Role of obesity in colorectal carcinogenesis

The obesity is the second most frequent cause of death which can be prevented. It elevates the risk of cardiovascular diseases, diabetes mellitus type 2, cancers and premature mortality. Overweight and obesity responsible for 14% of cancer caused death in males, and 20% in females, respectively. Authors review the connection between obesity, metabolic syndrome and related metabolic alterations with colorectal cancers. They summarize the role of inflammation, hyperinsulinemia, insulin-like growth factor-I and adipokines in the colorectal carcinogenesis.     

Diet, Lifestyle, and Colorectal Cancer: Is Hyperinsulinemia the Missing Link?

Several dietary and other lifestyle factors have been implicated in the development of colorectal cancer. However, the precise nature and actual magnitude of the relationship between individual nutrient intakes and other lifestyle factors and colorectal cancer risk are not clear. A unifying hypothesis has recently been proposed that explains why obesity, physical inactivity, alcohol, and consumption of a typical Western diet increase colorectal cancer risk. This hypothesis suggests that these dietary and other lifestyle factors are associated with insulin resistance and hyperinsulinemia and that hyperinsulinemia, in turn, may stimulate growth of colorectal tumors. Two recently published large prospective epidemiologic studies indicate a significant increase in colorectal cancer risk in subjects with diabetes mellitus, thereby supporting this hypothesis.     

Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence

Incidences of breast cancer, type 2 diabetes, and metabolic syndrome have increased over the past decades with the obesity epidemic, especially in industrialized countries. Insulin resistance, hyperinsulinemia, and changes in the signaling of growth hormones and steroid hormones associated with diabetes may affect the risk of breast cancer. We reviewed epidemiologic studies of the association between type 2 diabetes and risk of breast cancer and the available evidence on the role of hormonal mediators of an association between diabetes and breast cancer. The combined evidence supports a modest association between type 2 diabetes and the risk of breast cancer, which appears to be more consistent among postmenopausal than among premenopausal women. Despite many proposed potential pathways, the mechanisms underlying an association between diabetes and breast cancer risk remain unclear, particularly because the 2 diseases share several risk factors, including obesity, a sedentary lifestyle, and possibly intake of saturated fat and refined carbohydrates, that may confound this association. Although the metabolic syndrome is closely related to diabetes and embraces additional components that might influence breast cancer risk, the role of the metabolic syndrome in breast carcinogenesis has not been studied and thus remains unknown.     

Dyslipidemia in diabetes mellitus

Patients with diabetes mellitus are at high risk of cardiovascular diseases. Dyslipidemia is an important risk factor for cardiovascular complications in diabetes. Increased triglyceride and reduced HDL-cholesterol plasma concentrations are common features of dyslipidemia in type 2 diabetes. The LDL particles are small and dense and have an increased atherogenity. Abnormalities in lipoprotein composition are observed in diabetes mellitus, especially in type 2. Post-hoc subgroup analyses of studies on the effect of lipid-lowering therapy on cardiovascular events suggest that treatment of dyslipidemia in diabetes may prevent cardiovascular complications. There are increasing indications that dyslipidemia in diabetes mellitus deserves aggressive treatment and that lipid target levels should be very low.     

复旦大学教职工145例恶性肿瘤死因分析

目的了解高校教职工恶性肿瘤死亡情况,为该病的防治提供科学依据。方法回顾调查复旦大学近17年来教职工恶性肿瘤145例死亡资料,统计分析各种恶性肿瘤死因构成及时间趋势。结果恶性肿瘤死亡位于全死因之首,年平均死亡率有随时段呈上升趋势(χ2=5·65,P<0·05),恶性肿瘤死因前四位依次为:①肝癌,占22·07%;②肺癌,占20·69%;③胃癌,占12·41%;④肠癌,占11·72%。结论恶性肿瘤是高校教职工死亡的主要原因,其中肝癌位于之首,加强肝癌危险因素的干预仍是目前高校防治工作的重点之一。     

老年恶性肿瘤住院患者常见慢性疾病共病特点分析

目的 分析解放军总医院老年恶性肿瘤住院患者共病特点,为老年恶性肿瘤的防治提供依据.方法 利用解放军总医院2009～2017年住院病历数据库,对符合条件的36 015名65岁及以上老年肿瘤住院患者的共病种类及分布进行分析.结果 恶性肿瘤患者平均共病数量为1.73种,前5位共病分别为高血压(26.6％)、2型糖尿病(13....     

