Am J Epidemiol 2002; 156:702-713.
Copyright © 2002 by the
Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Familial Aggregation of Diabetes and Hypertension in a Case-Control Study of Colorectal Neoplasia
1 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
2 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
3 Samuel Lunenfeld Research Institute, University of Toronto, Toronto, Ontario, Canada.
4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
5 Department of Statistics, University of Toronto, Toronto, Ontario, Canada.
6 Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada.
7 Department of Medicine, Wellesley Hospital, Toronto, Ontario, Canada.
8 Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada.
9 Women’s Health Science Centre, Toronto, Ontario, Canada.
10 Department of Surgery, Ottawa Civic Hospital, Ottawa, Ontario, Canada.
11 Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
12 Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
13 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
14 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
15 Department of Medicine, Toronto Hospital (General Division), Toronto, Ontario, Canada.
Familial aggregation of diseases potentially associated with metabolic syndrome (diabetes mellitus, hypertension, and cardiovascular diseases) was assessed in a colonoscopy-based case-control study of colorectal neoplasia in Toronto and Ottawa, Canada, in 1993–1996. Each familial disease was analyzed by logistic regression using generalized estimating equations. Case probands had incident adenomatous polyps (n = 172) or incident (n = 25) or prevalent (n = 132) colorectal cancer (CRC), while control probands (n = 282) had a negative colonoscopy and no history of CRC or polyps. Significant effect modification was evident in the data, with the strongest positive associations between familial diabetes and colorectal neoplasia among older probands with symptoms (parents: odds ratio (OR) = 2.4, 95% confidence interval (CI): 1.2, 4.8; siblings: OR = 5.8, 95% CI: 2.6, 13.3). Familial hypertension was also associated with colorectal neoplasia among probands with symptoms (OR = 1.7, 95% CI: 1.1, 2.6). In stratified analyses, familial diabetes, hypertension, and stroke were positively associated with adenomatous polyps in subgroups of probands who were older and/or had symptoms, while only familial diabetes was possibly associated with CRC. Associations in other proband groups may have been obscured by high cumulative incidence of parental CRC. Family studies are needed to understand the contribution of specific environmental and genetic factors in accounting for the disease aggregations.
adenomatous polyps; case-control studies; colorectal neoplasms; diabetes mellitus; family; family health; hypertension; insulin resistance
Abbreviations: Abbreviations: BMI, body mass index; CI, confidence interval; CRC, colorectal cancer; FHQ, family history questionnaire; OR, odds ratio.
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