title: Association of insulin and insulin-like growth factors with Barrett's oesophagus.
abstract: BACKGROUND
  It is postulated that high serum levels of insulin and insulin growth factor 1 (IGF-1) mediate obesity-associated carcinogenesis. The relationship of insulin, IGF-1 and IGF binding proteins (IGFBP) with Barrett's oesophagus (BO) has not been well examined.
  
  
  METHODS
  Serum levels of insulin and IGFBPs in patients with BO were compared with two separate control groups: subjects with gastro-oesophageal reflux disease (GORD) and screening colonoscopy controls. Fasting insulin, IGF-1 and IGFBPs were assayed in the serum of BO cases (n = 135), GORD (n = 135) and screening colonoscopy (n = 932) controls recruited prospectively at two academic hospitals. Logistic regression was used to estimate the risk of BO.
  
  
  RESULTS
  Patients in the highest tertile of serum insulin levels had an increased risk of BO compared with colonoscopy controls (adjusted OR 2.02, 95% CI 1.15 to 3.54) but not compared with GORD controls (adjusted OR 1.55, 95% CI 0.76 to 3.15). Serum IGF-1 levels in the highest tertile were associated with an increased risk of BO (adjusted OR 4.05, 95% CI 2.01 to 8.17) compared with the screening colonoscopy control group but were not significantly different from the GORD control group (adjusted OR 0.57, 95% CI 0.27 to 1.17). IGFBP-1 levels in the highest tertile were inversely associated with a risk of BO in comparison with the screening colonoscopy controls (adjusted OR 0.11, 95% CI 0.05 to 0.24) but were not significantly different from the GORD control group (adjusted OR 1.04, 95% CI 0.49 to 2.16). IGFBP-3 levels in the highest tertile were inversely associated with the risk of BO compared with the GORD controls (OR 0.36, 95% CI 0.16 to 0.81) and also when compared with the colonoscopy controls (OR 0.40, 95% CI 0.20 to 0.79).
  
  
  CONCLUSIONS
  These results provide support for the hypothesis that the insulin/IGF signalling pathways have a role in the development of BO.
authors.affiliation: Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, Ohio, USA. katkagreer@yahoo.com
authors.forename: Katarina B
authors.initials: KB
authors.lastname: Greer
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Thompson
authors.forename: Lacie
authors.initials: L
authors.lastname: Brenner
authors.forename: Beth
authors.initials: B
authors.lastname: Bednarchik
authors.forename: Dawn
authors.initials: D
authors.lastname: Dawson
authors.forename: Joseph
authors.initials: J
authors.lastname: Willis
authors.forename: William M
authors.initials: WM
authors.lastname: Grady
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000097:blood* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood*; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011446:Prospective Studies
chemical_list: D007328:Insulin; D018970:Insulin-Like Growth Factor Binding Protein 1; D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I