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Tsujimoto T, Kajio H, Sugiyama T. Association between hyperinsulinemia and increased risk of cancer death in nonobese and obese people: A population-based observational study. Int J Cancer 2017; 141:102-111. [PMID: 28390156 PMCID: PMC5435954 DOI: 10.1002/ijc.30729] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/18/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
Obesity, metabolic syndrome and type 2 diabetes are associated with cancer-related mortality. We assessed whether hyperinsulinemia is a risk factor for cancer death in nonobese people without diabetes. We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey 1999-2010 and followed up the participants until December 31, 2011. For the primary analysis of cancer mortality, we used Cox proportional hazard models to estimate hazard ratios (HRs) in the participants with hyperinsulinemia and those without. Hyperinsulinemia was defined as a fasting insulin level of ≥10 μU/mL. To identify causes of deaths, the International Classification of Diseases, Tenth Revision codes were used. This study included 9,778 participants aged 20 years or older without diabetes or a history of cancer: 6,718 nonobese participants (2,057 with hyperinsulinemia [30.6%]) and 3,060 obese participants (2,303 with hyperinsulinemia [75.3%]). A total of 99.9% completed follow-up. Among all study participants, cancer mortality was significantly higher in those with hyperinsulinemia than in those without hyperinsulinemia (adjusted HR 2.04, 95% CI 1.24-3.34, p = 0.005). Similarly, among nonobese participants, multivariable analysis showed that cancer mortality was significantly higher in those with hyperinsulinemia than in those without (adjusted HR 1.89, 95% CI 1.07-3.35, p = 0.02). Considering that nonobese people with hyperinsulinemia were at higher risk of cancer mortality than those without hyperinsulinemia, improvement of hyperinsulinemia may be an important approach for preventing cancer regardless of the presence or absence of obesity.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Public Health/Health Policy, the University of Tokyo, Tokyo, Japan
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52
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Gathirua-Mwangi WG, Monahan PO, Murage MJ, Zhang J. Metabolic syndrome and total cancer mortality in the Third National Health and Nutrition Examination Survey. Cancer Causes Control 2017; 28:127-136. [PMID: 28097473 DOI: 10.1007/s10552-016-0843-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/20/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Although metabolic syndrome incidence has substantially increased during the last few decades, it largely remains unclear whether this metabolic disorder is associated with total cancer mortality. The present study was carried out to investigate this important question. METHODS A total of 687 cancer deaths were identified from 14,916 participants in the third National Health and Nutrition Examination Survey by linking them to the National Death Index database through December 31, 2006. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to metabolic syndrome and its individual components. RESULTS After adjustment for confounders, a diagnosis of metabolic syndrome was associated with 33% elevated total cancer mortality. Compared with individuals without metabolic syndrome, those with 3, 4 and 5 abnormal components had HRs (95% CIs) of 1.28 (1.03-1.59), 1.24 (0.96-1.60), and 1.87 (1.34-2.63), respectively (p-trend = 0.0003). Systolic blood pressure and serum glucose were associated with an increased risk of death from total cancer [HR (95% CI) for highest vs. lowest quartiles: 1.67 (1.19-2.33), p-trend = 0.002 and 1.34 (1.04-1.74), p-trend = 0.003, respectively]. Overall null results were obtained for lung cancer mortality. The effects of metabolic syndrome and its components on non-lung cancer mortality were generally similar to, but somewhat larger than, those for total cancer mortality. CONCLUSION Our study is among the first to reveal that metabolic syndrome is associated with increased total cancer mortality.
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Affiliation(s)
- Wambui G Gathirua-Mwangi
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA
| | - Patrick O Monahan
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mwangi J Murage
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA
| | - Jianjun Zhang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, RG5118, Indianapolis, IN, 46202, USA. .,Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
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53
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Verlingue L, Dugourd A, Stoll G, Barillot E, Calzone L, Londoño‐Vallejo A. A comprehensive approach to the molecular determinants of lifespan using a Boolean model of geroconversion. Aging Cell 2016; 15:1018-1026. [PMID: 27613445 PMCID: PMC6398530 DOI: 10.1111/acel.12504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2016] [Indexed: 12/11/2022] Open
Abstract
Altered molecular responses to insulin and growth factors (GF) are responsible for late‐life shortening diseases such as type‐2 diabetes mellitus (T2DM) and cancers. We have built a network of the signaling pathways that control S‐phase entry and a specific type of senescence called geroconversion. We have translated this network into a Boolean model to study possible cell phenotype outcomes under diverse molecular signaling conditions. In the context of insulin resistance, the model was able to reproduce the variations of the senescence level observed in tissues related to T2DM's main morbidity and mortality. Furthermore, by calibrating the pharmacodynamics of mTOR inhibitors, we have been able to reproduce the dose‐dependent effect of rapamycin on liver degeneration and lifespan expansion in wild‐type and HER2–neu mice. Using the model, we have finally performed an in silico prospective screen of the risk–benefit ratio of rapamycin dosage for healthy lifespan expansion strategies. We present here a comprehensive prognostic and predictive systems biology tool for human aging.
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Affiliation(s)
- Loic Verlingue
- Institut Curie CNRS, UMR3244 Telomere and Cancer Laboratory PSL Research University 75005 Paris France
- Department of Medical Oncology Institut Curie 75005 Paris France
| | - Aurélien Dugourd
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Gautier Stoll
- Sorbonne Paris Cité Université Paris Descartes 12 Rue de l'École de Médecine 75006 Paris France
- Equipe 11 labellisée Ligue contre le Cancer INSERM U 1138 Centre de Recherche des Cordeliers 15 rue de l'Ecole de Médecine 75006 Paris France
- Université Pierre et Marie Curie 4 Place Jussieu 75005 Paris France
| | - Emmanuel Barillot
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Laurence Calzone
- Institut Curie Mines Paris Tech, Inserm, U900 PSL Research University F‐75005 Paris France
| | - Arturo Londoño‐Vallejo
- Institut Curie CNRS, UMR3244 Telomere and Cancer Laboratory PSL Research University 75005 Paris France
- UPMC Univ Paris 06 CNRS, UMR3244 Sorbonne Universités 75005 Paris France
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54
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Dugnani E, Balzano G, Pasquale V, Scavini M, Aleotti F, Liberati D, Di Terlizzi G, Gandolfi A, Petrella G, Reni M, Doglioni C, Bosi E, Falconi M, Piemonti L. Insulin resistance is associated with the aggressiveness of pancreatic ductal carcinoma. Acta Diabetol 2016; 53:945-956. [PMID: 27552832 DOI: 10.1007/s00592-016-0893-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/27/2016] [Indexed: 12/15/2022]
Abstract
AIMS To study whether insulin resistance accelerates the development and/or the progression of pancreatic adenocarcinoma (PDAC), we hypothesized that patients with insulin resistance, compared with those without insulin resistance, show: (1) a younger age and more advanced PDAC stage at diagnosis and (2) a shorter disease-free and overall survival after PDAC diagnosis. METHODS Prospective observational study of patients admitted to a referral center for pancreatic disease. Insulin resistance was defined as a HOMA-IR value greater than the 66th percentile value of the patients included in this study. Survival was estimated according to Kaplan-Meier and by Cox regression. RESULTS Of 296 patients with PDAC, 99 (33 %) met criteria for being classified as insulin resistant at diagnosis. Median follow-up time after diagnosis was 5.27 ± 0.23 years. Patients with insulin resistance received a diagnosis of PDAC at a similar age compared to patients without insulin resistance (67.1 ± 9 vs. 66.8 ± 10 years, p = 0.68), but were more likely to have a cancer stage ≥3 (23.2 vs. 14.2 %, p = 0.053) and a residual disease after surgery (R1 56.4 vs. 38 %; p = 0.007). The median overall survival was 1.3 ± 0.14 and 1.79 ± 0.11 years for the patients with and without insulin resistance, respectively (p = 0.016). Results did not change when patients with diabetes at PDAC diagnosis were excluded from the analysis. Multivariate analysis showed that insulin resistance was independently associated with overall survival. CONCLUSIONS Insulin resistance is associated with the aggressiveness of PDAC.
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Affiliation(s)
- Erica Dugnani
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Valentina Pasquale
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Aleotti
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Daniela Liberati
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gaetano Di Terlizzi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Alessandra Gandolfi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanna Petrella
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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55
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Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Dannenberg AJ, Kwan ML, Xiao J, Quesenberry C, Weltzien EK, Castillo AL, Caan BJ. Metabolic Dysfunction, Obesity, and Survival Among Patients With Early-Stage Colorectal Cancer. J Clin Oncol 2016; 34:3664-3671. [PMID: 27601537 DOI: 10.1200/jco.2016.67.4473] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The effects of obesity and metabolic dysregulation on cancer survival are inconsistent. To identify high-risk subgroups of obese patients and to examine the joint association of metabolic syndrome (MetSyn) in combination with obesity, we categorized patients with early-stage (I to III) colorectal cancer (CRC) into four metabolic categories defined by the presence of MetSyn and/or obesity and examined associations with survival. METHODS We studied 2,446 patients diagnosed from 2006 to 2011 at Kaiser Permanente. We assumed MetSyn if patients had three or more of five components present at diagnosis: fasting glucose > 100 mg/dL or diabetes; elevated blood pressure (systolic ≥ 130 mm Hg, diastolic ≥ 85 mm Hg, or antihypertensives); HDL cholesterol < 40 mg/dL (men) or < 50 mg/dL (women); triglycerides ≥ 150 mg/dL or antilipids; and/or highest sex-specific quartile of visceral fat by computed tomography scan (in lieu of waist circumference). We then classified participants according to the presence (or absence) of MetSyn and obesity (BMI < 30 or ≥ 30 kg/m2) and assessed associations with overall and CRC-related survival using Cox proportional hazards models adjusted for demographic, tumor, and treatment factors and muscle mass at diagnosis. RESULTS Over a median follow-up of 6 years, 601 patients died, 325 as a result of CRC. Mean (SD) age was 64 (11) years. Compared with the reference of nonobese patients without MetSyn (n = 1,225), for overall survival the hazard ratios (HR) and 95% CIs were 1.45 (1.12 to 1.82) for obese patients with MetSyn (n = 480); 1.09 (0.83 to 1.44) for the nonobese with MetSyn (n = 417), and 1.00 (0.80 to 1.26) for obese patients without MetSyn (n = 324). Obesity with MetSyn also predicted CRC-related survival: 1.49 (1.09 to 2.02). The hazard of death increased with the number of MetSyn components present, independent of obesity. CONCLUSION Patients with early-stage CRC with obesity and MetSyn have worse survival, overall and CRC related.
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Affiliation(s)
- Elizabeth M Cespedes Feliciano
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Candyce H Kroenke
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Jeffrey A Meyerhardt
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Carla M Prado
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Patrick T Bradshaw
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Andrew J Dannenberg
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Marilyn L Kwan
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Jingjie Xiao
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Charles Quesenberry
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Erin K Weltzien
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Adrienne L Castillo
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
| | - Bette J Caan
- Elizabeth M. Cespedes Feliciano, Candyce H. Kroenke, Marilyn L. Kwan, Charles Quesenberry, Erin K. Weltzien, Adrienne L. Castillo, and Bette J. Caan, Kaiser Permanente Northern California, Oakland; Patrick T. Bradshaw, School of Public Health, University of California, Berkeley, Berkeley, CA; Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Carla M. Prado and Jingjie Xiao, University of Alberta, Edmonton, Alberta, Canada; and Andrew J. Dannenberg, Weill Cornell Medical College, New York, New York
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Tumour biology of obesity-related cancers: understanding the molecular concept for better diagnosis and treatment. Tumour Biol 2016; 37:14363-14380. [PMID: 27623943 DOI: 10.1007/s13277-016-5357-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
Obesity continues to be a major global problem. Various cancers are related to obesity and proper understanding of their aetiology, especially their molecular tumour biology is important for early diagnosis and better treatment. Genes play an important role in the development of obesity. Few genes such as leptin, leptin receptor encoded by the db (diabetes), pro-opiomelanocortin, AgRP and NPY and melanocortin-4 receptors and insulin-induced gene 2 were linked to obesity. MicroRNAs control gene expression via mRNA degradation and protein translation inhibition and influence cell differentiation, cell growth and cell death. Overexpression of miR-143 inhibits tumour growth by suppressing B cell lymphoma 2, extracellular signal-regulated kinase-5 activities and KRAS oncogene. Cancers of the breast, uterus, renal, thyroid and liver are also related to obesity. Any disturbance in the production of sex hormones and insulin, leads to distortion in the balance between cell proliferation, differentiation and apoptosis. The possible mechanism linking obesity to cancer involves alteration in the level of adipokines and sex hormones. These mediators act as biomarkers for cancer progression and act as targets for cancer therapy and prevention. Interestingly, many anti-cancerous drugs are also beneficial in treating obesity and vice versa. We also reviewed the possible link in the mechanism of few drugs which act both on cancer and obesity. The present review may be important for molecular biologists, oncologists and clinicians treating cancers and also pave the way for better therapeutic options.
