.85 for the
≥7.0% group). Among subjects who had
both high HbA1c levels (≥6.0%) and
Helicobacter pylori infection, the risk of
gastric cancer was dramatically elevated
(interaction term, P = .004).
Conclusions
Our findings suggest that casual
hyperglycemia is a risk factor for gastric
cancer and is a possible cofactor increasing
the risk posed by Helicobacter pylori
infection.
|
COMMENT: The
researchers say that diabetes and hyperglycemia are
considered possible risk factors for various types of
cancer, but that epidemiologic evidence concerning
gastric cancer is scarce.
Japan has a higher prevalence
of gastric cancer than Western countries, but uinlike
in western countries, wheref H. pylori is ubiquitous,
only a small proportion of the people carrying H.
pylori in Japan develop the disease. This indicates
that infection cannot be the only etiologic factor.
To investigate this, a team at
Kyushu University in Fukuoka divided 2603 Japanese
individuals aged at least 40 years into four groups
according to haemoglobin (Hb)A1C levels.
HbA1C levels were 4.9% or
below in 390 participants, 5.0 to 5.9% in 1685, 6.0 to
6.9% in 427, and more than 7.0% in 101 individuals.
During 14 years of follow-up,
97 participants developed gastric cancer.
The incidence of gastric
cancer was significantly higher with baseline HbA1C
levels of either 6.0% to 6.9% or more than 7.0% than at
levels of 5.0% to 5.9%, at rates of 5.1 and 5.5 versus
2.5 per 1000 person-years.
This association did not
substantially change after adjusting for the
confounding factors including H. pylori seropositivity,
with multivariate-adjusted hazard ratios of 2.13 with
HbA1C of 6.0% to 6.9% and 2.69 for levels of more than
7.0%.
Gastric cancer risk was
dramatically elevated for individuals with high HbA1C
levels of 6.0% and above who also had H. pylori
infection.
Last updated 6 April 2009
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