Department of Preventive Medicine, School of Medicine, Kangwon National University, 1 Gangwondeahakgil, Chuncheon, Gangwon, 24341, Republic of Korea.
Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, 1 Gangwondeahakgil, Chuncheon, Gangwon, 24341, Republic of Korea.
J Epidemiol Glob Health. 2024 Sep;14(3):1249-1256. doi: 10.1007/s44197-024-00282-w. Epub 2024 Aug 5.
Insulin-mediated pathways plausibly explain the pathogenesis of colorectal cancer (CRC). The triglyceride-glucose index (TyG) is a surrogate of insulin resistance (IR), but its association with CRC in the Korean population has not been evaluated.
From the 2004-2013 Korean Genome and Epidemiology Study, 98,800 participants aged 40-69 years were followed through 2020. Data on CRC incidence were obtained from the Korean National Cancer Center registry. Cox regression models and restricted cubic splines were fitted to examine the association between the TyG; In [(triglycerides) × (fasting glucose)/2] and CRC incidence. Joint effects of modifiable lifestyle factors and TyG on CRC risk were also investigated.
Median follow-up time was 10.6 years, and 699 CRC cases were observed. A unit-increment in TyG was associated with increased risk of CRC combined (hazard ratio, HR: 1.28, and 95% confidence interval, CI: 1.12-1.46), colon (1.29, 1.10-1.54), and rectal cancer (1.24, 1.01-1.52). Associations were dose-dependent, with linear associations observed for CRC and colon, but non-linear associations were observed for rectal cancer. A high TyG index (above 8.4) combined with overweight/obesity was linked to an increased risk of CRC (1.31, 1.07-1.61) and colon cancer (1.33, 1.03-1.72). When combined with low fruit and vegetable intake, the risks were higher for CRC (1.40, 1.12-1.74) and colon cancer (1.57, 1.18-2.09). Combined with high red meat consumption, the risks were elevated for CRC (1.32, 1.05-1.65) and colon cancer (1.52, 1.15-2.02).
A high TyG index was associated with a higher risk of colorectal cancer, and the risk was highest among participants with a high BMI, low fruit and vegetable intake, and high intake of red meat, suggesting a role of both insulin resistance and modifiable lifestyle in colorectal cancer development.
胰岛素介导的途径可以合理地解释结直肠癌（CRC）的发病机制。甘油三酯-葡萄糖指数（TyG）是胰岛素抵抗（IR）的替代指标，但在韩国人群中，其与 CRC 的关系尚未得到评估。
我们对 2004-2013 年韩国基因组和流行病学研究中的 98800 名年龄在 40-69 岁的参与者进行了随访，随访至 2020 年。CRC 发病率的数据来自韩国国家癌症中心登记处。使用 Cox 回归模型和限制立方样条拟合来检查 TyG[In[(甘油三酯)×(空腹血糖)/2]]与 CRC 发病率之间的关系。还研究了可改变的生活方式因素和 TyG 对 CRC 风险的联合影响。
中位随访时间为 10.6 年，观察到 699 例 CRC 病例。TyG 增加一个单位与 CRC 综合风险增加相关（风险比，HR：1.28，95%置信区间，CI：1.12-1.46）、结肠癌（1.29，1.10-1.54）和直肠癌（1.24，1.01-1.52）。这种关联呈剂量依赖性，CRC 和结肠癌呈线性关系，而直肠癌呈非线性关系。高 TyG 指数（高于 8.4）与超重/肥胖相结合与 CRC（1.31，1.07-1.61）和结肠癌（1.33，1.03-1.72）的风险增加有关。当与低水果和蔬菜摄入量结合时，CRC（1.40，1.12-1.74）和结肠癌（1.57，1.18-2.09）的风险更高。与高红肉摄入量结合时，CRC（1.32，1.05-1.65）和结肠癌（1.52，1.15-2.02）的风险升高。
高 TyG 指数与结直肠癌风险增加相关，在 BMI 较高、水果和蔬菜摄入量较低以及红肉摄入量较高的参与者中风险最高，提示胰岛素抵抗和可改变的生活方式在结直肠癌发展中均起作用。
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