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Masui K, Shibata N, Cavenee WK, Mischel PS. mTORC2 activity in brain cancer: Extracellular nutrients are required to maintain oncogenic signaling. Bioessays 2016; 38:839-44. [PMID: 27427440 PMCID: PMC5501721 DOI: 10.1002/bies.201600026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mutations in growth factor receptor signaling pathways are common in cancer cells, including the highly lethal brain tumor glioblastoma (GBM) where they drive tumor growth through mechanisms including altering the uptake and utilization of nutrients. However, the impact of changes in micro-environmental nutrient levels on oncogenic signaling, tumor growth, and drug resistance is not well understood. We recently tested the hypothesis that external nutrients promote GBM growth and treatment resistance by maintaining the activity of mechanistic target of rapamycin complex 2 (mTORC2), a critical intermediate of growth factor receptor signaling, suggesting that altered cellular metabolism is not only a consequence of oncogenic signaling, but also potentially an important determinant of its activity. Here, we describe the studies that corroborate the hypothesis and propose others that derive from them. Notably, this line of reasoning raises the possibility that systemic metabolism may contribute to responsiveness to targeted cancer therapies.
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Affiliation(s)
- Kenta Masui
- Department of Pathology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Noriyuki Shibata
- Department of Pathology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Webster K. Cavenee
- Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA
| | - Paul S. Mischel
- Ludwig Institute for Cancer Research, University of California San Diego, La Jolla, CA, USA
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Dugnani E, Gandolfi A, Balzano G, Scavini M, Pasquale V, Aleotti F, Liberati D, Di Terlizzi G, Petrella G, Reni M, Doglioni C, Bosi E, Falconi M, Piemonti L. Diabetes associated with pancreatic ductal adenocarcinoma is just diabetes: Results of a prospective observational study in surgical patients. Pancreatology 2016; 16:844-52. [PMID: 27546476 DOI: 10.1016/j.pan.2016.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Identification of a specific diabetes signature associated to pancreatic ductal carcinoma (PDAC) could be a key to detect asymptomatic, early stage tumors. We aim to characterize the clinical signature and the pathogenetic factors of the different types of diabetes associated with PDAC, based on the time between diabetes and cancer diagnosis. METHODS Prospective observational study on 364 PDAC patients admitted to a referral center for pancreatic disease. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. RESULTS The prevalence of diabetes in patients was 67%. Considering 174 patients (47.8%) already having diabetes when diagnosed with PDAC (long duration, short duration, concomitant), the clinical and biochemical profile was similar to that of patients with type 2 diabetes (T2D). Diabetes was associated with known risk factors (i.e., age, sex, family history for diabetes and increased BMI) and both beta-cell dysfunction and insulin resistance were present. Considering 70 patients (19.2%) with onset of diabetes after PDAC diagnosis (early and late onset), the strongest predictor was the loss of beta-cell mass following pancreatectomy in patients with risk factors for T2D. CONCLUSION Different types of diabetes according to the time between diabetes and PDAC diagnosis are clinical entities widely overlapping with T2D. Therefore, the success of a strategy considering diabetes onset as a marker of asymptomatic PDAC will largely depend on our ability to identify new diabetes-unrelated biomarkers of PDAC.
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Affiliation(s)
- Erica Dugnani
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandra Gandolfi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Valentina Pasquale
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Aleotti
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Daniela Liberati
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gaetano Di Terlizzi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanna Petrella
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milan, Italy
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy; Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milan, Italy
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Abstract
The life expectancy of people with type 1 diabetes is improving and now approaches that of those without diabetes. As this population ages, a growing number will be diagnosed with and treated for cancer. Cancer treatments can drastically affect insulin requirement and glycemic control through multiple mechanisms including high doses of glucocorticoids and targeted therapies that directly interfere with cellular pathways involved in the action of insulin. Patients with cancer frequently also have alterations in gastrointestinal motility or appetite and require supplemental enteral or parenteral nutrition. Few studies have evaluated these patients directly, but data on patients with and without diabetes suggest that glycemic control may play a larger role in cancer outcomes than is often recognized. Collaboration between the treating oncologist and diabetologist allows people with diabetes to receive the most effective therapies for their cancers without undue risk of hypoglycemia or adverse outcomes due to hyperglycemia.
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Affiliation(s)
- Conor J Best
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA.
| | - Sonali Thosani
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA
| | - Marjorie Ortiz
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA
| | - Celia Levesque
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA
| | - Sigi S Varghese
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA
| | - Victor R Lavis
- MD Anderson Cancer Center, Endocrine Neoplasia and Hormonal Disorders, 1400 Pressler St. Unit 1461, Houston, TX, 77030-4009, USA
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Magri CJ, Fava S, Galea J. Prediction of insulin resistance in type 2 diabetes mellitus using routinely available clinical parameters. Diabetes Metab Syndr 2016; 10:S96-S101. [PMID: 27131406 DOI: 10.1016/j.dsx.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
AIMS To determine if insulin resistance (IR), an important predictor of cardiovascular risk in the general population and in type 2 diabetes mellitus, can be assessed using simple parameters which are readily available in clinical practice. METHODS This cross-sectional study included 194 patients with type 2 diabetes. Body mass index, waist index (WI), triglyceride levels, 1/HDL, triglyceride/HDL, uric acid and urine albumin:creatinine ratio were investigated as possible predictors of IR. RESULTS WI correlated more strongly than any other parameter with log insulin levels, log fasting glucose to insulin ratio (FGIR), log fasting glucose to insulin product (FGIP), homeostatic model assessment (HOMA-IR) and quantitative insulin check index (QUICKI). WI also emerged as the strongest independent predictor of IR indices studied in regression as well as in ROC analyses. At a cut-off of 1.115, WI had a 78% sensitivity and 65% specificity for predicting IR when HOMA-IR was used as indicator of IR, and 74% sensitivity and specificity when QUICKI was used as indicator of IR. Combining WI with other variables did not improve performance significantly. CONCLUSIONS In our cohort of patients with type 2 diabetes, WI was the parameter with the strongest association with, and the best predictor of, IR.
