Baseline serum C‐reactive protein and death from colorectal cancer in the NHANES III cohort

• Published in: International journal of cancer Vol. 134; no. 8; pp. 1862 - 1870
• Main Authors: Swede, Helen, Hajduk, Alexandra M., Sharma, Jyoti, Rawal, Shristi, Rasool, Homaira, Vella, Anthony T., Tobet, Rebecca E., Stevens, Richard G.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley-Blackwell 15.04.2014; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; anti‐inflammatory drugs; Biological and medical sciences; Biomarkers, Tumor - blood; body mass index; Body Weight; C-Reactive Protein - analysis; Cancer; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; central adiposity; Cohort Studies; colon cancer; Colorectal cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - metabolism; Colorectal Neoplasms - mortality; Cross-Sectional Studies; C‐reactive protein; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health risk assessment; Humans; Inflammation; Inflammation - blood; Male; Medical research; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); neoplasms; Nutrition Surveys; obesity; Obesity - metabolism; Prospective Studies; Proteins; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Tumors; Waist Circumference; USA; Rectal disease; Adipose tissue; C-reactive protein; Colorectal cancer; anti-inflammatory drugs; central adiposity; Body mass index; Colon cancer; Cancerology; Adiposity; Cohort study; Intestinal disease; C reactive protein; Nutritional status; Drug; Obesity; Mortality; Nutrition disorder; Antiinflammatory agent; Inflammation; Malignant tumor; Serum protein; Colonic disease; Acute phase protein; Digestive diseases; Death; neoplasms; Cancer; colorectal cancer; inflammation; body mass index; colon cancer; cancer; obesity
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.28504

Several prospective studies suggest that C‐reactive protein (CRP), a nonspecific serologic marker of inflammation, might be linked to risk of colorectal cancer (CRC), whereas others have reported null or protective effects. We analyzed data from 7,072 participants (50–85 years) in the U.S. National Health and Nutrition Examination Survey III (1988–1994), a nationally representative cohort (n = 33,994; 2 months–85 years) with vital status follow‐up to 2000. Hazard ratios (HRs) for mortality associated with baseline clinically raised (≥1.00 mg/dL) and intermediate (≥0.22–0.99 mg/dL) CRP levels were estimated using Cox proportional hazards regression controlling for CRC risk factors. There were 59 deaths from CRC, 106 from other obesity‐related cancers (other‐ORCs) and 1,130 from cardiovascular disease (CVD). Participants with clinically raised CRP at baseline were found to have a statistically significant greater risk of CRC death (HRs = 2.36–2.47) in comparison to persons with undetected levels. HRs were lower for death from other‐ORC and CVD (1.82, 95% CI 1.05–3.15; 1.53, 95% CI 1.29–1.81, respectively). Intermediate CRP level was associated with a nonsignificant 10–21% increased risk for CRC death. HR for CRC death was higher among persons with a normal BMI (2.16, 95% 0.96–4.87, p = 0.06) compared to those who were overweight (1.22, 95% CI 0.53–2.78) or obese (1.23, 95% CI, 0.37–4.08). A similar pattern was observed for waist circumference. This effect modification suggests that the impact of chronic inflammation may be independent of excess body fat. Future research is recommended to confirm emerging data that elevated serologic CRP might reflect underlying colonic inflammation. What's new? The correlation between C‐Reactive Protein (CRP) and risk of colorectal cancer (CRC) has been unclear. In this study, the authors analyzed data from the long‐term NHANES III survey in order to clarify this association. They found that high levels of serum CRP more than doubled the risk of death from CRC. Surprisingly, this risk was much higher among subjects with a normal BMI than among those who were obese. These results indicate that elevated serum CRP may reflect underlying colonic inflammation, which could, in turn, aid in clinical assessment of CRC risk.