Diabetes and gastric cancer: The potential links
Journal
World Journal of Gastroenterology
Journal Volume
20
Journal Issue
7
Pages
1701-1711
Date Issued
2014
Author(s)
Tseng F.-H.
Abstract
This article reviews the epidemiological evidence linking diabetes and gastric cancer and discusses some of the potential mechanisms, confounders and biases in the evaluation of such an association. Findings from four meta-analyses published from 2011 to 2013 suggest a positive link, which may be more remarkable in females and in the Asian populations. Putative mechanisms may involve shared risk factors, hyperglycemia, Helicobacter pylori (H. pylori) infection, high salt intake, medications and comorbidities. Diabetes may increase the risk of gastric cancer through shared risk factors including obesity, insulin resistance, hyperinsulinemia and smoking. Hyperglycemia, even before the clinical diagnosis of diabetes, may predict gastric cancer in some epidemiological studies, which is supported by in vitro, and in vivo studies. Patients with diabetes may also have a higher risk of gastric cancer through the higher infection rate, lower eradication rate and higher reinfection rate of H. pylori. High salt intake can act synergistically with H. pylori infection in the induction of gastric cancer. Whether a higher risk of gastric cancer in patients with diabetes may be ascribed to a higher intake of salt due to the loss of taste sensation awaits further investigation. The use of medications such as insulin, metformin, sulfonylureas, aspirin, statins and antibiotics may also influence the risk of gastric cancer, but most of them have not been extensively studied. Comorbidities may affect the development of gastric cancer through the use of medications and changes in lifestyle, dietary intake, and the metabolism of drugs. Finally, a potential detection bias related to gastrointestinal symptoms more commonly seen in patients with diabetes and with multiple comorbidities should be pointed out. Taking into account the inconsistent findings and the potential confounders and detection bias in previous epidemiological studies, it is expected that there are still more to be explored for the clarification of the association between diabetes and gastric cancer. ? 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
SDGs
Other Subjects
acetylsalicylic acid; antibiotic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; metformin; somatomedin C receptor; sulfonylurea derivative; metformin; salt intake; article; clinical evaluation; comorbidity; diabetes mellitus; dietary intake; disease association; Helicobacter infection; human; hyperglycemia; hyperinsulinemia; insulin resistance; lifestyle; mortality; obesity; overall survival; risk factor; salt intake; smoking; stomach cancer; Asian continental ancestry group; complication; Diabetes Complications; diabetes mellitus; feeding behavior; female; Helicobacter pylori; male; meta analysis (topic); metabolism; Stomach Neoplasms; Asian Continental Ancestry Group; Comorbidity; Diabetes Complications; Diabetes Mellitus; Female; Food Habits; Helicobacter Infections; Helicobacter pylori; Humans; Hyperglycemia; Insulin; Male; Meta-Analysis as Topic; Metformin; Risk Factors; Sodium Chloride, Dietary; Stomach Neoplasms
Type
journal article