Critical review: vegetables and fruit in the prevention of chronic diseases

Background

Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association.

Methods

Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size.

Results

For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

Conclusions

This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.     

Metformin: its emerging role in oncology

Metformin is considered, in conjunction with lifestyle modification, as a first-line treatment modality for type 2 diabetes mellitus (DM). Recently, several clinical studies have reported reduced incidence of neoplastic diseases in DM type 2 patients treated with metformin, as compared to diet or other antidiabetic agents. Moreover, in vitro studies have disclosed significant antiproliferative and proapoptotic effects of metformin on different types of cancer. Metformin acts by activating AMP-activated protein kinase (AMPK), a key player in the regulation of energy homeostasis. Moreover, by activating AMPK, metformin inhibits the mammalian target of rapamycin complex 1 (mTORC1) resulting in decreased cancer cell proliferation. Concomitantly, metformin induces activation of LKB1 (serine/threonine kinase 11), a tumor suppressor gene, which is required for the phosphorylation and activation of AMPK. These new encouraging experimental data supporting the anti-cancer effects of metformin urgently require further clinical studies in order to establish its use as a synergistic therapy targeting the AMPK/mTOR signaling pathway.     

Is Time-Restricted Eating Safe in the Treatment of Type 2 Diabetes?—A Review of Intervention Studies

Time-restricted eating (TRE) has been shown to improve body weight and glucose metabolism in people at high risk of type 2 diabetes. However, the safety of TRE in the treatment of type 2 diabetes is unclear. We investigated the safety of TRE interventions in people with type 2 diabetes by identifying published and ongoing studies. Moreover, we identified the commonly used antidiabetic drugs and discussed the safety of TRE in people with type 2 diabetes considering the use of these drugs. In addition, we addressed the research needed before TRE can be recommended in the treatment of type 2 diabetes. A literature search was conducted to identify published (MEDLINE PubMed) and ongoing studies (ClinicalTrials.gov) on TRE in people with type 2 diabetes. To assess the usage of antidiabetic drugs and to discuss pharmacodynamics and pharmacokinetics in a TRE context, the most used antidiabetic drugs were identified and analysed. Statistics regarding sale of pharmaceuticals were obtained from MEDSTAT.DK which are based on data from the national Register of Medicinal Product Statistics, and from published studies on medication use in different countries. Four published studies investigating TRE in people with type 2 diabetes were identified as well as 14 ongoing studies. The completed studies suggested that TRE is safe among people with type 2 diabetes. Common antidiabetic drugs between 2010 and 2019 were metformin, insulin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sulfonylureas, and sodium-glucose cotransporter-2 inhibitors. Existing studies suggest that TRE is not associated with major safety issues in people with type 2 diabetes as long as medication is monitored and adjusted. However, because of low generalisability of the few studies available, more studies are needed to make concrete recommendations regarding efficacy and safety of TRE in people with type 2 diabetes.     

福州地区2004~2014年军队离退休老干部死亡原因分析

目的 分析福州地区近10年军队离退休老干部死亡原因,为老干部的预防保健工作提供参考资料.方法 回顾性分析2004年1月~2014年9月福州地区253例死亡离退休老干部的临床资料,分析其主要的死亡原因.结果 离退休老干部死因前4位依次为恶性肿瘤(54.6%)、心血管病(18.2%)、呼吸系统疾病(13.1%)和脑血管疾病(6.3%).在首要死因恶性肿瘤中,居前3位者依次为肺癌、胃癌和肝癌.最常见的基础疾病为冠心病、高血压病、脑梗死后遗症、糖尿病和慢性支气管炎.96.8%的老干部同时患有3种或3种以上慢性疾病.合并肺部感染是老干部死亡的另一重要因素.80岁以上患者因恶性肿瘤死亡的比例显著增加.结论 恶性肿瘤、心脑血管疾病和肺部感染是福州地区军队离退休老干部的主要死因.离退休老干部预防保健应重点加强恶性肿瘤筛查,加强心脑血管疾病的综合防治.     