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Affiliation(s)
- Caroline J Magri
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta; University of Malta Medical School, University of Malta, Tal-Qroqq, Msida MSD 2090, Malta.
| | - Stephen Fava
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida MSD 2090, Malta; Diabetes & Endocrine Centre, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Joseph Galea
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida MSD 2090, Malta; Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
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Ghasemi A, Tohidi M, Derakhshan A, Hasheminia M, Azizi F, Hadaegh F. Cut-off points of homeostasis model assessment of insulin resistance, beta-cell function, and fasting serum insulin to identify future type 2 diabetes: Tehran Lipid and Glucose Study. Acta Diabetol 2015; 52:905-15. [PMID: 25794879 DOI: 10.1007/s00592-015-0730-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/26/2015] [Indexed: 01/09/2023]
Abstract
AIMS To determine cut-off points of homeostasis model assessment of insulin resistance (HOMA-IR), β-cell function (HOMA-B), insulin sensitivity (HOMA-S), and fasting insulin for identifying the subjects with type 2 diabetes mellitus (T2DM) in Iranian adults using data from a prospective population-based study. METHODS From participants of Tehran Lipid and Glucose Study, 4942 Iranian subjects, aged 20-86 years, were followed for incident T2DM. Fasting serum insulin was determined by the electrochemiluminescence immunoasaay. The associations between HOMA-IR, HOMA-B, HOMA-S, and fasting insulin and incident T2DM were evaluated using Cox proportional hazards models. The receiver operator characteristic curve analysis was used to determine the cut-off points of HOMA-IR, HOMA-B, HOMA-S, and fasting insulin. RESULTS After 9.2 year follow-up, 346 (7.0 %) incident cases of T2DM were identified; the risk-factor-adjusted hazard ratios for HOMA1-IR, HOMA2-IR, HOMA1-B, HOMA2-B, HOMA1-S, HOMA2-S, and insulin were 1.15, 1.70, 0.732, 0.997, 0.974, 0.986, and 1.01 in women and 1.37, 1.67, 0.588, 0.993, 0.986, 0.991, and 1.06 in men, respectively (all p < 0.05 except for HOMA2-B in women). Optimal cut-off points for HOMA1-IR, HOMA2-IR, HOMA1-B, HOMA2-B, HOMA1-S, HOMA2-S, and insulin were 1.85, 1.41, 86.2, 72.5, 54.1, 63.7, and 11.13 µU/ml in women and 2.17, 1.18, 67.1, 74.6, 46.1, 74.1, and 9.16 µU/ml in men, respectively. CONCLUSIONS HOMA-IR, HOMA-B (except for HOMA2-B in women), HOMA-S, and fasting insulin were independent predictors of T2DM. Optimal cut-off points of HOMA-IR, HOMA-B, HOMA-S, and fasting serum insulin were determined from a population-based study for identifying incident T2DM.
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Affiliation(s)
- Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran.
| | - Arash Derakhshan
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran
| | - Mitra Hasheminia
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box 19395-4763, Tehran, Iran
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Nano R, Melzi R, Mercalli A, Balzano G, Scavini M, Bonadonna R, Piemonti L. Islet Volume and Indexes of β-Cell Function in Humans. Cell Transplant 2015; 25:491-501. [PMID: 26102316 DOI: 10.3727/096368915x688498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Islet volume and endocrine pancreas architecture (islet size distribution) may be independent determinants of β-cell function. Furthermore, the accuracy of homeostatic model assessment (HOMA) indexes in predicting β-cell mass has never been assessed. Here we investigated the relationships between islet volume, islet density, and islet size distribution, estimated after pancreatic tissue digestion, with established indexes of β-cell function in humans. We included in this study 42 patients who were candidates for islet autotransplantation and had well-characterized glucose metabolism. Indexes of insulin secretion were calculated and compared with the islet volume, as a surrogate of β-cell mass, obtained after digestion of pancreas. Islet counting analysis showed considerable interindividual variation in islet density and size. Islet volume, but not density nor size, was the only independent determinant of β-cell function assessed by insulin HOMA β-cell. Islet volume was significantly reduced in the patients with overt hyperglycemia, but not in patients with impaired fasting glucose. Insulin HOMA β-cell predicted islet volume better than other measures of fasting insulin secretion. In conclusion, the present study documented a close direct relationship between indexes of β-cell function and islet volume in humans. The insulin HOMA β-cell provides a more reliable estimate of pancreatic islet volume than fasting glucose before islet isolation.
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Affiliation(s)
- Rita Nano
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ariaans G, de Jong S, Gietema J, Lefrandt J, de Vries E, Jalving M. Cancer-drug induced insulin resistance: Innocent bystander or unusual suspect. Cancer Treat Rev 2015; 41:376-84. [DOI: 10.1016/j.ctrv.2015.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 02/08/2023]
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Vissers PAJ, Cardwell CR, van de Poll-Franse LV, Young IS, Pouwer F, Murray LJ. The association between glucose-lowering drug use and mortality among breast cancer patients with type 2 diabetes. Breast Cancer Res Treat 2015; 150:427-37. [PMID: 25762476 DOI: 10.1007/s10549-015-3331-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/04/2015] [Indexed: 12/14/2022]
Abstract
This study assessed the association between glucose-lowering drug (GLD) use, including metformin, sulphonylurea derivatives and insulin, after breast cancer diagnosis and breast cancer-specific and all-cause mortality. 1763 breast cancer patients, diagnosed between 1998 and 2010, with type 2 diabetes were included. Cancer information was retrieved from English cancer registries, prescription data from the UK Clinical Practice Research Datalink and mortality data from the Office of National Statistics (up to January 2012). Time-varying Cox regression models were used to calculate HRs and 95 % CIs for the association between GLD use and breast cancer-specific and all-cause mortality. In 1057 patients with diabetes before breast cancer, there was some evidence that breast cancer-specific mortality decreased with each year of metformin use (adjusted HR 0.88; 95 % CI 0.75-1.04), with a strong association seen with over 2 years of use (adjusted HR 0.47; 95 % CI 0.26-0.82). Sulphonylurea derivative use for less than 2 years was associated with increased breast cancer-specific mortality (adjusted HR 1.70; 95 % CI 1.18-2.46), but longer use was not (adjusted HR 0.94; 95 % CI 0.54-1.66). In 706 patients who developed diabetes after breast cancer, similar patterns were seen for metformin, but sulphonylurea derivative use was strongly associated with cancer-specific mortality (adjusted HR 3.64; 95 % CI 2.16-6.16), with similar estimates for short- and long-term users. This study provides some support for an inverse association between, mainly long-term, metformin use and (breast cancer-specific) mortality. In addition, sulphonylurea derivative use was associated with increased breast cancer-specific mortality, but this should be interpreted cautiously, as it could reflect selective prescribing in advanced cancer patients.
