To the Editor: The study by Dr Jee and colleagues1 presented evidence of an association between diabetes and cancer. We believe that these results are limited because they do not consider a number of important and independent risk factors for cancer in the data collection and analyses. First, the article does not report the number of patients who had diabetes but were undergoing treatment and therefore had a fasting blood glucose level within the normal range. It also does not specify if the patients with diabetes were taking insulin or other medications used to treat diabetes. Second, with the exception of smoking and alcohol, environmental exposure of the study participants to carcinogens such as dioxins was not included.
Third, there was no information on consumption of meat and folate, both of which may be related to cancer risk.2 In Korea during the 1980s and 1990s, there was a significant decline in plant-based food with a corresponding increase in intake of processed foods, particularly processed animal meat.3 Data on nutrient intake would have strengthened the study findings since the start of the study period and the change in dietary pattern occurred around the same time.
Fourth, while the role of physical activity in increasing or decreasing cancer risk is controversial,4 physical activity is a pivotal modulator of body weight, insulin, insulinlike growth factors, other hormones, free radicals, and the immune system, and could have been considered during data collection and data analyses. Finally, one fourth of the study patients had a body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) greater than 25; nonetheless, the authors used the cutoff of a BMI of 23 or higher (which includes normal weight, overweight, and obese persons) to determine the influence of BMI on the association between diabetes and cancer.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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