Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection: A Population-Based Cohort Study

Fumie Ikeda, Yasufumi Doi, Koji Yonemoto, Toshiharu Ninomiya, Michiaki Kubo, Kentaro Shikata, Jun Hata, Yumihiro Tanizaki, Takayuki Matsumoto, Mitsuo Iida, Yutaka Kiyohara

Research output: Contribution to journalArticle

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Abstract

Background & Aims: 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 ≥40 years were stratified into 4 groups according to baseline HbA1c levels (≤4.9%, 5.0%-5.9%, 6.0%-6.9%, and ≥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 ≥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 ≤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 ≥7.0% group). Among subjects who had both high HbA1c levels (≥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.

Original languageEnglish
Pages (from-to)1234-1241
Number of pages8
JournalGastroenterology
Volume136
Issue number4
DOIs
Publication statusPublished - 01-01-2009
Externally publishedYes

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Helicobacter Infections
Helicobacter pylori
Hyperglycemia
Stomach Neoplasms
Cohort Studies
Population
Hemoglobins
Confidence Intervals
Diabetes Mellitus
Incidence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Ikeda, Fumie ; Doi, Yasufumi ; Yonemoto, Koji ; Ninomiya, Toshiharu ; Kubo, Michiaki ; Shikata, Kentaro ; Hata, Jun ; Tanizaki, Yumihiro ; Matsumoto, Takayuki ; Iida, Mitsuo ; Kiyohara, Yutaka. / Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection : A Population-Based Cohort Study. In: Gastroenterology. 2009 ; Vol. 136, No. 4. pp. 1234-1241.
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title = "Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection: A Population-Based Cohort Study",
abstract = "Background & Aims: 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 ≥40 years were stratified into 4 groups according to baseline HbA1c levels (≤4.9{\%}, 5.0{\%}-5.9{\%}, 6.0{\%}-6.9{\%}, and ≥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 ≥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 ≤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 ≥7.0{\%} group). Among subjects who had both high HbA1c levels (≥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.",
author = "Fumie Ikeda and Yasufumi Doi and Koji Yonemoto and Toshiharu Ninomiya and Michiaki Kubo and Kentaro Shikata and Jun Hata and Yumihiro Tanizaki and Takayuki Matsumoto and Mitsuo Iida and Yutaka Kiyohara",
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Ikeda, F, Doi, Y, Yonemoto, K, Ninomiya, T, Kubo, M, Shikata, K, Hata, J, Tanizaki, Y, Matsumoto, T, Iida, M & Kiyohara, Y 2009, 'Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection: A Population-Based Cohort Study', Gastroenterology, vol. 136, no. 4, pp. 1234-1241. https://doi.org/10.1053/j.gastro.2008.12.045

Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection : A Population-Based Cohort Study. / Ikeda, Fumie; Doi, Yasufumi; Yonemoto, Koji; Ninomiya, Toshiharu; Kubo, Michiaki; Shikata, Kentaro; Hata, Jun; Tanizaki, Yumihiro; Matsumoto, Takayuki; Iida, Mitsuo; Kiyohara, Yutaka.

In: Gastroenterology, Vol. 136, No. 4, 01.01.2009, p. 1234-1241.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection

T2 - A Population-Based Cohort Study

AU - Ikeda, Fumie

AU - Doi, Yasufumi

AU - Yonemoto, Koji

AU - Ninomiya, Toshiharu

AU - Kubo, Michiaki

AU - Shikata, Kentaro

AU - Hata, Jun

AU - Tanizaki, Yumihiro

AU - Matsumoto, Takayuki

AU - Iida, Mitsuo

AU - Kiyohara, Yutaka

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background & Aims: 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 ≥40 years were stratified into 4 groups according to baseline HbA1c levels (≤4.9%, 5.0%-5.9%, 6.0%-6.9%, and ≥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 ≥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 ≤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 ≥7.0% group). Among subjects who had both high HbA1c levels (≥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.

AB - Background & Aims: 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 ≥40 years were stratified into 4 groups according to baseline HbA1c levels (≤4.9%, 5.0%-5.9%, 6.0%-6.9%, and ≥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 ≥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 ≤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 ≥7.0% group). Among subjects who had both high HbA1c levels (≥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.

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