Fasting serum insulin levels and insulin resistance are associated with colorectal adenoma in Koreans.
OBJECTIVE
Insulin has been associated with the risk of colorectal cancer (CRC). However, few studies have evaluated the association between insulin and colorectal adenoma. We investigated the relationship between fasting serum insulin levels or homeostasis model assessment of insulin resistance (HOMA-IR) and colorectal adenoma.


METHODS
We retrospectively enrolled 15,427 participants who underwent both fasting serum insulin measurement and colonoscopy for a routine health examination at Asan Medical Center from January 2007 to December 2008. Participants with a history of any cancer, previous colectomy or polypectomy, those taking antidiabetic medications, and inflammatory bowel disease, non-specific colitis, non-adenomatous polyps only or CRC on colonoscopic findings were excluded. Finally, 3,606 participants with histologically confirmed colorectal adenoma and 6,019 controls with no abnormal findings on colonoscopy were included. Participants were categorized into quartiles (Q) based on fasting serum insulin levels and HOMA-IR.


RESULTS
Fasting serum insulin and HOMA-IR were significantly higher in participants with colorectal adenomas compared with controls. Multivariate regression analysis adjusting for age, sex, smoking habits, drinking habits and family history of CRC showed that participants with higher quartiles of fasting serum insulin levels (odd ratio [OR] 1.17 for 2nd Q, 1.19 for 3rd Q, and 1.42 for 4th Q, P < 0.05) or HOMA-IR (OR 1.18 for 2nd Q and 1.45 for 4th Q, P < 0.05) showed significantly increased ORs of colorectal adenoma compared with the lowest quartiles.


CONCLUSIONS
These findings showed that increased serum insulin levels and insulin resistance were significantly associated with the presence of colorectal adenoma.
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Eun Hee
EH
Kim
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Hong-Kyu
HK
Kim
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Sung Jin
SJ
Bae
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Hye-Sook
HS
Chang
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Hye Won
HW
Park
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Mi Young
MY
Do
Division of Gastroenterology Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea.
Kyung-Jo
KJ
Kim
Division of Endocrinology & Metabolism Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea.
Chang Hee
CH
Jung
Division of Endocrinology & Metabolism Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea.
Woo Je
WJ
Lee
Division of Endocrinology & Metabolism Department of Internal Medicine University of Ulsan College of Medicine Seoul Korea.
Joong-Yeol
JY
Park
Health Screening and Promotion Center Asan Medical Center Seoul Korea.
Jaewon
J
Choe
Colorectal adenoma; Insulin; Insulin resistance