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Affiliation(s)
- Pauline A J Vissers
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, P. O. Box 90153, 5000 LE, Tilburg, The Netherlands,
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Huang Y, Cai X, Qiu M, Chen P, Tang H, Hu Y, Huang Y. Prediabetes and the risk of cancer: a meta-analysis. Diabetologia 2014; 57:2261-9. [PMID: 25208757 DOI: 10.1007/s00125-014-3361-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/31/2014] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS The results from prospective cohort studies of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) and risk of cancer are controversial. We conducted a meta-analysis to evaluate the risk of cancer in association with impaired fasting glucose and impaired glucose tolerance. METHODS The PubMed, EMBASE and Cochrane Library databases were searched for prospective cohort studies with data on prediabetes and cancer. Two independent reviewers assessed the reports and extracted the data. Prospective studies were included if they reported adjusted RRs with 95% CIs for the association between cancer and prediabetes. Subgroup analyses were conducted according to endpoint, age, sex, ethnicity, duration of follow-up and study characteristics. RESULTS Data from 891,426 participants were derived from 16 prospective cohort studies. Prediabetes was associated with an increased risk of cancer overall (RR 1.15; 95% CI 1.06, 1.23). The results were consistent across cancer endpoint, age, duration of follow-up and ethnicity. There was no significant difference for the risk of cancer with different definitions of prediabetes. In a site-specific cancer analysis, prediabetes was significantly associated with increased risks of cancer of the stomach/colorectum, liver, pancreas, breast and endometrium (all p < 0.05), but not associated with cancer of the bronchus/lung, prostate, ovary, kidney or bladder. The risks of site-specific cancer were significantly different (p = 0.01) and were highest for liver, endometrial and stomach/colorectal cancer. CONCLUSIONS/INTERPRETATION Overall, prediabetes was associated with an increased risk of cancer, especially liver, endometrial and stomach/colorectal cancer.
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Affiliation(s)
- Yi Huang
- Clinical Medicine Research Center, The First People's Hospital of Shunde, Penglai Road, Daliang Town, Shunde District, Foshan, 528300, People's Republic of China
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Balzano G, Dugnani E, Pasquale V, Capretti G, Radaelli MG, Garito T, Stratta G, Nini A, Di Fenza R, Castoldi R, Staudacher C, Reni M, Scavini M, Doglioni C, Piemonti L. Clinical signature and pathogenetic factors of diabetes associated with pancreas disease (T3cDM): a prospective observational study in surgical patients. Acta Diabetol 2014; 51:801-11. [PMID: 24974302 DOI: 10.1007/s00592-014-0614-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/12/2014] [Indexed: 01/27/2023]
Abstract
To characterize the clinical signature and etiopathogenetic factors of diabetes associated with pancreas disease [type 3 diabetes mellitus (T3cDM)]. To estimate incidence and identify predictors of both diabetes onset and remission after pancreatic surgery. A prospective observational study was conducted. From January 2008 to December 2012, patients (n = 651) with new diagnosis of pancreatic disease admitted to the Pancreatic Surgery Unit of the San Raffaele Scientific Institute were evaluated. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up. At baseline, the prevalence of diabetes was 38 % (age of onset 64 ± 11 years). In most cases, diabetes occurred within 48 months from pancreatic disease diagnosis. Among different pancreatic diseases, minor differences were observed in diabetes characteristics, with the exception of the prevalence. Diabetes appeared associated with classical risk factors for type 2 diabetes (i.e., age, sex, family history of diabetes and body mass index), and both beta-cell dysfunction and insulin resistance appeared relevant determinants. The prevalence of adult-onset autoimmune diabetes was as previously reported within type 2 diabetes. Within a few days after surgery, either diabetes remission or new-onset diabetes was observed. In patients with pancreatic cancer, no difference in diabetes remission was observed after palliative or resective surgery. Classical risk factors for type 2 diabetes were associated with the onset of diabetes after surgery. T3cDM appeared as a heterogeneous entity strongly overlapped with type 2 diabetes.
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Affiliation(s)
- Gianpaolo Balzano
- Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Zuliani G, Morieri ML, Volpato S, Maggio M, Cherubini A, Francesconi D, Bandinelli S, Paolisso G, Guralnik JM, Ferrucci L. Insulin resistance and systemic inflammation, but not metabolic syndrome phenotype, predict 9 years mortality in older adults. Atherosclerosis 2014; 235:538-45. [PMID: 24956526 PMCID: PMC4156965 DOI: 10.1016/j.atherosclerosis.2014.05.959] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although metabolic syndrome (MS) is a typical condition of middle-aged/older person, the association between MS and mortality risk has not been confirmed in people over 65 years. We hypothesized that while in the elderly MS phenotype might lose its value in predicting mortality risk, the two core factors of MS, i.e. insulin resistance (IR) and low grade systemic inflammation (LGSI) would not. METHODS 1011 community-dwelling older individuals (InCHIANTI study) were included. MS phenotype was defined by NCEP-ATP-III criteria. IR was calculated by HOMA; high-sensitivity C reactive protein was measured by ELISA. Subjects were divided into four groups based on presence/absence of IR (HOMA ≥ 2.27) and LGSI (hs-CRP ≥ 3 g/L): Group 1: no IR/LGSI (reference); Group 2: LGSI only; Group 3: IR only; Group 4: IR + LGSI. Hazard Ratios (HR) for 9-years cardiovascular (CVD) and total mortality, according to IR/LGSI groups, were estimated in subjects with (n.311) and without MS by Cox model. RESULTS 31.8% of subjects with MS phenotype had no IR, 45.3% had no LGSI; moreover, 51% of subjects with both IR and LGSI didn't display the MS phenotype. MS phenotype was not associated with CVD (HR: 1.29; 95%C.I.:0.92-1.81) or total (HR: 1.07; 95%C.I.:0.86-1.34) mortality risk, whereas the presence of IR plus LGSI was associated with increased CVD (no MS: HR 2.07, 95%CI: 1.12-3.72; MS: HR 9.88, 95%CI: 2.18-4), and overall (no MS: HR 1.72, 95%CI: 1.001-3.17; MS: HR 1.51, 95%CI: 1.02-2.28) mortality risk. The presence of IR (HR: 6.90, 95%CI: 1.45-32) or LGSI (HR 7.56, 95%CI: 1.63-35) was associated with CVD mortality, only among individuals with MS phenotype. CONCLUSIONS Among community-dwelling older individuals, IR and LGSI, but not MS phenotype, was associated with 9-years overall and CVD mortality risk. Since a reduced "overlap" between MS phenotype and its physiopathological core (IR and LGSI) might be present with aging, we suggest that the definition of MS might be more holistic in advanced age, and probably comprise the measurement of IR and LGSI.
