Hyperglycemia increases risk of gastric cancer posed by Helicobacter pylori infection: a population-based cohort study.
OBJECTIVE
Although diabetes mellitus and hyperglycemia are considered to be possible risk factors for various types of malignancy, the epidemiologic evidence concerning gastric cancer is scarce. The aim of this study was to evaluate the impact of hemoglobin A1c (HbA1c) levels on gastric cancer occurrence and their interaction with Helicobacter pylori infection.


METHODS
A total of 2603 Japanese subjects aged>or=40 years were stratified into 4 groups according to baseline HbA1c levels (<or=4.9%, 5.0%-5.9%, 6.0%-6.9%, and >or=7.0%) and followed up prospectively for 14 years.


RESULTS
During the follow-up, 97 subjects developed gastric cancer. The age- and sex-adjusted incidence of gastric cancer significantly increased in the 6.0%-6.9% (5.1 per 1000 person-years; P<.05) and >or=7.0% groups (5.5 per 1000 person-years; P<.05) compared with the 5.0%-5.9% group (2.5 per 1000 person-years), whereas it was slightly but not significantly high in the <or=4.9% group (3.6 per 1000 person-years). This association remained substantially unchanged even after adjusting for the confounding factors including Helicobacter pylori seropositivity, (multivariate-adjusted hazard ratio [HR], 2.13; 95% confidence interval [CI]: 1.30-3.47 for the 6.0%-6.9% group and HR, 2.69; 95% CI: 1.24-5.85 for the >or=7.0% group). Among subjects who had both high HbA1c levels (>or=6.0%) and Helicobacter pylori infection, the risk of gastric cancer was dramatically elevated (interaction term, P=.004).


CONCLUSIONS
Our findings suggest that casual hyperglycemia is a risk factor for gastric cancer and is a possible cofactor increasing the risk posed by Helicobacter pylori infection.
Ikeda
Fumie
F
Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. fumikeda@envmed.med.kyushu-u.ac.jp
Doi
Yasufumi
Y
Yonemoto
Koji
K
Ninomiya
Toshiharu
T
Kubo
Michiaki
M
Shikata
Kentaro
K
Hata
Jun
J
Tanizaki
Yumihiro
Y
Matsumoto
Takayuki
T
Iida
Mitsuo
M
Kiyohara
Yutaka
Y
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000382:microbiology*
D006442:Glycated Hemoglobin