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High blood glucose increases stomach cancer risk
| Fumie Ikeda, Yasufumi Doi, Koji
Yonemoto, et al. Hyperglycemia Increases Risk
of Gastric Cancer Posed by Helicobacter pylori
Infection: A Population-Based Cohort Study.
Gastroenterol 2009;
136: 1234-1241.
ABSTRACT Background & Aims Although diabetes mellitus and hyperglycemia are considered to be possible risk factors for various types of malignancy, the epidemiologic evidence concerning gastric cancer is scarce. The aim of this study was to evaluate the impact of hemoglobin A1c (HbA1c) levels on gastric cancer occurrence and their interaction with Helicobacter pylori infection. Methods A total of 2603 Japanese subjects aged ≥40 years were stratified into 4 groups according to baseline HbA1c levels (≤4.9%, 5.0%–5.9%, 6.0%–6.9%, and ≥7.0%) and followed up prospectively for 14 years. Results During the follow-up, 97 subjects developed gastric cancer. The age- and sex-adjusted incidence of gastric cancer significantly increased in the 6.0%–6.9% (5.1 per 1000 person-years; P < .05) and ≥7.0% groups (5.5 per 1000 person-years; P < .05) compared with the 5.0%–5.9% group (2.5 per 1000 person-years), whereas it was slightly but not significantly high in the ≤4.9% group (3.6 per 1000 person-years). This association remained substantially unchanged even after adjusting for the confounding factors including Helicobacter pylori seropositivity, (multivariate-adjusted hazard ratio [HR], 2.13; 95% confidence interval [CI]: 1.30–3.47 for the 6.0%–6.9% group and HR, 2.69; 95% CI: 1.24–5.85 for the ≥7.0% group). Among subjects who had both high HbA1c levels (≥6.0%) and Helicobacter pylori infection, the risk of gastric cancer was dramatically elevated (interaction term, P = .004). Conclusions Our findings suggest that casual hyperglycemia is a risk factor for gastric cancer and is a possible cofactor increasing the risk posed by Helicobacter pylori infection. |
COMMENT: The researchers say that diabetes and hyperglycemia are considered possible risk factors for various types of cancer, but that epidemiologic evidence concerning gastric cancer is scarce.
Japan has a higher prevalence of gastric cancer than Western countries, but uinlike in western countries, wheref H. pylori is ubiquitous, only a small proportion of the people carrying H. pylori in Japan develop the disease. This indicates that infection cannot be the only etiologic factor.
To investigate this, a team at Kyushu University in Fukuoka divided 2603 Japanese individuals aged at least 40 years into four groups according to haemoglobin (Hb)A1C levels.
HbA1C levels were 4.9% or below in 390 participants, 5.0 to 5.9% in 1685, 6.0 to 6.9% in 427, and more than 7.0% in 101 individuals.
During 14 years of follow-up, 97 participants developed gastric cancer.
The incidence of gastric cancer was significantly higher with baseline HbA1C levels of either 6.0% to 6.9% or more than 7.0% than at levels of 5.0% to 5.9%, at rates of 5.1 and 5.5 versus 2.5 per 1000 person-years.
This association did not substantially change after adjusting for the confounding factors including H. pylori seropositivity, with multivariate-adjusted hazard ratios of 2.13 with HbA1C of 6.0% to 6.9% and 2.69 for levels of more than 7.0%.
Gastric cancer risk was dramatically elevated for individuals with high HbA1C levels of 6.0% and above who also had H. pylori infection.
Last updated 6 April 2009Related Articles
