Original researchThe significant interaction between age and diabetes mellitus for colorectal cancer: Evidence from NHANES data 1999–2016⋆
Introduction
Diabetes Mellitus (DM) is increasing in prevalence in the United States, affecting nearly 10% of the adult population [1], and colorectal cancer (CRC) is the second cause of cancer death in women, and the third for men [2]. According to cancer statistics in the United States in 2017, there were estimated to be 135,430 individuals newly diagnosed with CRC and 50,260 deaths from the disease [3]. These two diseases are life threatening and huge burdens to patients and society. Diabetes was the seventh leading cause of death in the United States in 2015, and after adjusting for age group and sex, the average medical expenditures among people with diagnosed DM were approximately 2.3 times higher than expenditures for those without DM [4], [5].
There is much evidence that DM is an independent risk factor for the development of CRC. However, the reason why DM can be a risk factor for colorectal cancer is unclear [6]. DM has been repeatedly shown to be associated with CRC. In a large, population-based cohort study of postmenopausal women, type 2 DM was found to be associated with a 40% increase in the risk for incident CRC [7]. Some studies found CRC has been associated with markers of insulin or glucose control and insulin resistance might be the unifying mechanism by which several risk factors affect colorectal carcinogenesis. In accordance with previous studies, DM was observed to be a moderate risk factor for CRC [8].
The National Diabetes Statistics reports that 87.5% (95% CI, 84.8%–89.7%) of adults are overweight or obese, defined as a body mass index (BMI) of 25 kg/m2 or higher [1]. Overweight, obesity, or BMI have been consistently associated with increased risk for CRC incidence and mortality [9]. Sturmer et al. reported that genetic variation in the insulin-like growth factor (IGF) pathway may further increase the risk of CRC associated with BMI [10].
Although studies have shown that DM is associated with an elevated risk of CRC, any interaction between age and DM has not been well defined. In this study, we examined the relationship among DM, CRC and age through analyzing data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 to reveal the association between DM and CRC in different age ranges.
Section snippets
Study population
NHANES is a survey research program conducted by the Centers of Disease Control and Prevention to assess the health and nutritional status of adults and children in the United States. It is composed of cross-sectional, nationally representative health and nutrition surveys of the U.S. civilian, non- institutionalized population. In order to represent the U.S. population, a complex, stratified, multistage probability cluster sampling design is used in the survey. Selected subpopulations are
Results
Data from 22,580 subjects aged ≥18 years and with fasting blood sugar test values were analyzed. There were 20,896 subjects in the No-DM group, with a mean age of 45.4 years, female rate of 52.2%, and CRC rate of 0.45% and 1686 subjects in the DM group, with a mean age of 59.4 years, female rate of 46.0%, and CRC rate of 1.11% (Table 1).
Univariate analysis showed that the differences in age (p < 0.0001), sex (p < 0.0001), race (p < 0.0001), smoking (p = 0.002), and BMI (p < 0.0001) between No-DM and DM
Discussion
This study indicated that individuals with DM at ages 18–65 years were at significantly higher risk for CRC. However, in individuals aged ≥65 years, DM was not a significant risk factor for CRC. The results of this study support considering DM in diagnosis, screening, and managing individuals aged less than 65 years for CRC, and suggest DM is no more a risk factor for CRC in the individuals aged equal or greater than 65. Although the previous studies Ali Khan et al. [12] and Sander de Kort et
Conclusion
This study showed that age, DM, and interaction between age and DM are important risk factors for CRC. Individuals with DM at ages 18–65 years have a higher risk for CRC. However, individuals with DM at age ≥65 years have no increased risk for CRC.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
No relevant financial disclosures for all authors.
References (24)
- et al.
Metformin for chemoprevention of mecahronous colorectal adenoma or polyps in post-polypectomy patients without diabetes: a multicenter double-blind, placebo-controlled, randomized phase 3 trial
Lancet Oncol.
(2016) National Diabetes Statistics Report, 2017
(2017)- et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Int. J. Cancer
(2010) - et al.
Cancer statistics
CA Cancer J. Clin.
(2017) About Underlying Cause of Death 1999–2015. CDC WONDER Database
(2016)Economic costs of diabetes in the U.S. in 2012
Diabetes Care
(2013)- et al.
Diabetes mellitus and colorectal cancer prognosis: a meta-analysis
Dis. Colon Rectum
(2013) - et al.
Diabetes mellitus and subsite-specific colorectal cancer risks in the Iowa Women's Health Study
Cancer Epidemiol. Biomarkers Prev.
(2005) - et al.
Metabolic abnormalities and risk for colorectal cancer in the physician's health study
Cancer Epidemiol. Biomarkers Prev.
(2006) - et al.
Influence of obesity on the risk of developing colon cancer
Gut
(2006)
Body mass index and colon cancer: an evaluation of the modifying effects of estrogen (United States)
Cancer Causes Control
High total bilirubin as a protective factor for diabetes mellitus: an analysis of NHANES data from 1999–2006
J. Clin. Med. Res.
Cited by (7)
Healthy eating index-2015 and its association with the prevalence of stroke among US adults
2024, Scientific ReportsThe association of polyunsaturated fatty acids and asthma: a cross-sectional study
2023, Journal of Health, Population and NutritionThe dietary inflammatory index and its association with the prevalence of hypertension: A cross-sectional study
2023, Frontiers in Immunology
- ⋆
Poster presentation at the American College of Surgeons Scientific Forum at Clinical Congress 2020, Chicago, IL, October 4–8, 2020.