Ke Juzhong, Lin Tao, Liu Xiaolin, Wu Kang, Ruan Xiaonan, Ding Yibo, Liu Wenbin, Qiu Hua, Tan Xiaojie, Wang Xiaonan, Chen Xi, Li Zhitao, Cao Guangwen
Department of Epidemiology, Second Military Medical University, Shanghai, China.
Pudong New Area Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China.
Front Oncol. 2021 Aug 30;11:726672. doi: 10.3389/fonc.2021.726672. eCollection 2021.
Cancer becomes the leading cause of premature death in China. Primary objective of this study was to determine the major risk factors especially glucose intolerance for cancer prophylaxis.
A cluster sampling method was applied to enroll 10,657 community-based adults aged 15-92 years in Shanghai, China in 2013. A structured questionnaire and physical examination were applied in baseline survey. Prediabetes was diagnosed using 75-g oral glucose tolerance test. After excluding 1433 subjects including 224 diagnosed with cancer before and 1 year after baseline survey, the remaining 9,224 subjects were followed-up to December 31, 2020.
A total of 502 new cancer cases were diagnosed. The cancer incidence was 10.29, 9.20, and 5.95/1,000 person-years in diabetes patients, those with prediabetes, and healthy participants, respectively (<0.001). The multivariate Cox regression analysis indicated that age, prediabetes and diabetes, were associated with an increased risk of cancer in those <65 years, the hazard ratios (95% confidence interval) for prediabetes and diabetes were, 1.49(1.09-2.02) and 1.51(1.12-2.02), respectively. Glucose intolerance (prediabetes and diabetes) were associated with increased risks of stomach cancer, colorectal cancer, and kidney cancer in those <65 years. Anti-diabetic medications reduced the risk of cancer caused by diabetes. The multivariate Cox analysis showed that age, male, <9 years of education, and current smoking were associated with increased risks of cancer in those ≥65 years independently.
Glucose intolerance is the prominent cancer risk factor in adults <65 years. Lifestyle intervention and medications to treat glucose intolerance help prevent cancer in this population.
癌症成为中国过早死亡的主要原因。本研究的主要目的是确定主要危险因素，尤其是用于癌症预防的葡萄糖不耐受情况。
2013年在中国上海采用整群抽样方法招募了10657名年龄在15 - 92岁的社区成年人。在基线调查中采用结构化问卷和体格检查。采用75克口服葡萄糖耐量试验诊断糖尿病前期。在排除1433名受试者（包括基线调查前和后1年诊断为癌症的224名）后，对其余9224名受试者随访至2020年12月31日。
共诊断出502例新癌症病例。糖尿病患者、糖尿病前期患者和健康参与者的癌症发病率分别为10.29、9.20和5.95/1000人年（<0.001）。多因素Cox回归分析表明，年龄、糖尿病前期和糖尿病与65岁以下人群患癌风险增加有关，糖尿病前期和糖尿病的风险比（95%置信区间）分别为1.49（1.09 - 2.02）和1.51（1.12 - 2.02）。葡萄糖不耐受（糖尿病前期和糖尿病）与65岁以下人群患胃癌、结直肠癌和肾癌的风险增加有关。抗糖尿病药物降低了糖尿病所致癌症的风险。多因素Cox分析表明，年龄、男性、受教育年限<9年和当前吸烟与65岁及以上人群患癌风险增加独立相关。
葡萄糖不耐受是65岁以下成年人中突出的癌症危险因素。生活方式干预和治疗葡萄糖不耐受的药物有助于预防该人群患癌。
