Association between markers of glucose metabolism and risk of colorectal adenoma

Sanjay Rampal, Moon Hee Yang, Jidong Sung, Hee Jung Son, Yoon Ho Choi, Jun Haeng Lee, Young Ho Kim, Dong Kyung Chang, Poong Lyul Rhee, Jong Chul Rhee, Eliseo Guallar, Juhee Cho

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Abstract

Background & Aims Diabetes is a risk factor for colorectal cancer. We studied the association between markers of glucose metabolism and metabolic syndrome and the presence of colorectal adenomas in a large number of asymptomatic men and women attending a health screening program in South Korea. We also investigated whether these associations depend on adenoma location. Methods In a cross-sectional study, we measured fasting levels of glucose, insulin, hemoglobin A1c, and C-peptide and calculated homeostatic model assessment (HOMA) values (used to quantify insulin resistance) for 19,361 asymptomatic South Korean subjects who underwent colonoscopy examinations from January 2006 to June 2009. Participants completed a standardized self-administered health questionnaire and a validated semiquantitative food frequency questionnaire. Blood samples were collected on the day of the colonoscopy; fasting blood samples were also collected. Robust Poisson regression was used to model the associations of glucose markers with the prevalence of any adenoma. Results Using detailed multivariable-adjusted dose-response models, the prevalence ratios (aPR, 95% confidence interval [CI]) for any adenoma, comparing the 90th with the 10th percentile, were 1.08 (1.00-1.16; P =.04) for fasting glucose, 1.07 (0.99-1.15; P =.10) for insulin, 1.09 (1.02-1.18, P =.02) for HOMA, 1.09 (1.01-1.17; P =.02) for hemoglobin A1c, and 1.14 (1.05-1.24; P =.002) for C-peptide. The corresponding ratios for nonadvanced adenomas were 1.11 (0.99-1.25; P =.08), 1.10 (0.98-1.24; P =.12), 1.15 (1.02-1.29; P =.02), 1.14 (1.01-1.28; P =.03), and 1.20 (1.05-1.37; P =.007), respectively. The corresponding ratios for advanced adenomas were 1.32 (0.94-1.84; P =.11), 1.23 (0.87-1.75; P =.24), 1.30 (0.92-1.85; P =.14), 1.13 (0.79-1.61; P =.50), and 1.67 (1.15-2.42; P =.007), respectively. Metabolic syndrome was associated with the prevalence of any adenoma (aPR, 1.18; 95% CI, 1.13-1.24; P <.001), nonadvanced adenoma (aPR, 1.30; 95% CI, 1.20-1.40; P <.001), and advanced adenoma (aPR, 1.42; 95% CI, 1.14-1.78; P =.002). Associations were similar for adenomas located in the distal versus proximal colon. Conclusions Increasing levels of glucose, HOMA values, levels of hemoglobin A1c and C-peptide, and metabolic syndrome are significantly associated with the prevalence of adenomas. Adenomas should be added to the list of consequences of altered glucose metabolism.

Original languageEnglish (US)
Pages (from-to)78-87.e3
JournalGastroenterology
Volume147
Issue number1
DOIs
StatePublished - Jul 2014

Keywords

  • Colon Cancer
  • Epidemiology
  • Glycosylated Hemoglobin
  • Risk Factors

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Rampal, S., Yang, M. H., Sung, J., Son, H. J., Choi, Y. H., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Rhee, J. C., Guallar, E., & Cho, J. (2014). Association between markers of glucose metabolism and risk of colorectal adenoma. Gastroenterology, 147(1), 78-87.e3. https://doi.org/10.1053/j.gastro.2014.03.006