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      Prediabetes and diabetes in relation to risk of gastric adenocarcinoma

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          Abstract

          Background

          Whether prediabetes or diabetes increases the risk of gastric adenocarcinoma is not clear.

          Methods

          This cohort study included 111,198 participants in the Northern Swedish Health and Disease Study. The participants were followed up from November 1985 to April 2017. The exposure to prediabetes or diabetes was assessed by oral glucose tolerance tests and self-reports. The incidence of the outcome gastric adenocarcinoma was identified from the Swedish Cancer Registry. Multivariable Cox regressions were used to analyse the associations between prediabetes or diabetes and the risk of gastric adenocarcinoma, providing hazard ratios (HR) with 95% confidence intervals (CI), with adjustment for sex, age, calendar year, body mass index, tobacco smoking and education level.

          Results

          Compared with normoglycaemic participants, the risk of gastric adenocarcinoma was not increased among participants with prediabetes (HR 1.07, 95% CI 0.79–1.44), diabetes (HR 0.77, 95% CI 0.46–1.29) or any of these exposures (HR 0.96, 95% CI 0.73–1.27). No associations were identified between prediabetes or diabetes and the risk of gastric adenocarcinoma in stratified analyses or in analyses separating cardia and non-cardia gastric adenocarcinoma.

          Conclusions

          This study does not support the hypothesis that prediabetes or diabetes increases the risk of gastric adenocarcinoma.

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          Most cited references28

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          Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

          To assess the validity and repeatability of a simple index designed to rank participants according to their energy expenditure estimated by self-report, by comparison with objectively measured energy expenditure assessed by heart-rate monitoring with individual calibration. Energy expenditure was assessed over one year by four separate episodes of 4-day heart-rate monitoring, a method previously validated against whole-body calorimetry and doubly labelled water. Cardio-respiratory fitness was assessed by four repeated measures of sub-maximum oxygen uptake. At the end of the 12-month period, participants completed a physical activity questionnaire that assessed past-year activity. A simple four-level physical activity index was derived by combining occupational physical activity together with time participating in cycling and other physical exercise (such as keep fit, aerobics, swimming and jogging). One hundred and seventy-three randomly selected men and women aged 40 to 65 years. The repeatability of the physical activity index was high (weighted kappa=0.6, ). There were positive associations between the physical activity index from the questionnaire and the objective measures of the ratio of daytime energy expenditure to resting metabolic rate and cardio-respiratory fitness As an indirect test of validity, there was a positive association between the physical activity index and the ratio of energy intake, assessed by 7-day food diaries, to predicted basal metabolic rate. The summary index of physical activity derived from the questions used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study suggest it is useful for ranking participants in terms of their physical activity in large epidemiological studies. The index is simple and easy to comprehend, which may make it suitable for situations that require a concise, global index of activity.
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            Changing Trends in Stomach Cancer Throughout the World.

            The paper aims to discuss the global trends in gastric cancer incidence in relation to important factors involved in the pathogenesis of gastric cancer.
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              The Västerbotten Intervention Programme: background, design and implications

              Background and objective In Sweden, mortality from cardiovascular diseases (CVD) increased steadily during the 20th century and in the mid-1980s it was highest in the county of Västerbotten. Therefore, a community intervention programme was launched – the Västerbotten Intervention Programme (VIP) – with the aim of reducing morbidity and mortality from CVD and diabetes. Design The VIP was first developed in the small municipality of Norsjö in 1985. Subsequently, it was successively implemented across the county and is now integrated into ordinary primary care routines. A population-based strategy directed towards the public is combined with a strategy to reach all middle-aged persons individually at ages 40, 50 and 60 years, by inviting them to participate in systematic risk factor screening and individual counselling about healthy lifestyle habits. Blood samples for research purposes are stored at the Umeå University Medical Biobank. Results Overall, 113,203 health examinations have been conducted in the VIP and 6,500–7,000 examinations take place each year. Almost 27,000 subjects have participated twice. Participation rates have ranged between 48 and 67%. A dropout rate analysis in 1998 indicated only a small social selection bias. Cross-sectional, nested case-control studies and prospective studies have been based on the VIP data. Linkages between the VIP and local, regional and national databases provide opportunities for interdisciplinary research, as well as national and international collaborations on a wide range of disease outcomes. A large number of publications are based on data that are collected in the VIP, many of which also use results from analysed stored blood samples. More than 20 PhD theses have been based primarily on the VIP data. Conclusions The concept of the VIP, established as a collaboration between politicians and health care providers on the one hand and primary care, functioning as the operating machinery, and the public on the other, forms the basis for effective implementation and endurance over time. After more than 20 years of the VIP, there is a large comprehensive population-based database, a stable organisation to conduct health surveys and collect data, and a solid structure to enable widespread multidisciplinary and scientific collaborations.
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                Author and article information

                Contributors
                +46 8 517 70917 , shaohua.xie@ki.se
                Journal
                Br J Cancer
                Br. J. Cancer
                British Journal of Cancer
                Nature Publishing Group UK (London )
                0007-0920
                1532-1827
                7 May 2019
                11 June 2019
                : 120
                : 12
                : 1147-1152
                Affiliations
                [1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, , Karolinska University Hospital, ; Stockholm, Sweden
                [2 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Faculty of Medicine, Surgery, Department of Surgical and Perioperative Sciences, , Umeå University, ; Umeå, Sweden
                [3 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Wallenberg Centre for Molecular Medicine, , Umeå University, ; Umeå, Sweden
                [4 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Faculty of Medicine, Department of Dentistry, School of Dentistry, Cariology, , Umeå University, ; Umeå, Sweden
                [5 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, School of Cancer and Pharmaceutical Sciences, , King’s College London, ; London, United Kingdom
                Article
                470
                10.1038/s41416-019-0470-1
                6738058
                31061455
                35e8749f-a8db-4356-92df-f0b804771880
                © Cancer Research UK 2019

                This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

                History
                : 6 March 2019
                : 12 April 2019
                : 18 April 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100002794, Cancerfonden (Swedish Cancer Society);
                Award ID: CAN 2015/460
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/501100004359, Vetenskapsrådet (Swedish Research Council);
                Award ID: SIMSAM D0547801
                Award Recipient :
                Categories
                Article
                Custom metadata
                © Cancer Research UK 2019

                Oncology & Radiotherapy
                risk factors,epidemiology,gastric cancer,diabetes
                Oncology & Radiotherapy
                risk factors, epidemiology, gastric cancer, diabetes

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