Thiazolidinediones--a new class of oral antidiabetic drugs

The discovery of a new class of oral antidiabetic drugs was stimulated by difficulties with the treatment currently available for patients with type 2 diabetes mellitus. Thiazolidinediones can lower blood glucose values due to their special insulin-sensitiser effect. In this way, these drugs seem to be very effective in the treatment of type 2 diabetic patients with characteristics of metabolic syndrome. The intracellular action caused by thiazolidinediones differs markedly from that of other oral antidiabetic drugs available. Apart from antihyperglycaemic effect, thiazolidinediones have further beneficial effects in experimental diabetes which require corroboration by clinical studies. Troglitazone was the first drug which reached the market. Unfortunately, this drug was withdrawn soon due to its hepatotoxicity. Rosiglitazone proved to be much safer in clinical studies. Pioglitazone is being tested nowadays in clinical studies. Thiazolidinediones have been already listed among oral antidiabetic drugs in international therapeutical guidelines. Nevertheless, further clinical studies and experiences are needed to determine the final exact indication of thiazolidinediones for the treatment of type 2 diabetic patients.     

Diabetes and thyroid disorders

Both diabetes mellitus and thyroid disorders are common diseases. According to epidemiologic studies the prevalence of specific thyroid disorders in diabetic subjects is two times higher. Risk factors are age, female gender and autoimmune diabetes mellitus. However, thyroid disorders are diagnosed only half of the cases in diabetic population. The review briefly summarizes the association of autoimmune diabetes mellitus and thyreoiditis, the risk of thyroid disorders in type 1 diabetic pregnant women. Furthermore, the influence of obesity in the risk on thyroid cancer and the effect of glucagon-like peptide 1 analogue on thyroid medullary C-cells are discussed.     

Type 2 diabetes mellitus in Augsburg--an epidemiological overview

This article provides an overview of the prevalence of type 2 diabetes and the antidiabetic treatment over a 17 year study period. The causes of the disease and the impact of diabetes on cardiovascular disease (CVD) morbidity are discussed. Furthermore, changes in lifestyle and risk factor profile in persons with diabetes are reported. We present data from the MONICA/KORA surveys S1-S4 conducted between 1984/85 and 1999/2001 in the region of Augsburg, Southern Germany and the Augsburg Myocardial Infarction Registry. Contrary to most studies from other countries, in the 25 to 74 year old Augsburg population the prevalence of known diabetes did not increase over the last years. Obesity and decreased physical activity are the two main lifestyle related risk factors for type 2 diabetes. Recently, further modifiable risk factors such as smoking and hypertension have been associated with the development of type 2 diabetes in the Augsburg population. Consistent with recommendations to intensify glucose control in diabetic persons the diabetes treatment continuously improved during the study period. However, health status of persons with diabetes is far from optimal in the Augsburg population suggesting that recommendations for primary prevention of CVD in diabetic persons were not sufficiently put into practice until 1999/2001. Furthermore, data from the MONICA/KORA Augsburg Myocardial infarction registry underline the challenge that in particular men and women with diabetes should receive intensive preventive interventions proven to reduce CVD risk. In conclusion, data from the MONICA/KORA Augsburg studies suggest that it should become an important public health priority to prevent diabetes mellitus.     

