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Oncology
Research
Association between markers of glucose metabolism and risk of colorectal cancer
  1. Jinming Xu1,2,
  2. Yao Ye1,2,
  3. Han Wu1,3,
  4. Penelope Duerksen-Hughes4,
  5. Honghe Zhang1,5,
  6. Peiwei Li1,6,
  7. Jian Huang7,
  8. Jun Yang8,
  9. Yihua Wu1,2,
  10. Dajing Xia1,2
  1. 1Zhejiang University School of Public Health, Hangzhou, China
  2. 2Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, China
  3. 3Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
  4. 4Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
  5. 5Department of Pathology, Zhejiang University School of Medicine, Hangzhou, China
  6. 6Department of Gastroenterology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  7. 7Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  8. 8State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  1. Correspondence to Dr Yihua Wu; georgewuer{at}126.com and Dr Dajing Xia; dxia{at}zju.edu.cn

Abstract

Objectives Independent epidemiological studies have evaluated the association between markers of glucose metabolism (including fasting glucose, fasting insulin, homeostasis model of risk assessment-insulin resistance (HOMA-IR), glycated haemoglobin (HbA1c) and C peptide) and the risk of colorectal cancer (CRC). However, such associations have not been systematically analysed and no clear conclusions have been drawn. Therefore, we addressed this issue using a meta-analysis approach.

Design Systematic review and meta-analysis.

Data sources PubMed and EMBASE were searched up to May 2015.

Primary and secondary outcome measures Either a fixed-effects or random-effects model was adopted to estimate overall ORs for the association between markers of glucose metabolism and the risk of CRC. In addition, dose–response, meta-regression, subgroup and publication bias analyses were conducted.

Results 35 studies involving 25 566 patients and 5 706 361 participants were included. Higher levels of fasting glucose, fasting insulin, HOMA-IR, HbA1c and C peptide were all significantly associated with increased risk of CRC (fasting glucose, pooled OR=1.12, 95% CI 1.06 to 1.18; fasting insulin, pooled OR=1.42, 95% CI 1.19 to 1.69; HOMA-IR, pooled OR=1.47, 95% CI 1.24 to 1.74; HbA1c, pooled OR=1.22, 95% CI 1.02 to 1.47 (with borderline significance); C peptide, pooled OR=1.27, 95% CI 1.08 to 1.49). Subgroup analysis suggested that a higher HOMA-IR value was significantly associated with CRC risk in all subgroups, including gender, study design and geographic region. For the relative long-term markers, the association was significant for HbA1c in case–control studies, while C peptide was significantly associated with CRC risk in both the male group and colon cancer.

Conclusions The real-time composite index HOMA-IR is a better indicator for CRC risk than are fasting glucose and fasting insulin. The relative long-term markers, HbA1c and C peptide, are also valid predictors for CRC risk. Considering the included case–control studies in the current analysis, more cohort studies are warranted to enhance future analysis.

  • fasting glucose
  • fasting insulin
  • HOMA-IR
  • HbA1c
  • C-peptide
  • colorectal cancer

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

http://dx.doi.org/10.1136/bmjopen-2016-011430

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    Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/