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Impaired glucose tolerance significantly increases risk for death from colorectal and other cancers

People with impaired glucose tolerance, a condition considered a precursor to diabetes, are at increased risk for death from colorectal and other cancers, according to an article in the June 15th issue of the American Journal of Epidemiology.

In the current study, American researchers conducted a prospective cohort study with use of data from 2 national studies representing a total of 3,054 adults aged 30 to 74 years at baseline (1976-1980), none of whom had baseline cancer. Participants were classified as diagnosed diabetes (247 adults), undiagnosed diabetes (180 adults), impaired glucose tolerance (477 adults), or normal glucose tolerance (2,250 adults).
People with impaired glucose tolerance had a nearly 2-fold increase in risk for cancer death and more than 4 times as likely to die from colorectal cancer as peers with normal glucose tolerance.

"By contrast, adults with outright diabetes had little or no association with risk of cancer death (relative hazard 1.13 versus 1.87 for people with impaired glucose tolerance)," said senior study author Frederick L. Brancati, M.D.

The mechanism underlying the apparent increase in risk is not clear, Brancati said, although previous studies have suggested that high levels of insulin can act as a growth factor in promoting development of cancer cells.

Impaired glucose tolerance, which is present in about 15 percent of American adults, is defined as blood glucose levels that are higher than normal but not high enough to be classified as diabetes. Roughly 33 percent of affected people develop diabetes within 5 years. Although there are no proven methods for prevention of the condition, according to Brancati, most affected people are overweight and sedentary. Weight loss and increased exercise are usually recommended.

An analysis of study participants showed that people with impaired glucose tolerance (compared with those having normal glucose tolerance) were more likely to be older, female, less educated, and relatively sedentary. They also were less likely to be current smokers or to drink 1 or more alcoholic drinks per week. In addition, they had greater body fat, lower high-density lipoprotein cholesterol, and higher total cholesterol, triglycerides, and blood pressure.

Researchers confirmed deaths in the study groups occurring between 1976 and 1992 by search of national files. Of 737 participant deaths during the study period, 206 (28 percent) were from cancer. People with impaired glucose tolerance had the highest cancer death rate, followed by those with undiagnosed diabetes, diagnosed diabetes, and normal glucose tolerance. The authors suggest that impaired glucose tolerance be considered an independent predictor for cancer mortality.


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