Diabetes mellitus and Alzheimer's disease

The incidence of Alzheimer's disease and diabetes is increasing with age. Thus, in light of demographic change and aging societies, they are becoming a growing issue for public health. Further, there are linkages between the two diseases. In particular, risk assessment studies suggest that type 2 diabetes mellitus is a risk factor of Alzheimer's disease. Hence, even though Alzheimer's disease can only be influenced to a limited extent, optimal treatment of diabetes mellitus may have also a positive effect on Alzheimer's disease. While the relationship between the two diseases is not yet completely clear, in addition to the known vascular effects of diabetes mellitus recent results shed light on central nervous system effects directly influencing the neurodegenerative process. Treatment of central insulin resistance, a phenomenon explored in recent years, may be a promising avenue, not only in addressing metabolic disorder, but also Alzheimer's disease.     

Mortality for Certain Diseases in Areas with High Levels of Arsenic in Drinking Water

Blackfoot disease was prevalent in a limited area on the southwest coast of Taiwan, where artesian well water containing arsenic (median = 0.78 ppm arsenic) had been used for many years. Previous studies of arsenic exposure in the blackfoot disease endemic area have been focused on malignant tumors. We, therefore, conducted this study to analyze mortality of all death causes in blackfoot disease endemic areas and to determine other neglected cancers or noncancer diseases related to artesian well water containing high levels of arsenic. We calculated standardized mortality ratios for cancer and noncancer diseases, by sex, during the period from 1971 to 1994 and compared them to the local reference group (i.e, Chiayi-Tainan County) and the national reference group (i.e., Taiwan population). The results revealed marked standardized mortality ratio differences for the 2 reference groups. Greater mortality was found for males and females with bladder, kidney, skin, lung, nasal-cavity, bone, liver, larynx, colon, and stomach cancers, as well as lymphoma than in the local reference population. With respect to noncancer diseases, we found greater mortality for males and females who had vascular disease, ischemic heart disease, diabetes mellitus, and bronchitis than in the local reference group. Mortalities for other diseases–including rectal cancer, cerebrovascular disease, and other diseases–were higher among cases than the local reference group. Our results indicated that the hazardous effect of arsenic is systemic. Diseases related to arsenic exposure included those reported previously by other investigators, as well as diseases reported in the present study.     

Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease (CVD). Unfortunately, several potential barriers exist for CVD risk management in diabetes, including the need for significant lifestyle changes, potential problems with hypoglycemia, weight gain, injection tolerability, treatment complexity with current diabetes therapies and other, unmodifiable factors. Improving glycemic control may impact CVD risk. Treatment of T2DM usually starts with lifestyle changes such as diet and exercise. When these become insufficient, pharmacotherapy is required. Various oral antidiabetic drugs (OADs) are available that reduce hyperglycemia. The first line of therapy is usually metformin, since it does not increase weight and seems to have a beneficial effect on CVD mortality and risk factors. As T2DM progresses, insulin treatment becomes necessary for the majority of patients. The last few years have seen the development of long-acting, rapid-acting, and premixed insulin analog formulations. The treat-to-target algorithms of recent studies combining OADs plus insulin analogs have demonstrated that patients can reach glycemic treatment targets with low risk of hypoglycemia, greater convenience, and--with some analogs--limited weight gain vs conventional insulins. These factors may possibly have a positive influence on CVD risk. Future studies will hopefully elucidate the benefits of this approach.     

