Diabetes and cancer are common diseases with tremendous impact on health worldwide. Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Type 2 diabetes and cancer share many risk factors, but potential biologic links between the two diseases are incompletely understood. Moreover, evidence from observational studies suggests that some medications used to treat hyperglycemia are associated with either increased or reduced risk of cancer. Against this backdrop, the American Diabetes Association and the American Cancer Society convened a consensus development conference in December 2009. Following a series of scientific presentations by experts in the field, the writing group independently developed this consensus report to address the following questions: 1. Is there a meaningful association between diabetes and cancer incidence or prognosis? 2. What risk factors are common to both diabetes and cancer? 3. What are possible biologic links between diabetes and cancer risk? 4. Do diabetes treatments influence risk of cancer or cancer prognosis? For each area, the authors were asked to address the current gaps in evidence and potential research and epidemiologic strategies for developing more definitive evidence in the future. Table 1 includes a summary of findings and recommendations. Recommendations in this report are solely the opinions of the authors and do not represent official position of the American Diabetes Association or the American Cancer Society. View this table: Table 1 Summary and recommendations ### 1. Is there a meaningful association between diabetes and cancer incidence or prognosis? Both diabetes and cancer are prevalent diseases whose incidence is increasing globally. Worldwide, the prevalence of cancer has been difficult to establish because many areas do not have cancer registries, but in 2008 there were an estimated 12.4 million new cancer cases diagnosed. The most commonly diagnosed cancers are lung/bronchus, breast, and colorectal, whereas the most common causes of cancer deaths are lung, stomach, and liver cancer (1). In the U.S., the most commonly diagnosed …

Epidemiologic evidence suggests that cancer incidence is associated with diabetes as well as certain diabetes risk factors and treatments. This consensus statement of experts assembled jointly by the American Diabetes Association and the American Cancer Society reviews the state of science concerning 1) the association between diabetes and cancer incidence or prognosis; 2) risk factors common to both diabetes and cancer; 3) possible biologic links between diabetes and cancer risk; and 4) whether diabetes treatments influence the risk of cancer or cancer prognosis. In addition, key unanswered questions for future research are posed.

A variety of observations are not easily explained by known cardiovascular disease (CVD) risk factors. In most populations studied, the rate of CVD-related death is elevated at higher latitudes, increases during the winter months, and is lower at high altitudes. As noted elsewhere,¹ this pattern is consistent with an adverse effect of hypovitaminosis D, which is more prevalent at higher latitudes, during the winter, and at lower altitudes. Alternative explanations for these observations are possible, but a variety of plausible biological mechanisms support a role for vitamin D. The vitamin D axis affects vascular smooth muscle cell proliferation, inflammation, vascular calcification, the renin-angiotensin system (RAS), and blood pressure,¹ all of which affect risk of CVD and myocardial infarction (MI).

To evaluate the associations between coffee and caffeine consumption and various health outcomes, we performed an umbrella review of the evidence from meta-analyses of observational studies and randomized controlled trials (RCTs). Of the 59 unique outcomes examined in the selected 112 meta-analyses of observational studies, coffee was associated with a probable decreased risk of breast, colorectal, colon, endometrial, and prostate cancers; cardiovascular disease and mortality; Parkinson's disease; and type-2 diabetes. Of the 14 unique outcomes examined in the 20 selected meta-analyses of observational studies, caffeine was associated with a probable decreased risk of Parkinson's disease and type-2 diabetes and an increased risk of pregnancy loss. Of the 12 unique acute outcomes examined in the selected 9 meta-analyses of RCTs, coffee was associated with a rise in serum lipids, but this result was affected by significant heterogeneity, and caffeine was associated with a rise in blood pressure. Given the spectrum of conditions studied and the robustness of many of the results, these findings indicate that coffee can be part of a healthful diet.

Objective To investigate the association of predicted lean body mass, fat mass, and body mass index (BMI) with all cause and cause specific mortality in men. Design Prospective cohort study. Setting Health professionals in the United States Participants 38 006 men (aged 40-75 years) from the Health Professionals Follow-up Study, followed up for death (1987-2012). Main outcome measures All cause and cause specific mortality. Results Using validated anthropometric prediction equations previously developed from the National Health and Nutrition Examination Survey, lean body mass and fat mass were estimated for all participants. During a mean of 21.4 years of follow-up, 12 356 deaths were identified. A J shaped association was consistently observed between BMI and all cause mortality. Multivariable adjusted Cox models including predicted fat mass and lean body mass showed a strong positive monotonic association between predicted fat mass and all cause mortality. Compared with those in the lowest fifth of predicted fat mass, men in the highest fifth had a hazard ratio of 1.35 (95% confidence interval 1.26 to 1.46) for mortality from all causes. In contrast, a U shaped association was found between predicted lean body mass and all cause mortality. Compared with those in the lowest fifth of predicted lean body mass, men in the second to fourth fifths had 8-10% lower risk of mortality from all causes. In the restricted cubic spline models, the risk of all cause mortality was relatively flat until 21 kg of predicted fat mass and increased rapidly afterwards, with a hazard ratio of 1.22 (1.18 to 1.26) per standard deviation. For predicted lean body mass, a large reduction of the risk was seen within the lower range until 56 kg, with a hazard ratio of 0.87 (0.82 to 0.92) per standard deviation, which increased thereafter (P for non-linearity <0.001). For cause specific mortality, men in the highest fifth of predicted fat mass had hazard ratios of 1.67 (1.47 to 1.89) for cardiovascular disease, 1.24 (1.09 to 1.43) for cancer, and 1.26 (0.97 to 1.64) for respiratory disease. On the other hand, a U shaped association was found between predicted lean body mass and mortality from cardiovascular disease and cancer. However, a strong inverse association existed between predicted lean body mass and mortality from respiratory disease (P for trend <0.001). Conclusions The shape of the association between BMI and mortality was determined by the relation between two body components (lean body mass and fat mass) and mortality. This finding suggests that the “obesity paradox” controversy may be largely explained by low lean body mass, rather than low fat mass, in the lower range of BMI.