title: Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults.
abstract: BACKGROUND
  Chronic inflammation is known to be one of the main steps in carcinogenesis. Identification of those with chronic inflammation may help identify subjects at risk of cancer. Previous studies have reported low albumin-to-globulin ratio (AGR) to be associated with increased cancer mortality in cancer patients, but there has been no study based on healthy populations.
  
  
  METHODS
  Our retrospective cohort study involved 26 974 generally healthy adults aged 30 or older who visited Seoul National University Hospital Health Promotion Center for self-referred health checkup. National medical service claims data were used to determine cancer incidence, and Korean death registry data was used to determine mortality. Median follow-up time for survival was 5.9 years (interquartile range 4.1 years).
  
  
  RESULTS
  Compared with subjects with AGR ≥ 1.5, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR showed adjusted hazard ratio (aHR) 2.69 (95% confidence interval, CI, 1.54-4.72) and aHR 6.71 (95% CI 3.56-12.66) for all-cause mortality, aHR 2.95 (95% CI 1.42-6.11) and aHR 4.38 (95% CI 1.57-12.25) for cancer mortality, and aHR 2.07 (95% CI 1.28-3.36) and aHR 3.99 (95% CI 2.10-7.58) for cancer incidence, respectively. When cancer incidence events after 2 years from baseline were separately analyzed, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR were associated with aHR 1.88 (95% CI 1.01-3.48) and aHR 2.55 (95% CI 1.03-7.11) for cancer incidence, respectively. Cancer events were increased in all types of cancer, but especially in liver and hematologic malignancies.
  
  
  CONCLUSIONS
  Low AGR is a risk factor for cancer incidence and mortality, both short- and long terms, in a generally healthy screened population. The results of this study need to be replicated in larger studies, along with the determination of the sensitivity and other diagnostic values of low AGR.
authors: 3rd Air Defense Missile Brigade, Republic of Korea Air Force, Seoul; Departments of Family Medicine and Health Promotion Center.
authors: B
authors: B
authors: Suh
authors: Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Hospital, Seoul.
authors: S
authors: S
authors: Park
authors: Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul. Electronic address: dwshin.snuh@gmail.com.
authors: D W
authors: DW
authors: Shin
authors: Departments of Family Medicine and Health Promotion Center.
authors: J M
authors: JM
authors: Yun
authors: Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Hospital, Seoul.
authors: B
authors: B
authors: Keam
authors: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
authors: H-K
authors: HK
authors: Yang
authors: Departments of Family Medicine and Health Promotion Center.
authors: E
authors: E
authors: Ahn
authors: Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul.
authors: H
authors: H
authors: Lee
authors: Departments of Family Medicine and Health Promotion Center.
authors: J H
authors: JH
authors: Park
authors: Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul.
authors: B
authors: B
authors: Cho
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D012709:Serum Albumin; D012712:Serum Globulins; D016019:Survival Analysis
chemical_list: D012709:Serum Albumin; D012712:Serum Globulins
keywords: albumin; albumin-to-globulin ratio; cancer; chronic inflammation; total protein