2014-2018年无锡市锡山区30-69岁户籍居民重大慢性病死亡变化趋势分析

目的 分析2014-2018年无锡市锡山区30-69岁户籍居民重大慢性病死亡情况及变化趋势，为政府制定慢性病防治策略提供科学依据。方法 采用年估计变化百分比（EAPC）描述2014-2018年无锡市锡山区30-69岁户籍居民恶性肿瘤、心脑血管疾病、糖尿病以及慢性呼吸系统疾病的死亡率变化趋势，采用寿命表法计算四类重大慢性病的过早死亡率。结果 2014-2018年无锡市锡山区30-69岁户籍居民重大慢性病年均粗死亡率为250.85/10万，男性粗死亡率为344.22/10万，高于女性的粗死亡率161.36/10万（x2=454.738,P<0.001）。2014-2018年间，30-69岁全人群恶性肿瘤的粗死亡率（EAPC=-1.93%，P=0.017）及标化死亡率（EAPC=-2.31，P=0.039）均呈下降趋势；心脑血管疾病、糖尿病、慢性呼吸系统疾病的变化趋势无统计学意义（P>0.05）。2014-2018年间，重大慢性病过早死亡率以平均每年1.89%的速度下降（P=0.029）；恶性肿瘤的过早死亡率以平均每年2.19%的速度下降（P=0.022）。结论 无锡市锡山区30-69岁户籍居民恶性肿瘤的死亡率及过早死亡率呈下降趋势，四类重大慢性病合计的过早死亡率也呈下降趋势，但与实现“健康中国2030”的目标还有一定差距，政府部门需进一步加强慢性病的防治。     

Glycaemic control and macrovascular complications in patients with diabetes mellitus

According to a recent meta-analysis, proper glycaemic control due to intensive antidiabetic treatment could result in a decrease of cardiovascular complications in patients with diabetes mellitus. In comparison to conventional treatment, the relative risk reduction proved to be higher in type 2 than in type 1 diabetic patients. Although a decrease in incidence rate of cardiovascular complications could be documented in different areas (coronary, carotid and peripheral arteries), the decrease was different in terms of numerical changes. Comparing intensive and conventional treatment, no difference in mortality rate could be observed.     

Oral antidiabetic therapy and cardiovascular complications: theoretical problem or clinical evidence?

Theoretical and experimental research data as well as human epidemiological studies on large populations suggest a great difference in influencing cardiovascular processes and alterations among the oral antidiabetic drugs used in the treatment of type II diabetes mellitus. Drugs delaying or inhibiting carbohydrate absorption as well as insulin sensitizers have an unambiguous reducing effect on diabetic cardiovascular complications. Only fluid retention needs precaution during the treatment with thiazolidinedions in patients suffering from heart disease. Among insulin secretizers repaglinid, glibenclamid and glipizide have an ATP-sensitive potassium channel inhibiting effect in the vascular smooth muscle cells, too, reducing hereby vasodilation. Glibenclamide also inhibits ischaemic preconditioning. Therefore, the antidiabetic drug of choice can be decisive in diabetic patients suffering from ischaemic heart diseases or peripheral obliterative disorders. In the case of secondary sulphonylurea resistance and/or severe ischaemic alterations insulin treatment becomes necessary to avoid further cardiovascular complications.     

Mortality for certain diseases in areas with high levels of arsenic in drinking water.

Blackfoot disease was prevalent in a limited area on the southwest coast of Taiwan, where artesian well water containing arsenic (median = 0.78 ppm arsenic) had been used for many years. Previous studies of arsenic exposure in the blackfoot disease endemic area have been focused on malignant tumors. We, therefore, conducted this study to analyze mortality of all death causes in blackfoot disease endemic areas and to determine other neglected cancers or noncancer diseases related to artesian well water containing high levels of arsenic. We calculated standardized mortality ratios for cancer and noncancer diseases, by sex, during the period from 1971 to 1994 and compared them to the local reference group (i.e, Chiayi-Tainan County) and the national reference group (i.e., Taiwan population). The results revealed marked standardized mortality ratio differences for the 2 reference groups. Greater mortality was found for males and females with bladder, kidney, skin, lung, nasal-cavity, bone, liver, larynx, colon, and stomach cancers, as well as lymphoma than in the local reference population. With respect to noncancer diseases, we found greater mortality for males and females who had vascular disease, ischemic heart disease, diabetes mellitus, and bronchitis than in the local reference group. Mortalities for other diseases--including rectal cancer, cerebrovascular disease, and other diseases--were higher among cases than the local reference group. Our results indicated that the hazardous effect of arsenic is systemic. Diseases related to arsenic exposure included those reported previously by other investigators, as well as diseases reported in the present study.