Longitudinal associations of blood markers of insulin and glucose metabolism and cancer mortality in the third National Health and Nutrition Examination Survey

Cancer Causes Control. 2010 Apr;21(4):631-42. doi: 10.1007/s10552-009-9492-y. Epub 2010 Jan 23.


Insulin and glucose may influence cancer mortality via their proliferative and anti-apoptotic properties. Using longitudinal data from the nationally representative Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994), with an average follow-up of 8.5 years to death, we evaluated markers of glucose and insulin metabolism, with cancer mortality, ascertained using death certificates or the National Death Index. Plasma glucose, insulin, C-peptide, and lipid concentrations were measured. Anthropometrics, lifestyle, medical, and demographic information was obtained during in-person interviews. After adjusting for age, race, sex, smoking status, physical activity, and body mass index, for every 50 mg/dl increase in plasma glucose, there was a 22% increased risk of overall cancer mortality. Insulin resistance was associated with a 41% (95% confidence interval (CI) (1.07-1.87; p = 0.01) increased risk of overall cancer mortality. These associations were stronger after excluding lung cancer deaths for insulin-resistant individuals (HR: 1.67; 95% CI: 1.15-2.42; p = 0.01), specifically among those with lower levels of physical activity (HR: 2.06; 95% CI: 1.4-3.0; p = 0.0001). Similar associations were observed for other blood markers of glucose and insulin, albeit not statistically significant. In conclusion, hyperglycemia and insulin resistance may be 'high-risk' conditions for cancer mortality. Managing these conditions may be effective cancer control tools.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood*
  • Blood Glucose / metabolism
  • Body Mass Index
  • C-Peptide / blood
  • Female
  • Glucose / metabolism*
  • Health Surveys
  • Humans
  • Insulin / blood
  • Insulin / metabolism*
  • Insulin Resistance
  • Life Style
  • Lipids / blood
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / blood
  • Neoplasms / metabolism*
  • Neoplasms / mortality
  • Nutrition Surveys
  • Survival Rate
  • Time Factors
  • United States
  • Young Adult


  • Biomarkers
  • Blood Glucose
  • C-Peptide
  • Insulin
  • Lipids
  • Glucose