Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Cancer Causes Control. 2012 Feb;23(2):321-8. doi: 10.1007/s10552-011-9880-y. Epub 2011 Nov 29.
To investigate which glycemic index is more strongly associated with colorectal neoplasia.
This cross-sectional study enrolled 2,776 participants in a comprehensive health management program which included measurement of fasting plasma glucose and HbA1c, along with screening colonoscopy. Primary outcome was colorectal adenoma with or without dysplasia. Risk factors for colorectal neoplasia were determined by the multivariate regression analysis, which evaluated the interrelationship among different glycemic indices in a hierarchical way.
Colorectal neoplasms were found in 605 (21.79%) examinees, 68 (2.45%) of whom had high-risk tumors. Glycemic indices including diagnosis of diabetes mellitus, fasting plasma glucose, and HbA1c were all associated with colorectal tumors in the univariate analysis. However, HbA1c outperformed the other two markers as an independent risk factor (adjusted odds ratio, 1.22; 95% confidence interval, 1.10-1.36%) for colorectal neoplasia. Moreover, only HbA1c remained independently associated with colorectal tumor after patients with established diagnosis of diabetes (n = 132) were excluded. We also identified age, male gender, and smoking were independent risk factors for colorectal neoplasia.
HbA1c as compared with fasting plasma glucose is more strongly and independently associated with colorectal neoplasia. Further research is warranted to elucidate the value of HbA1c in stratifying risk of colorectal cancer.
探讨哪种血糖指数与结直肠肿瘤的相关性更强。
本横断面研究纳入了 2776 名参加全面健康管理计划的参与者，该计划包括空腹血糖和 HbA1c 测量以及筛查结肠镜检查。主要结局是结直肠腺瘤伴或不伴异型增生。通过多变量回归分析确定结直肠肿瘤的危险因素，该分析以分层的方式评估不同血糖指数之间的相互关系。
在 605 名（21.79%）受检者中发现了结直肠肿瘤，其中 68 名（2.45%）患有高危肿瘤。在单因素分析中，包括糖尿病诊断、空腹血糖和 HbA1c 在内的血糖指数均与结直肠肿瘤相关。然而，HbA1c 作为独立危险因素的表现优于其他两个标志物（调整后的优势比，1.22；95%置信区间，1.10-1.36%）。此外，在排除已确诊糖尿病患者（n=132）后，只有 HbA1c 与结直肠肿瘤独立相关。我们还发现年龄、男性和吸烟是结直肠肿瘤的独立危险因素。
与空腹血糖相比，HbA1c 与结直肠肿瘤的相关性更强且独立。需要进一步研究以阐明 HbA1c 在结直肠癌风险分层中的价值。
