Table_1_Glucose Intolerance and Cancer Risk: A Community-Based Prospective Cohort Study in Shanghai, China.docx

BackgroundCancer 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.
MethodsA 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.
ResultsA 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 (p<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.
ConclusionsGlucose 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.

背景 癌症现已成为中国居民过早死亡的首要病因。本研究的核心目标为明确癌症预防的关键危险因素，尤其是糖耐量异常（glucose intolerance）。
方法 本研究于2013年采用整群抽样法，在中国上海招募10657名年龄介于15~92岁的社区成年居民。基线调查采用结构化问卷与体格检查相结合的方式，通过75g口服葡萄糖耐量试验（75-g oral glucose tolerance test）诊断前驱糖尿病（prediabetes）。本研究排除了1433名研究对象，其中包括基线调查前及基线后1年内确诊癌症的224人；最终剩余9224名研究对象被随访至2020年12月31日。
结果 本研究共确诊新发癌症病例502例。糖尿病患者、前驱糖尿病患者及健康参与者的癌症发病率分别为10.29、9.20及5.95/1000人年（p<0.001）。多因素Cox回归分析（multivariate Cox regression analysis）显示，在年龄<65岁的人群中，年龄、前驱糖尿病与糖尿病均与癌症发病风险升高相关；前驱糖尿病与糖尿病的风险比（hazard ratios）及95%置信区间（confidence interval）分别为1.49（1.09~2.02）与1.51（1.12~2.02）。在<65岁人群中，糖耐量异常（即前驱糖尿病与糖尿病）与胃癌、结直肠癌及肾癌的发病风险升高显著相关。抗糖尿病药物可降低糖尿病患者因糖尿病导致的癌症发病风险。针对≥65岁人群的多因素Cox分析显示，年龄、男性、受教育年限不足9年及当前吸烟均为癌症发病的独立危险因素。
结论 糖耐量异常是<65岁成年人群中显著的癌症危险因素。针对糖耐量异常的生活方式干预与药物治疗，有助于该人群的癌症预防。