Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, China.
Oxid Med Cell Longev. 2022 Jul 13;2022:4530894. doi: 10.1155/2022/4530894. eCollection 2022.
The aim of this study is to investigate the association between visit-to-visit variability in fasting plasma glucose (FPG) and the risk of digestive cancers among individuals with and without diabetes.
Using data from Kailuan cohort, a prospective population-based study, individuals who had at least two measurements of FPG between 2006 and 2012 without prior cancer were included in this study. Four indexes of variability were used, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average successive variability (ARV). Cox regression was used to evaluate the relationship between the quartiles of FPG variability and digestive cancers.
A total of 98,161 individuals were studied. Over a mean follow-up of 9.32 ± 0.81 years, 1103 individuals developed incident digestive cancer (1.21 per 1000 person-years). Compared to the individuals in the lowest quartile, those in the highest quartile of FPG variability by SD had 38.7% higher risk of developing overall digestive cancers after adjusting for the significant confounders (hazard ratio, 1.387; 95% confidence interval, 1.160-1.659; = 0.0003). Higher FPG variability was associated with significantly higher risks of colorectal cancer (fully adjusted HR 1.432, 95% CI [1.073-1.912], = 0.015) and pancreatic cancer (fully adjusted HR 2.105, 95% CI [1.024-4.329], = 0.043), but not liver cancer (fully adjusted HR 1.427, 95% CI [0.973-2.092], = 0.069) or esophageal and gastric cancer (fully adjusted HR 1.139, 95% CI [0.776-1.670], = 0.506). Subgroup analyses showed that individuals who were younger (<65 years), male, and those without diabetes experienced a predominantly higher risk of developing digestive cancers. Similar results were observed when using CV, VIM, and ARV.
FPG variability was significantly associated with increasing risk of digestive cancers, especially for pancreatic and colorectal cancer. Our study suggested a potential role of FPG variability in risk stratification of digestive cancers. Approaches that reduce FPG variability may lower the risks of incident digestive cancers among the general population. This trial is registered with ChiCTR-TNRC-11001489.
本研究旨在探讨空腹血糖（FPG）变异性与糖尿病患者和非糖尿病患者罹患消化道癌症风险之间的关系。
本研究使用来自开滦队列的前瞻性人群研究数据，纳入了在 2006 年至 2012 年期间至少进行了两次 FPG 测量且无既往癌症的个体。本研究使用了四个变异指标，包括标准差（SD）、变异系数（CV）、均值独立变异（VIM）和平均连续变异（ARV）。Cox 回归用于评估 FPG 变异的四分位间距与消化道癌症之间的关系。
共纳入了 98161 名个体。在平均 9.32±0.81 年的随访期间，共有 1103 名个体发生了新发消化道癌症（1.21/1000 人年）。在校正了显著混杂因素后，与 FPG 变异的 SD 最低四分位数相比，SD 最高四分位数的个体罹患总体消化道癌症的风险高出 38.7%（风险比，1.387；95%置信区间，1.160-1.659； = 0.0003）。更高的 FPG 变异与结直肠癌（完全校正 HR 1.432，95%CI[1.073-1.912]， = 0.015）和胰腺癌（完全校正 HR 2.105，95%CI[1.024-4.329]， = 0.043）风险的显著升高相关，但与肝癌（完全校正 HR 1.427，95%CI[0.973-2.092]， = 0.069）或食管癌和胃癌（完全校正 HR 1.139，95%CI[0.776-1.670]， = 0.506）无关。亚组分析显示，年龄较小（＜65 岁）、男性和无糖尿病的个体罹患消化道癌症的风险显著升高。当使用 CV、VIM 和 ARV 时，也观察到了类似的结果。
FPG 变异与消化道癌症风险的增加显著相关，尤其是与胰腺癌和结直肠癌相关。我们的研究提示 FPG 变异在消化道癌症风险分层中可能具有潜在作用。降低 FPG 变异的方法可能会降低普通人群中消化道癌症的发病风险。本试验已在中国临床试验注册中心注册，注册号 ChiCTR-TNRC-11001489。
