American Journal of Epidemiology Advance Access originally published online on July 28, 2006
American Journal of Epidemiology 2006 164(7):652-664; doi:10.1093/aje/kwj253
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Original Contribution |
A Prospective Study of Anthropometric and Clinical Measurements Associated with Insulin Resistance Syndrome and Colorectal Cancer in Male Smokers
1 Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
2 Mayo Clinic, Rochester, MN
3 Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
4 Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
Correspondence to Katherine Bowers, c/o Dr. Rachael Stolzenberg-Solomon, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd., Suite 320, Bethesda, MD 20892 (e-mail: rs221z{at}nih.gov).
Type 2 diabetes mellitus shares risk factors for and has shown a positive association with colorectal cancer. Anthropometric measures (height, weight, and body mass index (weight (kg)/height (m)2) and metabolic abnormalities associated with insulin resistance syndrome (IRS) (abnormalities in measured blood pressure, high density lipoprotein (HDL) cholesterol, and total cholesterol) were prospectively evaluated for associations with incident colon (n = 227), rectal (n = 183), and colorectal (n = 410) cancers diagnosed between 1985 and 2002 in 28,983 Finnish male smokers from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals. In comparison with the lowest quintile, the highest quintile of body mass index was significantly associated with colorectal cancer (hazard ratio (HR) = 1.70, 95% confidence interval (CI): 1.01, 2.85; p-trend = 0.01), particularly colon cancer. Subjects with a cluster of three IRS-related conditions (hypertension, body mass index 
25 kg/m2, and HDL cholesterol level <40 mg/dl (<1.55 mmol/liter)), compared with those with fewer conditions, had a significantly increased risk of colorectal cancer (HR = 1.40, 95% CI: 1.12, 1.74), particularly colon cancer (HR = 1.58, 95% CI: 1.18, 2.10), but not rectal cancer. These results support the hypothesis that the significant association observed between IRS-defining metabolic abnormalities and colorectal cancer is determined primarily by adiposity.
body mass index; colorectal neoplasms; dyslipidemias; hyperinsulinism; hypertension; insulin resistance; metabolic syndrome X; smoking
Abbreviations: BMI, body mass index; CI, confidence interval; HDL, high density lipoprotein; HR, hazard ratio; ICD-9, International Classification of Diseases, Ninth Revision; IGF-1, insulin-like growth factor 1; IGFBP, insulin-like growth factor binding protein; IRS, insulin resistance syndrome
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