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American Journal of Epidemiology Advance Access published online on July 28, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj253
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received September 7, 2005
Accepted March 20, 2006

ORIGINAL CONTRIBUTIONS

A Prospective Study of Anthropometric and Clinical Measurements Associated with Insulin Resistance Syndrome and Colorectal Cancer in Male Smokers

Katherine Bowers 1 *, Demetrius Albanes 1, Paul Limburg 2, Pirjo Pietinen 3, Phil R. Taylor 4, Jarmo Virtamo 3, and Rachael Stolzenberg-Solomon 1

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

* To whom correspondence should be addressed.
Katherine Bowers, E-mail: rs221z{at}nih.gov


  Abstract

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.

Keywords: body mass index; colorectal neoplasms; dyslipidemias; hyperinsulinism; hypertension; insulin resistance; metabolic syndrome X; smoking.
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