The relationship between drinking alcohol and esophageal, gastric or colorectal cancer: A nationwide population-based cohort study of South Korea

<div><p>Background</p><p>Epidemiologic findings of low-volume alcohol consumption in relation to gastrointestinal cancers including gastric cancer are inconsistent.</p><p>Methods</p><p>The association between alcohol intake and esophageal, gastric and colorectal cancer risk was examined in a population-based prospective cohort of 23,323,730 adults in Korea who had undergone a biennial evaluation provided by the National Health Insurance Corporation between the years 2009 and 2012. After median 5.4 years of follow-up, 9,171 esophageal, 135,382 gastric and 154,970 colorectal cancer cases were identified. Cox regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI).</p><p>Results</p><p>Light drinking as well as moderate to heavy alcohol consumption significantly increased the risks of the three gastrointestinal cancers (HR 1.51; 95% CI, 1.43–1.60; HR 1.08; 95% CI, 1.06–1.09; HR 1.12; 95% CI, 1.11–1.14) compared with non-drinkers after adjusting for age, sex, smoking, exercise, income, body mass index, and diabetes. The synergistically increased cancer risk between excessive amount of alcohol consumption and currently smoking or underweight individuals was observed only in the esophageal cancers.</p><p>Conclusions</p><p>Light drinking including even one alcoholic drink a day is associated with increased risks of esophageal, gastric and colorectal cancer.</p></div

Risk factors and adjusted hazard ratios of esophageal, stomach and colorectal cancers.

<p>Risk factors and adjusted hazard ratios of esophageal, stomach and colorectal cancers.</p

Elevated serum gamma-glutamyltransferase is associated with an increased risk of oesophageal carcinoma in a cohort of 8,388,256 Korean subjects

<div><p>Gamma-glutamyltransferase (GGT) is a marker for hepatic injury and alcohol consumption. However, the association of GGT with the risk of oesophageal carcinoma (OC) has not been fully recognized to date. Therefore, this study aimed to determine the association between elevated GGT and OC, by also considering the body mass index (BMI) of the subjects. Clinical data from 8,388,256 Korean individuals, who were aged 40 years and over and who received healthcare check-ups arranged by the national insurance program in 2007 and 2008, were analysed. Newly diagnosed OC was identified using claims data during a median follow-up duration of 8.72 years. During the study period, 6,863 individuals (0.08%) developed OC. We found that there was an increased risk of OC in subjects with serum GGT values >18 IU/L. Furthermore, a BMI <18.5 kg/m² (underweight) was associated with increased OC risk, while a BMI ≥23.0 kg/m² was associated with a reduced OC risk. Individuals who were both underweight and in the highest GGT quartile (≥40 IU/L) had a far greater risk of OC compared to other individuals (hazard ratio: 3.65, 95% confidence interval: 3.10–4.30). In conclusion, increased serum GGT was associated with an increased risk of developing OC in the general Korean population, regardless of age, sex, smoker status, or alcohol consumption.</p></div

Flowchart showing the enrolment process for the study cohort.

<p>NHIC, National Health Insurance Corporation.</p

Demographics of the alcohol drinkers and nondrinkers in the NHIC cohort (2009–2012).

<p>Demographics of the alcohol drinkers and nondrinkers in the NHIC cohort (2009–2012).</p

The relationship between drinking alcohol and esophageal, gastric or colorectal cancer: A nationwide population-based cohort study of South Korea - Fig 2

<p>Esophagus, stomach and colorectal cancer risks based on the combined effect of the amount of alcohol consumption and smoking status (A) Esophageal cancer, (B) Gastric cancer, (C) colorectal cancer.</p

Subgroup analysis of the risk of esophageal, stomach and colorectal cancers according to alcohol consumption.

<p>Subgroup analysis of the risk of esophageal, stomach and colorectal cancers according to alcohol consumption.</p

The effect of change in the amount of alcohol consumption and the risk of developing esophageal, stomach and colorectal cancer.

<p>The effect of change in the amount of alcohol consumption and the risk of developing esophageal, stomach and colorectal cancer.</p

Kaplan-Meier survival curves showing freedom from oesophageal cancer in Korea.

<p>Q1-4 denotes the quartile of the serum value of gamma-glutamyltransferase (GGT). The incidence is presented as the annual incidence rate per 10,000 person-years, adjusted for age, sex, body mass index (BMI), smoking, drinking, exercise, income, residence locale, diabetes, hypertension, and dyslipidaemia. Subjects with (A) the highest serum GGT quartile and (B) lowest BMI quartile (underweight) showed the highest incidences of oesophageal cancer.</p

Demographics of the study enrolees.

<p>Demographics of the study enrolees.</p