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Affiliation(s)
- Giovanni Zuliani
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy.
| | - Mario Luca Morieri
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Italy
| | | | - Daniela Francesconi
- Department of Medical Sciences, Section of Internal and CardioRespiratory Medicine, University of Ferrara, Italy
| | - Stefania Bandinelli
- ASF Geriatric Rehabilitation, Florence, Italy; Tuscany Regional Health Agency, I.O.T., Florence, Italy
| | - Giuseppe Paolisso
- Department of Gerontology, Geriatrics and Metabolic Diseases, Second University of Naples, Italy
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, NIH, Baltimore, MD, USA
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Tseng CH. Metformin may reduce bladder cancer risk in Taiwanese patients with type 2 diabetes. Acta Diabetol 2014; 51:295-303. [PMID: 24509842 DOI: 10.1007/s00592-014-0562-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 01/25/2014] [Indexed: 12/13/2022]
Abstract
Whether metformin therapy affects bladder cancer risk in patients with type 2 diabetes mellitus (T2DM) has not been extensively investigated. The reimbursement databases of all Taiwanese patients with a new diagnosis of T2DM between 1998 and 2002 (n = 940,708) were retrieved from the National Health Insurance for follow-up of bladder cancer up to the end of 2009. Metformin was treated as a time-dependent variable, and of these patients, 532,519 were never-users and 408,189 were ever-users of metformin. A time-dependent approach was applied in the calculation of bladder cancer incidence and in the estimation of hazard ratios by Cox regression for ever-users, never-users, and subgroups of metformin exposure (using tertile cutoffs of cumulative duration of therapy and cumulative dose). During the study period, 1,847 (0.45%) metformin ever-users and 6,213 (1.17%) metformin never-users developed bladder cancer, representing an incidence of 72.03 and 189.22 per 100,000 person-years, respectively. The age-sex-adjusted and multivariable-adjusted hazard ratios (95% confidence intervals) for ever- versus never-users were 0.382 (0.360-0.405) and 0.600 (0.564-0.638), respectively. The multivariable-adjusted hazard ratios for the first, second, and third tertiles of cumulative duration of metformin therapy were 1.034 (0.954-1.120), 0.696 (0.632-0.766), and 0.258 (0.229-0.291), respectively (P trend <0.0001). Similarly, the multivariable-adjusted hazard ratios for the first, second, and third tertiles of cumulative dose of metformin were 0.997 (0.920-1.080), 0.615 (0.559-0.677), and 0.285 (0.253-0.321), respectively (P trend <0.0001). This study suggests that metformin use is associated with a decreased risk of bladder cancer in patients with T2DM.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan,
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Monami M, Dicembrini I, Mannucci E. Thiazolidinediones and cancer: results of a meta-analysis of randomized clinical trials. Acta Diabetol 2014; 51:91-101. [PMID: 23851465 DOI: 10.1007/s00592-013-0504-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/06/2013] [Indexed: 12/21/2022]
Abstract
Recent epidemiological data have contributed to the formulation of the hypothesis about the long-term safety of pioglitazone, a thiazolidinedione (TZD), with respect to malignancies, in particular bladder cancer. The primary aim of this meta-analysis of randomized clinical trials, not designed a priori to test this hypothesis, was to explore whether TZDs affect the risk of cancer. A meta-analysis was performed including published and unpublished randomized trials with a duration of at least 52 weeks, enrolling patients with or without diabetes, comparing TZDs with either placebo or other drug therapies on various different outcomes. We found 22 trials reporting at least one cancer and enrolling 13,197 patients to TZD (pioglitazone: n = 3,710 and rosiglitazone: n = 9,487) and 12,359 to placebo or active comparator groups. The mean follow-up was 26.1 months. Overall, those assigned at random to TZDs had a significant reduction (MH-OR 0.85 [0.73-0.98]; p = 0.027) in the incidence of malignancies, with no significant difference in effect between pioglitazone and rosiglitazone. Specifically, subgroup analyses showed a significant reduction for rosiglitazone (MH-OR 0.82 [0.69-0.98]; p = 0.029), but not for pioglitazone (MH-OR 0.66 [0.34-1.28]; p = 0.22). In further subgroup analyses of site-specific malignancies based on the data from four trials, the risk of bladder cancer with pioglitazone (MH-OR) was 2.05 [0.84-5.02]; p = 0.12. Further, rosiglitazone, but not pioglitazone, was associated with a significantly reduced risk of bowel cancer. In contrast, pioglitazone, but not rosiglitazone, was associated with a significant reduction in breast cancer. The present meta-analysis of trials, not designed a priori to test the hypothesis, provides reassuring evidence that TZDs are not associated with risk of overall malignancies. In fact, they are compatible with the possibility of a decreased risk of cancer. In site-specific subgroup analyses, for rosiglitazone, there was a significant decreased risk of bowel cancer. Subgroup analyses for pioglitazone did not allow to exclude an increased risk of bladder cancer, while the risk of breast cancer was significantly decreased. While these data are also useful to formulate not test hypotheses, they provide somewhat more cogent evidence than the previously published epidemiological data.
