The association between fasting blood glucose trajectory and cancer risk in Chinese population without diabetes

• Published in: International journal of cancer 2020-08, Vol.147 (4), p.958-966
• Main Authors: Feng, Xiaoshuang, Wang, Gang, Lyu, Zhangyan, Chen, Shuohua, Wei, Luopei, Li, Xin, Wen, Yan, Chen, Yuheng, Xie, Shuanghua, Cui, Hong, Chen, Hongda, Li, Jiang, Lin, Chunqing, Ren, Jiansong, Shi, Jufang, Wu, Shouling, Dai, Min, Li, Ni, He, Jie
• Format: Article
• Language: English
• Subjects: Adult; Asian Continental Ancestry Group - statistics & numerical data; Blood cancer; Blood Glucose - metabolism; Body mass index; Cancer; China - epidemiology; Chinese; Diabetes; Diabetes mellitus; Fasting; Fasting - blood; fasting blood glucose; Female; Health risk assessment; Humans; Male; Medical research; Middle Aged; Neoplasms - blood; Neoplasms - diagnosis; Neoplasms - epidemiology; Prevalence; Proportional Hazards Models; prospective; Prospective Studies; Regression analysis; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; trajectory
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.32858

To examine the associations between fasting blood glucose (FBG) trajectories, the changes in FBG over time and the risk of cancer, particularly for gastrointestinal cancer, we enrolled 69,742 participants without diabetes from the Kailuan cohort. FBG trajectories (2006–2010) were modeled by group‐based trajectory modeling, and five trajectories were identified: low‐increasing (n = 6,275), moderate‐stable (n = 44,120), moderate‐increasing (n = 10,149), elevated‐decreasing (n = 5,244) and elevated‐stable (n = 3,954). A total of 1,364 cancer cases were accumulated between 2010 and 2015, including 472 gastrointestinal cancer cases. We used Cox proportional hazards regression models to evaluate the associations between FBG trajectory patterns and the risk of cancer. We further assessed the associations while carefully controlling for initial body mass index (BMI) in 2006 and for changes in BMI during 2006–2010. Relative to the moderate‐stable group, we found a higher hazard ratio (HR) for overall cancer in the low‐increasing group (HR = 1.26, 95% confidence interval (CI) 1.06–1.50); and for gastrointestinal cancer in the elevated‐stable group (HR = 1.66, 95% CI 1.22–2.26). Moreover, among participants with an initial BMI ≥25 kg/m2, a positive association with the low‐increasing group was observed for both overall cancer and gastrointestinal cancer (HR = 1.54, 95% CI 1.17–2.04; HR = 1.65, 95% CI 1.02–2.66; respectively); among participants with a stable BMI (4.40% loss–5.15% gain), a positive association with the elevated‐stable group was observed both for overall cancer and gastrointestinal cancer (HR = 1.43, 95% CI 1.10–1.87; HR = 1.95, 95% CI 1.33–2.86; respectively). Our study observed that FBG trajectories were associated with cancer risk among participants without diabetes, and BMI may modify the associations. What's new? Impaired fasting blood glucose (IFG) is associated with an increased risk of cancer. In China, lifestyle changes have significantly increased the prevalence of IFG. But are high fasting blood‐glucose (FBG) levels the only culprit in increased cancer risk? In this study, the authors found that people with initially low FBG that rose over time (the “FBG trajectory”) also had an increased risk both for overall cancer and especially for gastrointestinal cancer. BMI may modify these associations. A deeper understanding of these phenomena may improve future prevention strategies.