Uterine leiomyomata in relation to insulin-like growth factor-I, insulin, and diabetes.
BACKGROUND
Insulin-like growth factor-I (IGF-I) and insulin stimulate cell proliferation in uterine leiomyoma (fibroid) tissue. We hypothesized that circulating levels of these proteins would be associated with increased prevalence and size of uterine fibroids.


METHODS
Participants were 35-49-year-old, randomly selected members of an urban health plan who were enrolled in the study in 1996-1999. Premenopausal participants were screened for fibroids with ultrasound. Fasting blood samples were collected. Associations between fibroids and diabetes, plasma IGF-I, IGF binding protein 3 (BP3), and insulin were evaluated for blacks (n = 585) and whites (n = 403) by using multiple logistic regression.


RESULTS
IGF-I showed no association with fibroids in blacks, but in whites the adjusted odds ratios (aORs) for both mid and upper tertiles compared with the lowest tertile were 0.6 (95% confidence intervals [CI] = 0.3-1.0 and 0.4-1.1, respectively). Insulin and diabetes both tended to be inversely associated with fibroids in blacks. The insulin association was with large fibroids; aOR for the upper insulin tertile relative to the lowest was 0.4 (0.2-0.9). The aOR for diabetes was 0.5 (0.2-1.0). Associations of insulin and diabetes with fibroids were weak for whites. Binding protein 3 showed no association with fibroids.


CONCLUSIONS
Contrary to our hypothesis, high circulating IGF-I and insulin were not related to increased fibroid prevalence. Instead, there was suggestion of the opposite. The inverse association with diabetes, although based on small numbers, is consistent with previously reported findings. Future studies might investigate vascular dysfunction as a mediator between hyperinsulinemia or diabetes and possible reduced risk of fibroids.
Baird
Donna D
DD
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA. baird@niehs.nih.gov
Travlos
Greg
G
Wilson
Ralph
R
Dunson
David B
DB
Hill
Michael C
MC
D'Aloisio
Aimee A
AA
London
Stephanie J
SJ
Schectman
Joel M
JM
D000328:Adult; D049109:Cell Proliferation; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D007889:Leiomyoma / Q000097:blood* / Q000453:epidemiology*; D016015:Logistic Models; D008875:Middle Aged; D014599:Uterus / Q000503:physiopathology*
C032231:IGFBP1 protein, human; D007328:Insulin; D018970:Insulin-Like Growth Factor Binding Protein 1