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Affiliation(s)
- Matteo Monami
- Geriatric Cardiology, Careggi Teaching Hospital, Florence, Italy,
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Tseng CH. Diabetes, insulin use, smoking, and pancreatic cancer mortality in Taiwan. Acta Diabetol 2013; 50:879-86. [PMID: 23508375 DOI: 10.1007/s00592-013-0471-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/07/2013] [Indexed: 12/13/2022]
Abstract
The aim of the study was to evaluate the link between diabetes and pancreatic cancer (PC) mortality and the joint effect of smoking and insulin use on PC mortality. A total of 39,988 men and 46,909 women with type 2 diabetes, aged ≥25 years and recruited in 1995-1998, were followed to 2006 for PC mortality. Age-sex-specific mortality rate ratios for diabetic patients versus the general population were calculated. Cox regression was used to evaluate hazard ratios for PC mortality for covariates including age, sex, diabetes duration, body mass index, smoking, insulin use, and area of residence. The interaction and joint effect of smoking and insulin use were also evaluated. A total of 89 men and 63 women died of PC. The mortality rate ratios (95 % CI) showed a significantly higher risk in diabetic patients with a magnitude most remarkable at the youngest age: 1.51 (1.15, 1.98), 2.02 (1.35, 3.03), and 8.36 (5.39, 12.98) for ≥65, 55-64, and 25-54 years old, respectively, for men; and 1.16 (0.84, 1.59), 2.12 (1.39, 3.23) and 3.33 (1.14, 9.68), respectively, for women. In multivariable Cox regression analysis, only age was significantly predictive for PC mortality. Although smoking and insulin use might be associated with a 50 % higher risk when analyzed as individual risk factors, they did not reach statistical significance. The interaction term of smoking and insulin use was also not statistically significant in additional modeling. However, smoking and insulin use jointly increased the risk with an adjusted hazard ratio (95 % CI) of 3.04 (1.37, 6.73) when compared to patients who did not smoke and did not use insulin. Diabetic patients have a significantly higher risk of PC mortality. In patients with type 2 diabetes, smoking and insulin use may jointly increase the risk by threefold.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei, 100, Taiwan,
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Risk of cancer in diabetes: the effect of metformin. ISRN ENDOCRINOLOGY 2013; 2013:636927. [PMID: 24224094 PMCID: PMC3800579 DOI: 10.1155/2013/636927] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 08/16/2013] [Indexed: 12/20/2022]
Abstract
Cancer is the second cause of death. Association of diabetes as a growing and costly disease with cancer is a major health concern. Meanwhile, preexisting diabetes is associated with an increased risk of all-cause and cancer-specific mortalities. Presence of diabetes related comorbidities, poorer response to cancer treatment, and excess mortality related to diabetes are among the most important explanations. Although diabetes appear to be a risk factor for cancer and is associated with the mortality risk in cancer patients, several factors such as diabetes duration, multiple drug therapy, and the presence of diabetes comorbidities make the assessment of the effect of diabetes treatment on cancer risk and mortality difficult. Metformin is the drug of choice for the treatment of type 2 diabetes. The available evidence from basic science, clinical, and population-based research supports the anticancer effect of metformin. However, randomized controlled clinical trials do not provide enough evidence for a strong protective effect of metformin on cancer incidence or mortality. One of the most important limitations of these trials is the short duration of the followup. Further long-term randomized controlled clinical trials specifically designed to determine metformin effect on cancer risk are needed to provide the best answer to this challenge.
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Abstract
PURPOSE OF REVIEW The association of diabetes and cancer has received increased attention as data have emerged to indicate that the type of diabetes treatment may influence the risk of cancer, and that the risk of cancer among diabetic individuals can be reduced by intervention. The association of diabetes and pancreatic cancer is particularly strong, but often misunderstood. Long-standing type 1 diabetes and type 2 diabetes increase the risk for this malignancy, but the cancer can also induce pancreatogenic, or type 3c, diabetes as well. RECENT FINDINGS This review covers the recent findings which help to clarify these relationships, and offers guidance for prevention, early detection, and treatment. Obesity and, separately, diabetes increase the risk of several common malignancies by about two-fold. This risk is reduced by successful treatments. Type 3c diabetes is more common than previously realized, and strategies to differentiate type 3c diabetes from type 2 diabetes, to identify those candidates who will benefit from screening studies, are discussed. SUMMARY The death rate because of pancreatic and other cancers can be reduced by an aggressive approach to reversing obesity and hyperinsulinemia, achieving good glycemic control in diabetic patients, and identifying at an early timepoint those patients with pancreatogenic diabetes.
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MESH Headings
- Blood Glucose/metabolism
- Carcinoma, Pancreatic Ductal/blood
- Carcinoma, Pancreatic Ductal/etiology
- Carcinoma, Pancreatic Ductal/pathology
- Cell Transformation, Neoplastic
- Diabetes Complications/blood
- Diabetes Complications/pathology
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/pathology
- Early Detection of Cancer
- Female
- Humans
- Hyperinsulinism/blood
- Hyperinsulinism/complications
- Hypoglycemic Agents/adverse effects
- Male
- Metformin/administration & dosage
- Metformin/adverse effects
- Obesity/blood
- Obesity/complications
- Obesity/pathology
- Pancreatic Neoplasms/blood
- Pancreatic Neoplasms/etiology
- Pancreatic Neoplasms/pathology
- Peptides/blood
- Risk Factors
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Affiliation(s)
- Dana K Andersen
- Clinical Studies Program, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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Yao J, Zhi M, Gao X, Hu P, Li C, Yang X. Effect and the probable mechanisms of silibinin in regulating insulin resistance in the liver of rats with non-alcoholic fatty liver. Braz J Med Biol Res 2013; 46:270-7. [PMID: 23532271 PMCID: PMC3854368 DOI: 10.1590/1414-431x20122551] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 12/04/2012] [Indexed: 02/07/2023] Open
Abstract
Our previous study has shown that reduced insulin resistance (IR) was one of the
possible mechanisms for the therapeutic effect of silibinin on non-alcoholic
fatty liver disease (NAFLD) in rats. In the present study, we investigated the
pathways of silibinin in regulating hepatic glucose production and IR
amelioration. Forty-five 4- to 6-week-old male Sprague Dawley rats were divided
into a control group, an HFD group (high-fat diet for 6 weeks) and an HFD +
silibinin group (high-fat diet + 0.5 mg kg-1·day-1
silibinin, starting at the beginning of the protocol). Both subcutaneous and
visceral fat was measured. Homeostasis model assessment-IR index (HOMA-IR),
intraperitoneal glucose tolerance test and insulin tolerance test (ITT) were
performed. The expression of adipose triglyceride lipase (ATGL) and of genes
associated with hepatic gluconeogenesis was evaluated. Silibinin intervention
significantly protected liver function, down-regulated serum fat, and improved
IR, as shown by decreased HOMA-IR and increased ITT slope. Silibinin markedly
prevented visceral obesity by reducing visceral fat, enhanced lipolysis by
up-regulating ATGL expression and inhibited gluconeogenesis by down-regulating
associated genes such as Forkhead box O1, phosphoenolpyruvate carboxykinase and
glucose-6-phosphatase. Silibinin was effective in ameliorating IR in NAFLD rats.
