Association between surrogate markers of insulin resistance and gastric cancer risk in South Korea: A nationwide population-based study

Abstract

Several studies have reported a significant association between insulin resistance (IR) and malignant tumors of the gastrointestinal tract. However, the association between gastric cancer and IR remains controversial. This study evaluated the association between IR and gastric cancer (GC) among South Korean individuals who participated in the National Health Screening Program using surrogate markers for IR. We utilized claims data from the National Health Insurance Service and analyzed a cohort of 316,129 individuals aged 40 years or older who participated in the National Health Screening Program between 2009 and 2010. The follow-up period for this dataset was extended to December 31, 2019. IR was assessed using the triglyceride-glucose index and the ratio of triglycerides to high-density lipoprotein cholesterol. Participants were classified into 4 groups based on the quartiles of these markers. None of the IR markers were significantly associated with GC. Crude data revealed a higher incidence of GC in patients with elevated levels of IR markers. However, no significant differences were observed after accounting for various confounders in the adjusted data. Although numerous positive findings regarding the association between IR markers and GC have been reported, they may have been influenced by various factors other than IR that contribute to GC. Establishing an association between IR markers and GC remains challenging. Therefore, the relationship between metabolic syndrome, including IR, and GC should be evaluated more cautiously.

Keywords: gastric cancer; insulin resistance; metabolic syndrome.

Graphical abstract

Figure 1.

The flow of the study population. HDL-C = high-density lipoprotein cholesterol, TG = triglyceride, TyG = triglyceride-glucose index.

Figure 2.

Restricted cubic spline of hazard ratio with 95% confidence intervals for gastric cancer according to metabolic markers. HDL-C = high-density lipoprotein cholesterol, TG = triglyceride, TyG = triglyceride-glucose index.