Giovannucci Edward
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Am J Clin Nutr. 2007 Sep;86(3):s836-42. doi: 10.1093/ajcn/86.3.836S.
An impressive body of epidemiologic data collected over the past decade indicates that the risk of colon cancer is elevated in those with metabolic syndrome. This evidence includes studies that examined the risk of colon cancer or adenoma in relation to determinants of the metabolic syndrome (obesity, abdominal distribution of adiposity, and physical inactivity), clinical consequences of this syndrome (type 2 diabetes and hypertension), plasma or serum components of the definition of metabolic syndrome (hypertriglyceridemia, hyperglycemia, and low HDL cholesterol), and markers of hyperinsulinemia or insulin resistance (insulin and C-peptide), which is the underlying metabolic defect of the metabolic syndrome. The mechanism underlying these associations is unknown but may involve the influence of hyperinsulinemia in enhancing free or bioavailable concentrations of insulin-like growth factor-1. Future studies should also be based on better measurements of insulin resistance, beta-cell depletion, and insulin responses to better assess which aspects of insulin resistance are most closely related to the risk of colon neoplasia.
过去十年收集的大量流行病学数据表明，代谢综合征患者患结肠癌的风险会升高。这些证据包括一些研究，这些研究考察了结肠癌或腺瘤风险与代谢综合征的决定因素（肥胖、腹部脂肪分布和身体活动不足）、该综合征的临床后果（2型糖尿病和高血压）、代谢综合征定义中的血浆或血清成分（高甘油三酯血症、高血糖和低高密度脂蛋白胆固醇）以及高胰岛素血症或胰岛素抵抗的标志物（胰岛素和C肽）之间的关系，而胰岛素抵抗是代谢综合征潜在的代谢缺陷。这些关联背后的机制尚不清楚，但可能涉及高胰岛素血症对提高胰岛素样生长因子-1的游离或生物可利用浓度的影响。未来的研究还应基于对胰岛素抵抗、β细胞耗竭和胰岛素反应的更精确测量，以更好地评估胰岛素抵抗的哪些方面与结肠肿瘤形成风险最为密切相关。