Reduction of visceral obesity, enhancement of lipolysis and inhibition of
gluconeogenesis might be the underlying mechanisms.
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Affiliation(s)
- Jiayin Yao
- Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
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Li X, Wang X, Liu R, Ma Y, Guo H, Hao L, Yao P, Liu L, Sun X, He K, Cao W, Yang X. Chronic leucine supplementation increases body weight and insulin sensitivity in rats on high-fat diet likely by promoting insulin signaling in insulin-target tissues. Mol Nutr Food Res 2013; 57:1067-79. [DOI: 10.1002/mnfr.201200311] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/02/2012] [Accepted: 12/29/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Xiang Li
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Xiaolei Wang
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | | | - Yan Ma
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Huailan Guo
- Department of Preventive Medicine; Hubei University of Medicine; Shiyan; Hubei; P. R. China
| | - Liping Hao
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Ping Yao
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Liegang Liu
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Xiufa Sun
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
| | - Ka He
- Department of Nutrition; Gillings School of Global Public Health and School of Medicine, The University of North Carolina at Chapel Hill; Chapel Hill; NC; USA
| | - Wenhong Cao
- Department of Nutrition; Gillings School of Global Public Health and School of Medicine, The University of North Carolina at Chapel Hill; Chapel Hill; NC; USA
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene and MOE Key Laboratory of Environment and Health; School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Wuhan; Hubei; P. R. China
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Yang X, So WY, Ma RCW, Kong APS, Lee HM, Xu G, Ozaki R, Chan JCN. Synergistic effects of low LDL cholesterol with other factors for the risk of cancer in type 2 diabetes: the Hong Kong Diabetes Registry. Acta Diabetol 2012; 49 Suppl 1:S185-93. [PMID: 22722949 DOI: 10.1007/s00592-012-0409-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 05/29/2012] [Indexed: 12/23/2022]
Abstract
We have reported associations of cancer with low triglyceride and high high-density lipoprotein cholesterol (HDL-C) as well as co-presence of low low-density lipoprotein cholesterol (LDL-C) and albuminuria in type 2 diabetes (T2D). This analysis aims to test (1) whether low LDL-C and low triglyceride have synergistic effects to increase cancer risk in T2D and (2) whether high HDL-C enhances the effect of co-presence of low LDL-C and albuminuria on cancer risk. A prospective cohort of patients with T2D, established within the Prince of Wales Hospital, was used in the analysis. A total of 3,476 T2D patients in Hong Kong enrolled between 1996 and 2005, free of cancer at enrolment and not using statins or fibrates within 2.5 years before enrolment and during follow-up, were followed until 2005. The study measured additive interactions of low LDL-C with other factors for cancer using relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP). A statistically significant RERI > 0 or AP > 0 indicates additive interaction. During 5.11 years of follow-up, 199 patients developed cancer. Co-presence of triglyceride <1.70 mmol/L and LDL-C < 2.80 mmol/L was associated with increased cancer risk (multivariable hazard ratio [HR]:2.13, P = 0.0008) with significant interaction. Co-presence of HDL-C ≥ 1.30 mmol/L and LDL-C < 2.80 mmol/L plus albuminuria was also associated with increased cancer risk (HR: 3.84, P < 0.0001) with significant interaction. In T2D, low triglyceride may potentiate cancer risk associated with low LDL-C while high HDL-C enhances the synergistic effect of low LDL-C with albuminuria towards increased cancer risk.
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Affiliation(s)
- Xilin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Zhang F, Yang Y, Skrip L, Hu D, Wang Y, Wong C, Qiu J, Lei H. Diabetes mellitus and risk of prostate cancer: an updated meta-analysis based on 12 case-control and 25 cohort studies. Acta Diabetol 2012; 49 Suppl 1:S235-46. [PMID: 23124624 DOI: 10.1007/s00592-012-0439-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/25/2012] [Indexed: 12/11/2022]
Abstract
The association between diabetes and risk of prostate cancer has been investigated widely. However, study results remain inconsistent and contradictory. Using a meta-analytic approach, the present study explore the relationship incorporating more recent studies and provide more powerful evidence without the limitations of any individual study. Relevant studies were identified by searching Pubmed and the Cochrane Central Register of Controlled Trials through May 18, 2012. The strength of the relationship between diabetes mellitus and risk of prostate cancer was assessed using relative risk (RR). Either a fixed effects or random effects model was used to calculate the pooled RRs. Stratification analyses and sensitivity analyses were conducted, and publication bias was assessed by Egger's test and Begg's test. Twelve case-control studies involving 9,767 cases and 19,790 controls, and 25 cohort studies involving 118,825 cases were included. The person-years of follow-up ranged from 29,963 to 6,264,890 among included cohort studies. Diabetes was not significantly associated with incidence of prostate cancer in our analysis of case-control studies only (RR = 0.846, 95 % CI [0.710, 1.009]) or that of cohort studies only (RR = 0.925, 95 % CI [0.811, 1.054]). However, through subgroup analyses, statistically significant associations between diabetes and prostate cancer were found when considering population-based studies only (RR = 0.719, 95 % CI [0.637, 0.812]), cohort studies conducted in the United States (RR = 0.789, 95 % CI [0.727, 0.857]), and studies with follow-up of more than 5 years. Compared to risk of prostate cancer among people without diabetes, diabetic patients using insulin treatment experienced reduced incidence of prostate cancer in both case-control and cohort studies. The results suggest that diabetes mellitus is associated with decreased incidence of prostate cancer, specifically in the population of the United States. In addition, the time since onset of diabetes was positively associated with decreasing incidence of prostate cancer. The present conclusions should be considered carefully, however, and confirmed with further studies.
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Affiliation(s)
- Fan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
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