title: Elevated serum concentrations of insulin and glucose increase risk of recurrent colorectal adenomas.
abstract: OBJECTIVE
  Indicators of insulin resistance have been hypothesized to promote colorectal cancer.
  
  
  METHODS
  We assayed fasting serum from 375 subjects with and 375 subjects without a recurrent adenoma during the course of the Polyp Prevention Trial to determine baseline concentrations of insulin and glucose, as well as changes in these measurements over the course of 4 years of follow-up evaluation. To estimate the relative risk of adenoma recurrence for each of these serum measures, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression models adjusting for age, sex, body mass index, intervention group, and an interaction term for sex and intervention group.
  
  
  RESULTS
  For both insulin and glucose, we found higher risk for subjects in the high quartile compared with the low quartile (OR, 1.56; 95% CI, 1.00-2.43 for insulin; OR, 1.49; 95% CI, 0.95-2.31 for glucose). The association for glucose was most apparent for advanced adenomas (OR, 2.43; 95% CI, 1.23-4.79) but for insulin, we did not observe this pattern. When we restricted the analysis to those without a family history of colorectal cancer, we observed an even stronger association between increased glucose at study entry and adenoma recurrence (OR, 1.78; 95% CI, 1.06-3.01 for all adenomas; OR, 3.52; 95% CI, 1.47-8.42 for advanced adenoma).
  
  
  CONCLUSIONS
  Our findings suggest that patients with increased insulin and glucose are at higher risk of adenoma recurrence, and for those with increased glucose, the increase in risk for recurrence of advanced adenomas is even greater.
authors: Division of Epidemiology and Community Health and the Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA. flood009@umn.edu
authors: Andrew
authors: A
authors: Flood
authors: Volker
authors: V
authors: Mai
authors: Ruth
authors: R
authors: Pfeiffer
authors: Lisa
authors: L
authors: Kahle
authors: Alan T
authors: AT
authors: Remaley
authors: Elaine
authors: E
authors: Lanza
authors: Arthur
authors: A
authors: Schatzkin
mesh_terms: D000236:Adenoma / Q000097:blood / Q000473:pathology*; D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin