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Kanehara R, Park SY, Okada Y, Iwasaki M, Tsugane S, Sawada N, Inoue M, Haiman CA, Wilkens LR, Le Marchand L. Intake of Sugar and Food Sources of Sugar and Colorectal Cancer Risk in the Multiethnic Cohort Study. J Nutr 2024; 154:2481-2492. [PMID: 38795743 PMCID: PMC11375464 DOI: 10.1016/j.tjnut.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND The influence of sugar intake on the risk of colorectal cancer (CRC) remains controversial, and there is a need to investigate the heterogeneity of effects among racial and ethnic groups. OBJECTIVES To examine the association of intake of simple sugars and their food sources with CRC risk according to race/ethnicity in a multiethnic cohort study. METHODS We analyzed data from 192,651 participants who participated in the Multiethnic Cohort Study comprising African American, Japanese American, Latino, Native Hawaiian, and White older adults living in Hawaii and California with an average follow-up of 19 y. Intakes of total and specific types of sugars and sugary foods were estimated from a quantitative food frequency questionnaire completed by the participants in 1993-1996. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC risk according to quintiles (Q) of sugar and food intakes using Cox models adjusted for potential confounders. RESULTS As of December 2017, 4403 incident CRC cases were identified. Among all participants, multivariable-adjusted CRC HRs for Q2, Q3, Q4, and Q5 compared with Q1 for total sugars were 1.03 (95% CI: 0.94, 1.13), 1.05 (95% CI: 0.96, 1.16), 1.12 (95% CI: 1.01, 1.24), and 1.13 (95% CI: 1.01, 1.27), respectively. A similar positive association was observed for total fructose, glucose, fructose, and maltose but not for added sugars and sugary foods. The increased risk appeared to be limited to colon cancer and to be strongest among younger participants (i.e., 45-54 y at baseline); an association with CRC was observed for sugar-sweetened beverages in the latter group. Among racial and ethnic groups, increased risk of CRC was most apparent in Latinos. CONCLUSIONS In this diverse cohort, intakes of total sugar, total fructose, glucose, fructose, and maltose were associated with an increased risk of CRC, and the association was strongest for colon cancer, younger participants, and Latinos.
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Affiliation(s)
- Rieko Kanehara
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States; Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
| | - Song-Yi Park
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Yuito Okada
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Christopher A Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States
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Jenkins DJA, Willett WC, Yusuf S, Hu FB, Glenn AJ, Liu S, Mente A, Miller V, Bangdiwala SI, Gerstein HC, Sieri S, Ferrari P, Patel AV, McCullough ML, Le Marchand L, Freedman ND, Loftfield E, Sinha R, Shu XO, Touvier M, Sawada N, Tsugane S, van den Brandt PA, Shuval K, Khan TA, Paquette M, Sahye-Pudaruth S, Patel D, Siu TFY, Srichaikul K, Kendall CWC, Sievenpiper JL. Association of glycaemic index and glycaemic load with type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality: a meta-analysis of mega cohorts of more than 100 000 participants. Lancet Diabetes Endocrinol 2024; 12:107-118. [PMID: 38272606 DOI: 10.1016/s2213-8587(23)00344-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality. METHODS We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689. FINDINGS From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21-1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11-1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02-1·08]; p=0·0010), and all-cause mortality (1·08 [1·05-1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09-1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10-1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets. INTERPRETATION Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain. FUNDING Banting and Best and the Karuna Foundation.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada.
| | - Walter C Willett
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Frank B Hu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Department of Epidemiology, Department of Medicine, and Department of Surgery, Brown University, Providence, RI, USA
| | - Andrew Mente
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Victoria Miller
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erikka Loftfield
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and Statistics, Nutritional Epidemiology Research Team, Bobigny, France; French Network for Nutrition and Cancer Research, Jouy-en-Josas, France
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Piet A van den Brandt
- GROW School for Oncology and Developmental Biology, and Department of Epidemiology, Care and Public Health Research Institute-School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Tauseef Ahmad Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Teenie Fei Yi Siu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
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3
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Tosti G, Pepe F, Gnagnarella P, Silvestri F, Gaeta A, Queirolo P, Gandini S. The Role of Nicotinamide as Chemo-Preventive Agent in NMSCs: A Systematic Review and Meta-Analysis. Nutrients 2023; 16:100. [PMID: 38201930 PMCID: PMC10780437 DOI: 10.3390/nu16010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Nicotinamide is the active form of vitamin B3 (niacin) obtained through endogenous synthesis, mainly through tryptophan metabolism and dietary supplements, fish, meats, grains, and dairy products. It participates in cellular energy metabolism and modulates multiple cellular survival and death pathways. Nicotinamide has been widely studied as a safe chemopreventive agent that reduces actinic keratosis (AKs) and non-melanoma skin cancers (NMSC). METHODS We used the Medline, EMBASE, PubMed, and Cochrane databases to search the concepts "nicotinamide", "chemoprevention", and "skin cancer" up to August 2023. Three independent authors screened titles and abstracts for intervention and study design before searching full texts for eligibility criteria. The primary outcome was the impact of oral nicotinamide on the incidence of NMSC in high-risk patients. We also conducted a systematic search to identify relevant epidemiological studies published evaluating dietary niacin intake and the risk of NMSC. RESULTS Two hundred and twenty-five studies were reviewed, and four met the inclusion criteria. There was no association between NAM consumption and risk for squamous cell carcinoma (SCC) (rate ratio (RR) 0.81, 95% CI 0.48-1.37; I2 = 0%), basal cell carcinoma (BCC) (RR 0.88, 95% CI 0.50-1.55; I2 = 63%), and NMSC (RR 0.82, 95% CI 0.61-1.12; I2 = 63%). Adverse events were rare and acceptable, allowing optimal compliance of patients to the treatment. We found only one article evaluating the association between niacin dietary intake and NMSC risk, supporting a potential beneficial role of niacin intake concerning SCC but not BCC or melanoma. CONCLUSIONS The present meta-analysis shows, by pooling immunocompetent and immunosuppressed patients, that there is insufficient evidence that oral nicotinamide therapy significantly reduces the number of keratinocyte cancers.
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Affiliation(s)
- Giulio Tosti
- Dermato-Oncology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.P.); (F.S.)
| | - Francesca Pepe
- Dermato-Oncology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.P.); (F.S.)
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Flavia Silvestri
- Dermato-Oncology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.T.); (F.P.); (F.S.)
| | - Aurora Gaeta
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca 8, 20126 Milan, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
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4
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Kanehara R, Katagiri R, Goto A, Yamaji T, Sawada N, Iwasaki M, Inoue M, Tsugane S. Sugar intake and colorectal cancer risk: A prospective Japanese cohort study. Cancer Sci 2023. [PMID: 36851860 DOI: 10.1111/cas.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
The influence of sugar consumption on the risk of colorectal cancer (CRC) remains controversial. Prospective cohort studies focusing on total and specific types of sugar intake among the Asian population who have different patterns of sugar intake sources than American and European populations are scarce. We intended to examine the association of sugar intake with CRC risk among middle-aged adults in a Japanese large-scale population-based cohort study. The participants (42,405 men and 48,600 women) who were 45-74 years old and answered the questionnaire in 1995-1999 in the Japan Public Health Center-based Prospective Study were followed up until December 2013. Total sugars, total fructose, and specific types of sugar intake were estimated using a validated 147-item food frequency questionnaire and divided into quintiles (Q1-Q5). We used Cox proportional hazard regression models adjusted for potential confounders to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During the follow-up, 2118 CRC cases (1226 men and 892 women) were identified. We did not observe any clear association between all types of sugar intake and an increased risk of CRC. Analyses by tumor sites yielded a positive association of total sugar consumption with rectal cancer in women (1.75 [1.07-2.87] for Q1 vs. Q5; p linear trend = 0.03), but no statistically significant trend was detected among men. Sugar intake was not associated with CRC risk in middle-aged Japanese adults. However, for rectal cancer, the probability of an increased risk among women with a higher total sugar intake cannot be excluded.
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Affiliation(s)
- Rieko Kanehara
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Ryoko Katagiri
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,National Institute of Health and Nutrition, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Atsushi Goto
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,National Institute of Health and Nutrition, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
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Pandey H, Tang DWT, Wong SH, Lal D. Gut Microbiota in Colorectal Cancer: Biological Role and Therapeutic Opportunities. Cancers (Basel) 2023; 15:cancers15030866. [PMID: 36765824 PMCID: PMC9913759 DOI: 10.3390/cancers15030866] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. While CRC is thought to be an interplay between genetic and environmental factors, several lines of evidence suggest the involvement of gut microbiota in promoting inflammation and tumor progression. Gut microbiota refer to the ~40 trillion microorganisms that inhabit the human gut. Advances in next-generation sequencing technologies and metagenomics have provided new insights into the gut microbial ecology and have helped in linking gut microbiota to CRC. Many studies carried out in humans and animal models have emphasized the role of certain gut bacteria, such as Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, and colibactin-producing Escherichia coli, in the onset and progression of CRC. Metagenomic studies have opened up new avenues for the application of gut microbiota in the diagnosis, prevention, and treatment of CRC. This review article summarizes the role of gut microbiota in CRC development and its use as a biomarker to predict the disease and its potential therapeutic applications.
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Affiliation(s)
- Himani Pandey
- Redcliffe Labs, Electronic City, Noida 201301, India
| | - Daryl W. T. Tang
- School of Biological Sciences, Nanyang Technological University, Singapore 308232, Singapore
| | - Sunny H. Wong
- Centre for Microbiome Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Correspondence: (S.H.W.); (D.L.)
| | - Devi Lal
- Department of Zoology, Ramjas College, University of Delhi, Delhi 110007, India
- Correspondence: (S.H.W.); (D.L.)
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The interaction between glycemic index, glycemic load, and the genetic variant ADIPOQ T45G (rs2241766) in the risk of colorectal cancer: a case-control study in a Korean population. Eur J Nutr 2022; 61:2601-2614. [PMID: 35243553 DOI: 10.1007/s00394-022-02845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The glycemic index (GI), glycemic load (GL), and adiponectin level contribute to glycemic response and insulin sensitivity in the body. Studies have shown that tumor development is related to glycemic disorders; however, the results are contradictory. We aimed to investigate the association of GI and GL with colorectal cancer (CRC) risk in a Korean population and their possible interactions with the genetic variant ADIPOQ T45G. METHODS AND RESULTS A case-control study including 2096 participants with 695 CRC cases was conducted. The results showed that diets with high GI or GL were significantly associated with an increased risk of CRC [odds ratio (OR) = 5.44, 95% confidence interval (CI) 3.85-7.68; OR = 4.43, 95% CI 3.18-6.15, respectively; all p-trends < 0.001]. Moreover, even with a low-GI and low-GL diet, G/G genotype carriers may have 2.93-fold and 3.77-fold higher risk of rectal cancer compared to carriers of other genotypes (T/T + T/G), (OR = 2.93, 95% CI 1.01-8.59, p-interaction = 0.011 for GI; OR = 3.77, 95% CI 1.46-9.77, p-interaction = 0.025 for GL). CONCLUSIONS Overall, our study suggests positive associations of GI and GL with CRC risk. Moreover, the associations of GI and GL with rectal cancer risk could be modified by ADIPOQ T45G in a Korean population. Further studies with larger sample sizes are needed to confirm our findings.
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Adherence to low-carbohydrate diet in relation to gastric cancer: findings from a case-control study in Iran. Eur J Cancer Prev 2021; 30:297-303. [PMID: 34103461 DOI: 10.1097/cej.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the association between adherence to low carbohydrate diet (LCD) and risk of gastric cancer (GC). This hospital-based case-control study was conducted in Iran Cancer Institute, Tehran, Iran between 2010 and 2012. Totally, 178 patients with GC and 276 apparently healthy controls participated in this study. Cases were histo-pathologically confirmed GC patients aged ≥40 years diagnosed with GC in the last year. Dietary intakes were assessed using a validated 146-item Diet History Questionnaire. We computed the LCD score trough the protocol explained by Halton. Patients with GC were older (60.8 vs. 53.2 years, P < 0.001) and more likely to be male (74.2 vs. 63.8%, P = 0.02), married (97.8 vs. 86.6%, P < 0.001) and illiterate (62.4% vs. 26.1%, P < 0.001) than controls. Before adjusting for covariates, adherence to LCD-diet was not associated with risk of GC [odds ratio (OR) 1.31; 95% confidence interval (CI) 0.82-2.09 for highest vs. lowest tertile; Ptrend < 0.26]. Adjustments for several potential confounders including H-pylori infection and BMI, participants in the highest tertile of LCD score were 7% more likely to have GC than those in the lowest tertile; however, it was not statistically significant (OR 1.07; 95% CI 0.59-1.95 for highest vs. lowest tertile; Ptrend < 0.79). No significant association was also seen between adherence to animal- or vegetable-based LCD diet and risk of GC. In conclusion, we failed to find any evidence on the association between consumption of LCD and odds of GC. Further studies, in particular of prospective design, are required to confirm these findings.
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Mirzaei R, Afaghi A, Babakhani S, Sohrabi MR, Hosseini-Fard SR, Babolhavaeji K, Khani Ali Akbari S, Yousefimashouf R, Karampoor S. Role of microbiota-derived short-chain fatty acids in cancer development and prevention. Biomed Pharmacother 2021; 139:111619. [PMID: 33906079 DOI: 10.1016/j.biopha.2021.111619] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Following cancer, cells in a particular tissue can no longer respond to the factors involved in controlling cell survival, differentiation, proliferation, and death. In recent years, it has been indicated that alterations in the gut microbiota components, intestinal epithelium, and host immune system are associated with cancer incidence. Also, it has been demonstrated that the short-chain fatty acids (SCFAs) generated by gut microbiota are vitally crucial in cell homeostasis as they contribute to the modulation of histone deacetylases (HDACs), resulting effected cell attachment, immune cell immigration, cytokine production, chemotaxis, and the programmed cell death. Therefore, the manipulation of SCFA levels in the intestinal tract by alterations in the microbiota structure can be potentially taken into consideration for cancer treatment/prevention. In the current study, we will explain the most recent findings on the detrimental or protective roles of SFCA (particularly butyrate, propionate, and acetate) in several cancers, including bladder, colon, breast, stomach, liver, lung, pancreas, and prostate cancers.
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Affiliation(s)
- Rasoul Mirzaei
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Venom and Biotherapeutics Molecules Lab, Medical Biotechnology Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran.
| | - Azam Afaghi
- Department of Biology, Sofian Branch, Islamic Azad University, Sofian, Iran
| | - Sajad Babakhani
- Department of Microbiology, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Masoud Reza Sohrabi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Hosseini-Fard
- Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiandokht Babolhavaeji
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shabnam Khani Ali Akbari
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasoul Yousefimashouf
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Sajad Karampoor
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Hatami Marbini M, Amiri F, Sajadi Hezaveh Z. Dietary glycemic index, glycemic load, insulin index, insulin load and risk of diabetes-related cancers: A systematic review of cohort studies. Clin Nutr ESPEN 2021; 42:22-31. [PMID: 33745582 DOI: 10.1016/j.clnesp.2021.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIMS It is believed that diets high in glycemic index (GI), glycemic load (GL), Insulin index (II), and Insulin load (IL) are associated with the increased risks of certain cancers through increasing serum glucose or insulin levels. METHODS We conducted this systematic review of cohort studies to evaluate the possible relation between GI, GL, II, and IL with diabetes-related cancers, including colorectal, bladder, breast, endometrium, liver, pancreas, and prostate cancers. Two separate investigators conducted a literature search through PubMed/Medline, Scopus, and Web of Science databases up to February 2020, plus reference lists of relevant articles. RESULTS Fifty-three cohort studies with a total of 100 098 cancer cases were included in this systematic review. Fifteen out of eighteen studies among breast cancer cases reported no significant association between GI/GL and cancer risk. These numbers were 4 out of 13 for colorectal cancer, 7 out of 9 for endometrial cancer, 2 out of 3 for liver cancer, 8 out of 10 for pancreatic cancer, and 3 out of 3 for prostate cancer. Only one cohort investigated this association in terms of bladder cancer and reported a significant association. Also, five studies reported this relation in terms of II/IL, and only one cohort among endometrial cancer patients observed a significant positive association between the risk of cancer and IL. CONCLUSION We concluded a weak association between dietary GI/GL and no association between II/IL with diabetes-related cancer risk. More cohort studies are required to be performed regarding II/IL and the risk of cancer.
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Affiliation(s)
- Motahare Hatami Marbini
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemehsadat Amiri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Sajadi Hezaveh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Debras C, Chazelas E, Srour B, Kesse-Guyot E, Julia C, Zelek L, Agaësse C, Druesne-Pecollo N, Galan P, Hercberg S, Latino-Martel P, Deschasaux M, Touvier M. Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Santé cohort. Am J Clin Nutr 2020; 112:1267-1279. [PMID: 32936868 DOI: 10.1093/ajcn/nqaa246] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Excessive sugar intake is now recognized as a key risk factor for obesity, type 2 diabetes, and cardiovascular diseases. In contrast, evidence on the sugar-cancer link is less consistent. Experimental data suggest that sugars could play a role in cancer etiology through obesity but also through inflammatory and oxidative mechanisms and insulin resistance, even in the absence of weight gain. OBJECTIVE The objective was to study the associations between total and added sugar intake and cancer risk (overall, breast, and prostate), taking into account sugar types and sources. METHODS In total, 101,279 participants aged >18 y (median age, 40.8 y) from the French NutriNet-Santé prospective cohort study (2009-2019) were included (median follow-up time, 5.9 y). Sugar intake was assessed using repeated and validated 24-h dietary records, designed to register participants' usual consumption for >3500 food and beverage items. Associations between sugar intake and cancer risk were assessed by Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). RESULTS Total sugar intake was associated with higher overall cancer risk (n = 2503 cases; HR for quartile 4 compared with quartile 1: 1.17; 95% CI: 1.00, 1.37; Ptrend = 0.02). Breast cancer risks were increased (n = 783 cases; HRQ4vs.Q1 = 1.51; 95% CI: 1.14, 2.00; Ptrend = 0.0007). Results remained significant when weight gain during follow-up was adjusted for. In addition, significant associations with cancer risk were also observed for added sugars, free sugars, sucrose, sugars from milk-based desserts, dairy products, and sugary drinks (Ptrend ≤ 0.01). CONCLUSIONS These results suggest that sugars may represent a modifiable risk factor for cancer prevention (breast in particular), contributing to the current debate on the implementation of sugar taxation, marketing regulation, and other sugar-related policies. This trial was registered at clinicaltrials.gov as NCT03335644.
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Affiliation(s)
- Charlotte Debras
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Eloi Chazelas
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Bernard Srour
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.,Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Laurent Zelek
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.,Oncology Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Cédric Agaësse
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.,Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Paule Latino-Martel
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Mélanie Deschasaux
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAe U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
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11
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Hidaka A, Harrison TA, Cao Y, Sakoda LC, Barfield R, Giannakis M, Song M, Phipps AI, Figueiredo JC, Zaidi SH, Toland AE, Amitay EL, Berndt SI, Borozan I, Chan AT, Gallinger S, Gunter MJ, Guinter MA, Harlid S, Hampel H, Jenkins MA, Lin Y, Moreno V, Newcomb PA, Nishihara R, Ogino S, Obón-Santacana M, Parfrey PS, Potter JD, Slattery ML, Steinfelder RS, Um CY, Wang X, Woods MO, Van Guelpen B, Thibodeau SN, Hoffmeister M, Sun W, Hsu L, Buchanan DD, Campbell PT, Peters U. Intake of Dietary Fruit, Vegetables, and Fiber and Risk of Colorectal Cancer According to Molecular Subtypes: A Pooled Analysis of 9 Studies. Cancer Res 2020; 80:4578-4590. [PMID: 32816852 PMCID: PMC7572895 DOI: 10.1158/0008-5472.can-20-0168] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
Protective associations of fruits, vegetables, and fiber intake with colorectal cancer risk have been shown in many, but not all epidemiologic studies. One possible reason for study heterogeneity is that dietary factors may have distinct effects by colorectal cancer molecular subtypes. Here, we investigate the association of fruit, vegetables, and fiber intake with four well-established colorectal cancer molecular subtypes separately and in combination. Nine observational studies including 9,592 cases with molecular subtypes for microsatellite instability (MSI), CpG island methylator phenotype (CIMP), and somatic mutations in BRAF and KRAS genes, and 7,869 controls were analyzed. Both case-only logistic regression analyses and polytomous logistic regression analyses (with one control set and multiple case groups) were used. Higher fruit intake was associated with a trend toward decreased risk of BRAF-mutated tumors [OR 4th vs. 1st quartile = 0.82 (95% confidence interval, 0.65-1.04)] but not BRAF-wildtype tumors [1.09 (0.97-1.22); P difference as shown in case-only analysis = 0.02]. This difference was observed in case-control studies and not in cohort studies. Compared with controls, higher fiber intake showed negative association with colorectal cancer risk for cases with microsatellite stable/MSI-low, CIMP-negative, BRAF-wildtype, and KRAS-wildtype tumors (P trend range from 0.03 to 3.4e-03), which is consistent with the traditional adenoma-colorectal cancer pathway. These negative associations were stronger compared with MSI-high, CIMP-positive, BRAF-mutated, or KRAS-mutated tumors, but the differences were not statistically significant. These inverse associations for fruit and fiber intake may explain, in part, inconsistent findings between fruit or fiber intake and colorectal cancer risk that have previously been reported. SIGNIFICANCE: These analyses by colorectal cancer molecular subtypes potentially explain the inconsistent findings between dietary fruit or fiber intake and overall colorectal cancer risk that have previously been reported.
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Affiliation(s)
- Akihisa Hidaka
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Tabitha A Harrison
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lori C Sakoda
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Richard Barfield
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mingyang Song
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amanda I Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Syed H Zaidi
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Amanda E Toland
- Departments of Cancer Biology and Genetics and Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Efrat L Amitay
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ivan Borozan
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Steven Gallinger
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mark A Guinter
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
| | - Heather Hampel
- Departments of Cancer Biology and Genetics and Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yi Lin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Victor Moreno
- Oncology Data Analytics Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- ONCOBEL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- School of Public Health, University of Washington, Seattle, Washington
| | - Reiko Nishihara
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shuji Ogino
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mireia Obón-Santacana
- Oncology Data Analytics Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- ONCOBEL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert S Steinfelder
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Caroline Y Um
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Xiaoliang Wang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michael O Woods
- Memorial University of Newfoundland, Discipline of Genetics, St. John's, Canada
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Stephen N Thibodeau
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wei Sun
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Li Hsu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Daniel D Buchanan
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
- Genetic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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12
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Cho H, Budhathoki S, Kanehara R, Goto A, Yamaji T, Kakugawa Y, Saito Y, Matsuda T, Iwasaki M, Tsugane S. Association between dietary sugar intake and colorectal adenoma among cancer screening examinees in Japan. Cancer Sci 2020; 111:3862-3872. [PMID: 32741012 PMCID: PMC7540999 DOI: 10.1111/cas.14596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/06/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Although intake of highly sugary foods is considered to be a potential risk factor for colorectal cancer through hyperinsulinemia, the association of sugar intake and colorectal adenoma, a precursor lesion to most colorectal cancer, is poorly understood, particularly in Asian populations. We undertook a cross‐sectional study in a Japanese population to investigate the association between dietary sugar intake and the prevalence of colorectal adenoma. Study subjects were selected from participants who underwent magnifying colonoscopy with dye spraying as part of a cancer screening program and who responded to a self‐administered questionnaire before the colonoscopy. A total of 738 cases with colorectal adenoma and 697 controls were enrolled. Dietary intakes of glucose, fructose, galactose, sucrose, maltose, lactose, and total sugars (sum of these six mono‐ or disaccharides) were calculated from a food frequency questionnaire, and divided into quartiles based on the distribution among controls. Odds ratios and 95% confidence intervals of colorectal adenoma were estimated using unconditional logistic regression models, with adjustment for potential confounding factors. Total sugar intake was not significantly associated with the prevalence of colorectal adenoma (odds ratio for the highest intake group compared to reference group = 1.18; 95% confidence interval, 0.81‐1.73; P for trend = .34). Furthermore, no statistically significant positive associations were observed for any of the six mono‐ or disaccharides. Findings were similar on additional analyses by site, size, and number of adenomas. Our findings do not support an association between high sugar intake and increased odds ratios of colorectal adenoma.
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Affiliation(s)
- Hourin Cho
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan.,Cancer Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Minato-ku, Japan.,Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Japan
| | - Sanjeev Budhathoki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Rieko Kanehara
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Atsushi Goto
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Japan.,Screening Center, National Cancer Center Hospital, Chuo-ku, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Japan.,Screening Center, National Cancer Center Hospital, Chuo-ku, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan.,Cancer Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Minato-ku, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
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13
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The Effects of Dietary Nutrition on Sleep and Sleep Disorders. Mediators Inflamm 2020; 2020:3142874. [PMID: 32684833 PMCID: PMC7334763 DOI: 10.1155/2020/3142874] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022] Open
Abstract
Sleep disorder significantly affects the life quality of a large number of people but is still an underrecognized disease. Dietary nutrition is believed to play a significant impact on sleeping wellness. Many nutritional supplements have been used trying to benefit sleep wellness. However, the relationship between nutritional components and sleep is complicated. Nutritional factors vary dramatically with different diet patterns and depend significantly on the digestive and metabiotic functions of each individual. Moreover, nutrition can profoundly affect the hormones and inflammation status which directly or indirectly contribute to insomnia. In this review, we summarized the role of major nutritional factors, carbohydrates, lipids, amino acids, and vitamins on sleep and sleep disorders and discussed the potential mechanisms.
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14
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Yuan C, Giovannucci EL. Epidemiological Evidence for Dietary Sugars and Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-020-00453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Dietary carbohydrate intake, glycaemic index, glycaemic load and digestive system cancers: an updated dose-response meta-analysis. Br J Nutr 2019; 121:1081-1096. [PMID: 30837012 DOI: 10.1017/s0007114519000424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Several studies analysed the associations between dietary carbohydrate intake, glycaemic index (GI) and glycaemic load (GL) and digestive system cancers; however, the results remain controversial. This study was to perform a meta-analysis evaluating the quantitative and dose-response associations between carbohydrate intake, GI and GL, and risk of digestive system cancers. We searched medical and biological databases up to June 2018 and identified twenty-six cohort studies and eighteen case-control studies. Meta-analytic fixed or random effects models were applied to process data. We also performed dose-response analysis, meta-regression and subgroup analyses. We found that high levels of GI were significantly associated with the risk of digestive system cancers at the highest compared with the lowest categories from cohort studies (summary relative risk (RR)=1·10, 95 % CI 1·05, 1·15). Similar effects were observed from case-control studies of the comparison between the extreme categories, but the difference did not reach statistical significance (summary OR=1·28, 95 % CI 0·97, 1·69). We also observed significant dose-response association between GI and digestive system cancers, with every 10-unit increase in GI (summary RR=1·003; 95 % CI 1·000, 1·012 for cohort studies; summary OR=1·09; 95 % CI 1·06, 1·11 for case-control studies). In addition, both cohort studies and case-control studies indicated that neither dietary carbohydrate intake nor GL bore any statistical relationship to digestive system cancers from the results of the highest compared with the lowest categories analyses and dose-response analyses. The results suggest a moderate association between high-GI diets and the risk of digestive system cancers.
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16
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Ma Y, Hu M, Zhou L, Ling S, Li Y, Kong B, Huang P. Dietary fiber intake and risks of proximal and distal colon cancers: A meta-analysis. Medicine (Baltimore) 2018; 97:e11678. [PMID: 30200062 PMCID: PMC6133424 DOI: 10.1097/md.0000000000011678] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to conduct a systematic review and meta-analysis of studies investigating the relationship between dietary fiber intake and subsite-specific colon cancer.The PubMed database was searched to identify relevant cohort studies published from inception to August 2016 in order to examine individually the association between dietary fiber intake and the risk of proximal colon cancer (PCC), and that between dietary fiber intake and the risk of distal colon cancer (DCC). We searched the reference lists of the studies included in our analysis as well as those listed in the published meta-analyses. A random-effects model was used to compute summary risk estimates. Heterogeneity was assessed using I and Q statistics. Publication bias was assessed with the Egger's and Begg's tests, with a P value of P < .10 indicating publication bias. All statistical tests were 2-sided.We identified and included 11 prospective cohort studies in the final meta-analysis. The risks of PCC and DCC among individuals in the highest dietary fiber intake quartile/quintile were 14% (relative risk [RR] = 0.86, 95% confidence interval [CI] = 0.78-0.95) and 21% (RR = 0.79, 95% CI = 0.71-0.87) lower, respectively, than those among individuals with the lowest dietary fiber intake. In a subgroup analysis, the inverse association observed in the sex-based subgroup was apparent only for men with PCC. Dietary fiber intake was inversely associated with DCC for both men and women. In addition, dietary fiber intake appeared to be inversely associated with PCC only in European countries, whereas this association was observed for DCC in both European countries and the United States.Our findings reveal that dietary fiber intake is associated inversely with the risk of both PCC and DCCs.
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Affiliation(s)
- Yu Ma
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
| | - Mingyue Hu
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
| | - Lingna Zhou
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
| | - Sunkai Ling
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
| | - Yuan Li
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
| | - Bo Kong
- Department of Surgery, School of Medicine, Technical University Munich (TUM), Munich, Germany
| | - Peilin Huang
- Department of Oncology, School of Medicine, Southeast University, Nanjing, China
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17
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Makarem N, Bandera EV, Nicholson JM, Parekh N. Consumption of Sugars, Sugary Foods, and Sugary Beverages in Relation to Cancer Risk: A Systematic Review of Longitudinal Studies. Annu Rev Nutr 2018; 38:17-39. [DOI: 10.1146/annurev-nutr-082117-051805] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High sugar intake may increase cancer risk by promoting insulin–glucose dysregulation, oxidative stress, inflammation, and body adiposity, but epidemiologic evidence is unclear. Associations between dietary sugars and lifestyle-related cancer risk from longitudinal studies were evaluated. We systematically searched PubMed, Embase, and CINAHL and identified 37 prospective cohort studies (1990–2017) reporting multivariable adjusted risk estimates for dietary sugars in relation to cancer. Of 15 and 14 studies on total sugar and sucrose respectively, 11 reported a null association in relation to cancer. Of 14 studies on fructose, 8 reported null associations, and 2 reported protective and 4 reported detrimental associations. In two of five studies on added sugars, a 60–95% increased cancer risk was observed with higher intakes. In 8 of 15 studies on sugary foods and beverages, a 23–200% higher cancer risk was observed with higher sugary beverage consumption. In conclusion, most studies were indicative of a null association, but suggestive detrimental associations were reported for added sugars and sugary beverages.
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Affiliation(s)
- Nour Makarem
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Elisa V. Bandera
- Rutgers School of Public Health, The State University of New Jersey, Piscataway, New Jersey 08854, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey 08903-2681, USA
| | - Joseph M. Nicholson
- NYU Health Sciences Library, New York University School of Medicine, New York, NY 10016, USA
| | - Niyati Parekh
- College of Global Public Health, New York University, New York, NY 10003, USA
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA
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Predictors of the Healthy Eating Index and Glycemic Index in Multi-Ethnic Colorectal Cancer Families. Nutrients 2018; 10:nu10060674. [PMID: 29861441 PMCID: PMC6024360 DOI: 10.3390/nu10060674] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
For personalized nutrition in preparation for precision healthcare, we examined the predictors of healthy eating, using the healthy eating index (HEI) and glycemic index (GI), in family-based multi-ethnic colorectal cancer (CRC) families. A total of 106 participants, 53 CRC cases and 53 family members from multi-ethnic families participated in the study. Machine learning validation procedures, including the ensemble method and generalized regression prediction, Elastic Net with Akaike’s Information Criterion with correction and Leave-One-Out cross validation methods, were applied to validate the results for enhanced prediction and reproducibility. Models were compared based on HEI scales for the scores of 77 versus 80 as the status of healthy eating, predicted from individual dietary parameters and health outcomes. Gender and CRC status were interactive as additional predictors of HEI based on the HEI score of 77. Predictors of HEI 80 as the criterion score of a good diet included five significant dietary parameters (with intake amount): whole fruit (1 cup), milk or milk alternative such as soy drinks (6 oz), whole grain (1 oz), saturated fat (15 g), and oil and nuts (1 oz). Compared to the GI models, HEI models presented more accurate and fitted models. Milk or a milk alternative such as soy drink (6 oz) is the common significant parameter across HEI and GI predictive models. These results point to the importance of healthy eating, with the appropriate amount of healthy foods, as modifiable factors for cancer prevention.
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Yang J, Yu J. The association of diet, gut microbiota and colorectal cancer: what we eat may imply what we get. Protein Cell 2018; 9:474-487. [PMID: 29713943 PMCID: PMC5960467 DOI: 10.1007/s13238-018-0543-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/10/2018] [Indexed: 12/15/2022] Open
Abstract
Despite the success of colonoscopy screening and recent advances in cancer treatment, colorectal cancer (CRC) still remains one of the most commonly diagnosed and deadly cancers, with a significantly increased incidence in developing countries where people are adapting to Western lifestyle. Diet has an important impact on risk of CRC. Multiple epidemiological studies have suggested that excessive animal protein and fat intake, especially red meat and processed meat, could increase the risk of developing CRC while fiber could protect against colorectal tumorigenesis. Mechanisms have been investigated by animal studies. Diet could re-shape the community structure of gut microbiota and influence its function by modulating the production of metabolites. Butyrate, one of the short-chain fatty acids (SCFAs), which act as a favorable source for colonocytes, could protect colonic epithelial cells from tumorigenesis via anti-inflammatory and antineoplastic properties through cell metabolism, microbiota homeostasis, antiproliferative, immunomodulatory and genetic/epigenetic regulation ways. In contrast, protein fermentation and bile acid deconjugation, which cause damage to colonic cells through proinflammatory and proneoplastic ways, lead to increased risk of developing CRC. In conclusion, a balanced diet with an increased abundance of fiber should be adopted to reduce the risk and prevent CRC.
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Affiliation(s)
- Jia Yang
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jun Yu
- State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
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20
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Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Lane DS, Ho GYF, Hou L, Snetselaar L, Ockene JK, Hebert JR. Changes in the Inflammatory Potential of Diet Over Time and Risk of Colorectal Cancer in Postmenopausal Women. Am J Epidemiol 2017; 186:514-523. [PMID: 28486621 DOI: 10.1093/aje/kwx115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
We examined the associations between changes in dietary inflammatory potential and risk of colorectal cancer (CRC) in 87,042 postmenopausal women recruited from 1993-1998 by the Women's Health Initiative, conducted in the United States. Food frequency questionnaire data were used to compute patterns of change in dietary inflammatory index (DII) scores and cumulative average DII scores over 3 years. Cox regression models were used to estimate hazard ratios for CRC risk. After a median of 16.2 years of follow-up, 1,038 CRC cases were diagnosed. DII changes were not substantially associated with overall CRC, but proximal colon cancer risk was higher in the proinflammatory-change DII group than in the antiinflammatory-stable DII group (hazard ratio = 1.32, 95% confidence interval: 1.01, 1.74). Among nonusers of nonsteroidal antiinflammatory drugs (NSAIDs) (Pinteraction = 0.055), the proinflammatory-stable DII group was at increased risk of overall CRC and proximal colon cancer. Also among nonusers of NSAIDs, risks of overall CRC, colon cancer, and proximal colon cancer were higher in the highest quintile compared with the lowest cumulative average DII quintile (65%, 61%, and 91% higher risk, respectively). Dietary changes toward, or a history of, proinflammatory diets are associated with an elevated risk of colon cancer, particularly for proximal colon cancer and among nonusers of NSAIDs.
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21
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A meta-analysis between dietary carbohydrate intake and colorectal cancer risk: evidence from 17 observational studies. Biosci Rep 2017; 37:BSR20160553. [PMID: 28298476 PMCID: PMC5469332 DOI: 10.1042/bsr20160553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 01/05/2023] Open
Abstract
The association between dietary carbohydrate intake and colorectal cancer (CRC) risk remains controversial. We therefore conducted this meta-analysis to assess the relationship between them. A literature search from the databases of PubMed, Embase, Web of Science and Medline was performed for available articles published in English (up to September 2016). Pooled relative risk (RR) with 95% confidence interval (CI) was calculated to evaluate the association between dietary carbohydrate intake and CRC risk. The random-effect model (REM) was selected as the pooling method. Publication bias was estimated using Egger’s regression asymmetry test and funnel plot. A total of 17 articles involving 14402 CRC patients and 846004 participants were eligible with the inclusion criteria in this meta-analysis. The pooled RR with 95% CI of dietary carbohydrate intake for CRC, colon cancer and rectum cancer risk were 1.08 (95% CI =0.93–1.23, I2 =68.3%, Pheterogeneity<0.001), 1.09 (95% CI =0.95–1.25, I2 =48.3%) and 1.17 (95% CI =0.98–1.39, I2 =17.8%) respectively. When we conducted the subgroup analysis by gender, the significant association was found in men’s populations (summary RR =1.23, 95% CI =1.01–1.57), but not in the women’s populations. In the further subgroup analyses for study design and geographic locations, we did not find any association between dietary carbohydrate intake and CRC risk in the subgroup results respectively. No significant publication bias was found either by the Egger’s regression asymmetry test or by the funnel plot. This meta-analysis suggested that higher dietary carbohydrate intake may be an increased factor for CRC risk in men populations. Further studies are wanted to confirm this relationship.
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22
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Glycemic index and glycemic load and risk of colorectal cancer: a population-based cohort study (JPHC Study). Cancer Causes Control 2016; 27:583-93. [DOI: 10.1007/s10552-016-0733-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/24/2016] [Indexed: 12/13/2022]
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23
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Zhong X, Fang YJ, Pan ZZ, Lu MS, Zheng MC, Chen YM, Zhang CX. Dietary fiber and fiber fraction intakes and colorectal cancer risk in Chinese adults. Nutr Cancer 2015; 66:351-61. [PMID: 24673635 DOI: 10.1080/01635581.2013.877496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Few studies have been conducted in Chinese adults to investigate the effect of fiber intake on colorectal cancer risk. The present study aimed to examine the associations of dietary fiber and fiber fraction intakes with colorectal cancer risk in Chinese adults. A total of 613 cases with colorectal cancer were consecutively recruited between July 2010 and October 2012 and frequency matched to 613 controls by age (5-yr interval) and gender. Dietary information was collected through a validated food frequency questionnaire by face-to-face interviews. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for potential confounders. Total dietary fiber and fiber fraction intakes were found to be inversely associated with colorectal cancer risk. Compared with the lowest quartile, the adjusted ORs (95% CIs) for the highest quartile were 0.38 (0.27-0.55) for total dietary fiber, 0.45 (0.32-0.64) for vegetable fiber, and 0.41 (0.28-0.58) for fruit fiber, respectively. In addition, no significant association was found between soy fiber intake and colorectal cancer risk. This study showed that a high intake of dietary fiber, particularly derived from vegetables and fruit, was inversely associated with colorectal cancer risk in Chinese adults.
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Affiliation(s)
- Xiao Zhong
- a Department of Medical Statistics and Epidemiology, School of Public Health , Sun Yat-sen University , Guangzhou , China
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24
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Song M, Garrett WS, Chan AT. Nutrients, foods, and colorectal cancer prevention. Gastroenterology 2015; 148:1244-60.e16. [PMID: 25575572 PMCID: PMC4409470 DOI: 10.1053/j.gastro.2014.12.035] [Citation(s) in RCA: 406] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Abstract
Diet has an important role in the development of colorectal cancer. In the past few decades, findings from extensive epidemiologic and experimental investigations have linked consumption of several foods and nutrients to the risk of colorectal neoplasia. Calcium, fiber, milk, and whole grains have been associated with a lower risk of colorectal cancer, and red meat and processed meat have been associated with an increased risk. There is substantial evidence for the potential chemopreventive effects of vitamin D, folate, fruits, and vegetables. Nutrients and foods also may interact, as a dietary pattern, to influence colorectal cancer risk. Diet likely influences colorectal carcinogenesis through several interacting mechanisms. These include the direct effects on immune responsiveness and inflammation, and the indirect effects of overnutrition and obesity-risk factors for colorectal cancer. Emerging evidence also implicates the gut microbiota as an important effector in the relationship between diet and cancer. Dietary modification therefore has the promise of reducing colorectal cancer incidence.
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Affiliation(s)
- Mingyang Song
- Department of Nutrition, Harvard School of Public Health, Boston, MA,Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Wendy S. Garrett
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA,Department of Genetics and Complex Diseases, Harvard School of Public Health, Boston, MA,Department of Medicine, Harvard Medical School, Boston, MA,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Andrew T. Chan
- Department of Medicine, Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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25
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Sieri S, Krogh V, Agnoli C, Ricceri F, Palli D, Masala G, Panico S, Mattiello A, Tumino R, Giurdanella MC, Brighenti F, Scazzina F, Vineis P, Sacerdote C. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study. Int J Cancer 2014; 136:2923-31. [PMID: 25403784 DOI: 10.1002/ijc.29341] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/07/2014] [Indexed: 11/06/2022]
Abstract
A carbohydrate-rich diet, resulting in high blood glucose and insulin, has been hypothesized as involved in colorectal cancer etiology. We investigated dietary glycemic index (GI) and glycemic load (GL), in relation to colorectal cancer, in the prospectively recruited EPIC-Italy cohort. After a median 11.7 years, 421 colorectal cancers were diagnosed among 47,749 recruited adults. GI and GL were estimated from validated food frequency questionnaires. Multivariable Cox modeling estimated hazard ratios (HRs) for associations between colorectal cancer and intakes of total, high GI and low GI carbohydrate and GI and GL. The adjusted HR of colorectal cancer for highest versus lowest GI quartile was 1.35; 95% confidence interval (CI) 1.03-1.78; p trend 0.031. Increasing high GI carbohydrate intake was also significantly associated with increasing colorectal cancer risk (HR 1.45; 95% CI 1.04-2.03; p trend 0.034), whereas increasing low GI carbohydrate was associated with reducing risk (HR 0.73; 95% CI 0.54-0.98; p trend 0.033). High dietary GI and high GI carbohydrate were associated with increased risks of cancer at all colon sites (HR 1.37; 95% CI 1.00-1.88, HR 1.80; 95% CI 1.22-2.65, respectively), whereas high GI carbohydrate and high GL were associated with increased risk of proximal colon cancer (HR 1.94; 95% CI 1.18-3.16, HR 2.01; 95% CI 1.08-3.74, respectively). After stratification for waist-to-hip ratio (WHR), cancer was significantly associated with GI, and high GI carbohydrate, in those with high WHR. These findings suggest that high dietary GI and high carbohydrate intake from high GI foods are associated with increased risk of colorectal cancer.
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Affiliation(s)
- S Sieri
- Department of Preventive & Predictive Medicine, Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
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26
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Zelenskiy S, Thompson CL, Tucker TC, Li L. High dietary glycemic load is associated with increased risk of colon cancer. Nutr Cancer 2014; 66:362-8. [PMID: 24611536 DOI: 10.1080/01635581.2014.884231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
High dietary glycemic load (GL) has been inconsistently associated with risk of colon cancer. We analyzed data for 1093 incident cases and 1589 controls in a population-based case-control study of colon cancer to further clarify the GL-colon cancer relationship. GL was assessed using a self-administered food frequency questionnaire. Cases had a significantly higher GL intake (mean = 136.4, SD = 24.5) than controls (mean = 132.8, SD = 25.2) (P = 0.0003). In a multivariate unconditional logistic regression model, the odds ratios (ORs) for colon cancer increased significantly with increasing GL: compared to the bottom quartile of GL, the ORs (95% CI) for the 2nd through the upper quartiles were 1.38 (1.06, 1.80), 1.67 (1.30, 2.13), and 1.61 (1.25, 2.07), respectively (P trend < 0.0001). Stratified analyses showed that the association was more pronounced among older participants [ORs (95% CI) for the 2nd through the upper quartiles were 1.35 (0.91, 2.00), 1.87 (1.29, 2.71), 2.02 (1.39, 2.95), respectively] than among younger participants [ORs were 1.46 (1.02, 2.10), 1.53 (1.09, 2.15), and 1.35 (0.96, 1.91), respectively] (P int = 0.02). Our results provide support for the hypothesis that a diet with high GL increases the risk of colon cancer.
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Affiliation(s)
- Svetlana Zelenskiy
- a Department of Family Medicine and Community Health and Department of Epidemiology and Biostatistics , Case Western Reserve University , Cleveland , Ohio , USA
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27
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Subsite-specific dietary risk factors for colorectal cancer: a review of cohort studies. JOURNAL OF ONCOLOGY 2013; 2013:703854. [PMID: 23577027 PMCID: PMC3610350 DOI: 10.1155/2013/703854] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/30/2012] [Indexed: 02/08/2023]
Abstract
Objective. A shift in the total incidence from left- to right-sided colon cancer has been reported and raises the question as to whether lifestyle risk factors are responsible for the changing subsite distribution of colon cancer. The present study provides a review of the subsite-specific risk estimates for the dietary components presently regarded as convincing or probable risk factors for colorectal cancer: red meat, processed meat, fiber, garlic, milk, calcium, and alcohol. Methods. Studies were identified by searching PubMed through October 8, 2012 and by reviewing reference lists. Thirty-two prospective cohort studies are included, and the estimates are compared by sex for each risk factor. Results. For alcohol, there seems to be a stronger association with rectal cancer than with colon cancer, and for meat a somewhat stronger association with distal colon and rectal cancer, relative to proximal colon cancer. For fiber, milk, and calcium, there were only minor differences in relative risk across subsites. No statement could be given regarding garlic. Overall, many of the subsite-specific risk estimates were nonsignificant, irrespective of exposure. Conclusion. For some dietary components the associations with risk of cancer of the rectum and distal colon appear stronger than for proximal colon, but not for all.
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Meyerhardt JA, Sato K, Niedzwiecki D, Ye C, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Wigler DS, Venook A, Fuchs CS. Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Natl Cancer Inst 2012; 104:1702-11. [PMID: 23136358 DOI: 10.1093/jnci/djs399] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The influence of glycemic load and related measures on survival among colon cancer patients remains largely unknown. METHODS We conducted a prospective, observational study of 1011 stage III colon cancer patients reporting dietary intake during and 6 months after participation in an adjuvant chemotherapy trial. We examined the influence of glycemic load, glycemic index, fructose, and carbohydrate intakes on cancer recurrence and mortality using Cox proportional hazards regression; all tests of statistical significance were two-sided. RESULTS Stage III colon cancer patients in the highest quintile of dietary glycemic load experienced an adjusted hazard ratio (HR) for disease-free survival of 1.79 (95% confidence interval [CI] = 1.29 to 2.48), compared with those in the lowest quintile (P (trend) across quintiles <.001). Increased glycemic load was associated with similar detriments in recurrence-free (P (trend) across quintiles <.001) and overall survival (P (trend) across quintiles <.001). These associations differed statistically significant by body mass index (BMI) (P (interaction) =.01). Whereas glycemic load was not associated with disease-free survival in patients with BMI < 25kg/m(2), higher glycemic load was statistically significant associated with worse disease-free survival among overweight or obese participants (BMI ≥ 25kg/m(2); HR = 2.26; 95% CI = 1.53 to 3.32; P (trend) across quintiles <.001). Increasing total carbohydrate intake was similarly associated with inferior disease-free, recurrence-free, and overall survival (P (trend) across quintiles <.001). CONCLUSION Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality in stage III colon cancer patients. These findings support the role of energy balance factors in colon cancer progression and may offer potential opportunities to improve patient survival.
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Huxley RR, Woodward M, Clifton P. The Epidemiologic Evidence and Potential Biological Mechanisms for a Protective Effect of Dietary Fiber on the Risk of Colorectal Cancer. Curr Nutr Rep 2012. [DOI: 10.1007/s13668-012-0030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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30
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Glycaemic index and glycaemic load in relation to risk of diabetes-related cancers: a meta-analysis. Br J Nutr 2012; 108:1934-47. [PMID: 23167978 DOI: 10.1017/s0007114512003984] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diets high in glycaemic index (GI) or glycaemic load (GL) have been hypothesised to increase the risks of certain cancers by increasing blood glucose or insulin concentrations. We aimed to conduct a meta-analysis of prospective cohort studies to evaluate the association between GI or GL and diabetes-related cancers (DRC), including bladder, breast, colon-rectum, endometrium, liver and pancreas, which are associated with an increased risk for diabetes, and prostate cancer, which is associated with a reduced risk for diabetes. We searched Pubmed, EMBASE and MEDLINE databases up to September 2011 and reference lists of relevant articles. Relative risks (RR) and 95 % CI for the highest v. the lowest categories were extracted and pooled using a random-effects model. Thirty-six prospective cohort studies with a total of 60 811 DRC cases were included in the present meta-analysis. In a comparison of the highest and lowest categories, the pooled RR of DRC were 1·07 (95 % CI 1·04, 1·11; n 30) for GI and 1·02 (95 % CI 0·96, 1·08; n 33) for GL. In an analysis of site-specific cancer risks, we found significant associations for GI in relation to breast cancer (RR 1·06; 95 % CI 1·02, 1·11; n 11) and colorectal cancer (RR 1·08; 95 % CI 1·00, 1·17; n 9 studies). GL was significantly associated with the risk of endometrial cancer (RR 1·21; 95 % CI 1·07, 1·37; n 5). In conclusion, the findings of the present study suggest a modest-to-weak association between a diet that induces a high glucose response and DRC risks.
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31
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Risk factors for colon cancer in 150,912 postmenopausal women. Cancer Causes Control 2012; 23:1599-605. [DOI: 10.1007/s10552-012-0037-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 07/18/2012] [Indexed: 01/08/2023]
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Abstract
PURPOSE OF REVIEW There is a growing body of in-vivo evidences that sucrose-rich diets cause mutations in the rat colon epithelium, with several biological mechanism hypothesized, but epidemiological studies have yielded conflicting results. In order to provide a quantification of the magnitude of the risk of colon cancer for high intake of added sugar, high dietary glycemic index and glycemic load, we performed a meta-analysis based on a systematic review of the literature to date. RECENT FINDINGS Recent epidemiological data indicate a lack of association between high intake of added sugar, high-glycemic index and glycemic load diets and risk of colon cancer. SUMMARY There is no consistent evidence from epidemiological studies, although a modest excess risk emerged in case-control studies, that added sugars, dietary glycemic index and glycemic load are associated with increased risk of colon cancer, independently from their effect on energy intake, overweight, obesity and diabetes, which are related to excess colon cancer risk.
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Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, Dahm CC, Overvad K, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Racine A, Kaaks R, Teucher B, Boeing H, Bergmann MM, Trichopoulou A, Trichopoulos D, Lagiou P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Siersema P, van Duijnhoven F, Peeters PHM, Hjartaker A, Engeset D, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Ardanaz E, Quirós JR, Sonestedt E, Ericson U, Nilsson L, Palmqvist R, Khaw KT, Wareham N, Key TJ, Crowe FL, Fedirko V, Wark PA, Chuang SC, Riboli E. Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition (EPIC). PLoS One 2012; 7:e39361. [PMID: 22761771 PMCID: PMC3382210 DOI: 10.1371/journal.pone.0039361] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/18/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. METHODOLOGY/PRINCIPAL FINDINGS After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. CONCLUSIONS/SIGNIFICANCE Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.
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Affiliation(s)
- Neil Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Pietro Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Bas Bueno-de-Mesquita
- The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - Guri Skeie
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Christina C. Dahm
- Department of Cardiology, Aarhus University Hospital, Aalborg, Denmark and Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Françoise Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Institut Gustave Roussy, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
| | - Marie Christine Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Institut Gustave Roussy, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
| | - Antoine Racine
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Institut Gustave Roussy, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
| | - Rudolf Kaaks
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Birgit Teucher
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Manuela M. Bergmann
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Antonia Trichopoulou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Dimitrios Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, Untied States of America
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Pagona Lagiou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, Untied States of America
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Valeria Pala
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civile - M.P. Arezzo” Hospital, Ragusa, Italy
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- HuGeF Foundation, Torino, Italy
| | - Peter Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - Franzel van Duijnhoven
- The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Anette Hjartaker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Dagrun Engeset
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Carlos A. González
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Maria-José Sánchez
- Andalusian School of Public Health, Granada, Spain
- CIBER Epidemiology and Public Health CIBERESP, Spain
| | - Miren Dorronsoro
- Public Health Division of Gipuzkoa., Basque Regional Health Department and Ciberesp-Biodonostia, San Sebastian, Spain
| | - Carmen Navarro
- CIBER Epidemiology and Public Health CIBERESP, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - José R. Quirós
- Public Health and Health Planning Directorate, Asturias, Spain
| | - Emily Sonestedt
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Lena Nilsson
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | | | - Kay-Tee Khaw
- University of Cambridge, Cambridge, United Kingdom
| | - Nick Wareham
- MRC Epidemiology Unit, Cambridge, United Kingdom
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine University of Oxford, Oxford, United Kingdom
| | - Francesca L. Crowe
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine University of Oxford, Oxford, United Kingdom
| | - Veronika Fedirko
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Petra A. Wark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Shu-Chun Chuang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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The association of diabetes with breast cancer incidence and mortality in the Long Island Breast Cancer Study Project. Cancer Causes Control 2012; 23:1193-203. [PMID: 22674293 DOI: 10.1007/s10552-012-9989-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 05/03/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Diabetes has been associated with increased risk of breast cancer in a number of epidemiologic studies, but its effects on survival among women diagnosed with breast cancer have been examined less frequently. Importantly, prior investigations have rarely considered the influence of factors associated with diabetes such as obesity, age at diabetes diagnosis, duration of diabetes, or diabetes treatments. METHODS We evaluated the effect of self-reported diabetes on breast cancer incidence and mortality in the Long Island Breast Cancer Study Project, which includes 1,447 breast cancer cases and 1,453 controls. Follow-up data for all-cause (n = 395) and 5-year breast cancer-specific mortality (n = 104) through December 2005 were determined for case women from the National Death Index. Adjusted logistic regression and Cox proportional hazards models were used to estimate odds ratios (OR) and hazards ratios (HR), respectively. RESULTS Postmenopausal women with diabetes were at increased risk of developing breast cancer [OR = 1.35; 95 % confidence interval (CI) = 0.99-1.85], as were those who were not of white race regardless of menopausal status [OR = 3.89; 95 % CI = 1.66-9.11]. Among case women, diabetes was associated with a modestly increased risk of death from all causes [HR = 1.65; 95 % CI = 1.18-2.29], an association that was stronger in women who were obese at breast cancer diagnosis [HR = 2.49; 94 % CI = 1.58-3.93]. In analyses restricted to diabetics, there was no statistically significant effect of duration of diabetes or type of treatment on breast cancer incidence or mortality. CONCLUSIONS Our findings suggest that diabetes may increase incidence of breast cancer in older women and non-whites, and mortality due to all causes.
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Carbohydrates, glycemic index, glycemic load, and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Cancer Causes Control 2012; 23:521-35. [DOI: 10.1007/s10552-012-9918-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 02/09/2012] [Indexed: 01/17/2023]
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Hauner H, Bechthold A, Boeing H, Brönstrup A, Buyken A, Leschik-Bonnet E, Linseisen J, Schulze M, Strohm D, Wolfram G. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. ANNALS OF NUTRITION AND METABOLISM 2012; 60 Suppl 1:1-58. [PMID: 22286913 DOI: 10.1159/000335326] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition - next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.
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Affiliation(s)
- Hans Hauner
- Technical University of Munich, Freising-Weihenstephan, Germany
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Perera PS, Thompson RL, Wiseman MJ. Recent Evidence for Colorectal Cancer Prevention Through Healthy Food, Nutrition, and Physical Activity: Implications for Recommendations. Curr Nutr Rep 2012. [DOI: 10.1007/s13668-011-0006-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Tasevska N, Jiao L, Cross AJ, Kipnis V, Subar AF, Hollenbeck A, Schatzkin A, Potischman N. Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. Int J Cancer 2012; 130:159-69. [PMID: 21328345 PMCID: PMC3494407 DOI: 10.1002/ijc.25990] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 01/26/2011] [Indexed: 12/13/2022]
Abstract
Prospective epidemiologic data on the effects of different types of dietary sugars on cancer incidence have been limited. In this report, we investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies. Participants (n = 435,674) aged 50-71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ). Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) in multivariable models adjusted for confounding factors pertinent to individual cancers. We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma (HR(Q5 vs. Q1) : 1.62, 95% CI: 1.07-2.45; p(trend) = 0.01), added fructose was associated with risk of small intestine cancer (HR(Q5 vs. Q1) : 2.20, 95% CI: 1.16-4.16; p(trend) = 0.009) and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer. Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.
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Affiliation(s)
- Nataša Tasevska
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7242, USA.
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Aune D, Chan DSM, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ (CLINICAL RESEARCH ED.) 2011. [PMID: 22074852 DOI: 10.1136/bmj.d6617]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer. DESIGN Systematic review and meta-analysis of prospective observational studies. DATA SOURCES PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses. STUDY SELECTION Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer. RESULTS 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%). CONCLUSION A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK.
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Aune D, Chan DSM, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ (CLINICAL RESEARCH ED.) 2011. [PMID: 22074852 DOI: 10.1136/bmj.d6617].] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer. DESIGN Systematic review and meta-analysis of prospective observational studies. DATA SOURCES PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses. STUDY SELECTION Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer. RESULTS 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%). CONCLUSION A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK.
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Aune D, Chan DSM, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011; 343:d6617. [PMID: 22074852 PMCID: PMC3213242 DOI: 10.1136/bmj.d6617] [Citation(s) in RCA: 678] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer. DESIGN Systematic review and meta-analysis of prospective observational studies. DATA SOURCES PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses. STUDY SELECTION Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer. RESULTS 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%). CONCLUSION A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK.
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Hansen L, Skeie G, Landberg R, Lund E, Palmqvist R, Johansson I, Dragsted LO, Egeberg R, Johnsen NF, Christensen J, Overvad K, Tjønneland A, Olsen A. Intake of dietary fiber, especially from cereal foods, is associated with lower incidence of colon cancer in the HELGA cohort. Int J Cancer 2011; 131:469-78. [DOI: 10.1002/ijc.26381] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 07/05/2011] [Indexed: 02/06/2023]
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Li HL, Yang G, Shu XO, Xiang YB, Chow WH, Ji BT, Zhang X, Cai H, Gao J, Gao YT, Zheng W. Dietary glycemic load and risk of colorectal cancer in Chinese women. Am J Clin Nutr 2011; 93:101-7. [PMID: 20962156 PMCID: PMC3001600 DOI: 10.3945/ajcn.110.003053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mixed results have been reported in recent epidemiologic studies in Western populations that have investigated the hypothesis that high glycemic load may increase the risk of colorectal cancer. This association has not been prospectively evaluated in other populations. OBJECTIVE We examined the association of overall glycemic index and glycemic load with colorectal cancer risk in a prospective cohort of Chinese women. DESIGN A total of 73,061 women aged 40-70 y and free of cancer at enrollment were included in this analysis. Usual dietary intake was assessed at baseline (1997-2000) and reassessed during the first follow-up (2000-2002) through in-person interviews by using a validated food-frequency questionnaire. RESULTS During an average follow-up of 9.1 y, 475 incident colorectal cancer cases were identified. Glycemic load was not associated with colorectal cancer risk (P for trend = 0.84). The multivariable hazard ratio for the highest compared with the lowest quintile of glycemic load was 0.94 (95% CI: 0.71, 1.24). Similar results were also observed for associations with dietary glycemic index and total carbohydrate intake, and results did not vary by excluding individuals with a history of diabetes from the analysis. CONCLUSION This prospective study, conducted in a population with a high intake of carbohydrates, provides no evidence that a high-glycemic index diet or high glycemic load is associated with an increased risk of colorectal cancer.
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Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, Pollak M, Regensteiner JG, Yee D. Diabetes and cancer: a consensus report. Diabetes Care 2010; 33:1674-85. [PMID: 20587728 PMCID: PMC2890380 DOI: 10.2337/dc10-0666] [Citation(s) in RCA: 1385] [Impact Index Per Article: 98.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Epidemiologic evidence suggests that cancer incidence is associated with diabetes as well as certain diabetes risk factors and diabetes 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 risk of cancer or cancer prognosis. In addition, key unanswered questions for future research are posed.
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Affiliation(s)
- Edward Giovannucci
- Department of Nutrition, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology 2010; 138:2029-2043.e10. [PMID: 20420944 PMCID: PMC2947820 DOI: 10.1053/j.gastro.2010.01.057] [Citation(s) in RCA: 411] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 01/10/2010] [Accepted: 01/14/2010] [Indexed: 02/07/2023]
Abstract
Colorectal cancer has been strongly associated with a Western lifestyle. In the past several decades, much has been learned about the dietary, lifestyle, and medication risk factors for this malignancy. Although there is controversy about the role of specific nutritional factors, consideration of dietary pattern as a whole appears useful for formulating recommendations. For example, several studies have shown that high intake of red and processed meats, highly refined grains and starches, and sugars is related to increased risk of colorectal cancer. Replacing these factors with poultry, fish, and plant sources as the primary source of protein; unsaturated fats as the primary source of fat; and unrefined grains, legumes and fruits as the primary source of carbohydrates is likely to lower risk of colorectal cancer. Although a role for supplements, including vitamin D, folate, and vitamin B6, remains uncertain, calcium supplementation is likely to be at least modestly beneficial. With respect to lifestyle, compelling evidence indicates that avoidance of smoking and heavy alcohol use, prevention of weight gain, and maintenance of a reasonable level of physical activity are associated with markedly lower risks of colorectal cancer. Medications such as aspirin and nonsteroidal anti-inflammatory drugs and postmenopausal hormones for women are associated with substantial reductions in colorectal cancer risk, though their utility is affected by associated risks. Taken together, modifications in diet and lifestyle should substantially reduce the risk of colorectal cancer and could complement screening in reducing colorectal cancer incidence.
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Abstract
In this review, we briefly summarize some of the key developments in nutritional epidemiology and cancer over the past two decades with a focus on the strengths and limitations of study designs and dietary assessment methods. We present the evidence on dietary fat, meat, fiber, antioxidant nutrients, and calcium in relation to carcinogenesis from large cohort studies and randomized clinical trials (RCTs) and refer to the conclusions of the 2007 World Cancer Research Fund/American Institute for Cancer Research summary report. One prominent theme that emerged is the lack of concordance of results from RCTs and observational studies. There are multiple potential reasons for these discrepancies, including differences in study population, dose and timing of the exposure, adherence to an intervention, length of follow-up, and the primary endpoint. Therefore, null findings of RCTs do not necessarily indicate a lack of effect for the tested dietary factors on cancer risk, as some of these nutrients may have chemopreventive effects if given at the right time and in the right dose. It is likely that potential benefits from diet are due to a combination of food constituents rather than single components acting in isolation. Future efforts need to recognize the integrative nature of dietary exposures and attempt to study nutrients in the larger context of the foods and diets in which they are consumed.
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Affiliation(s)
- Todd M Gibson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD 20852, USA.
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Nutrients and risk of colon cancer. Cancers (Basel) 2010; 2:51-67. [PMID: 24281033 PMCID: PMC3827591 DOI: 10.3390/cancers2010051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/19/2010] [Accepted: 02/03/2010] [Indexed: 12/17/2022] Open
Abstract
Dietary fats are thought to be important in the etiology of colon cancer. However, the evidence linking them is inconclusive. Studies on dietary protein, cholesterol and carbohydrate and the risk of colon cancer are also inconsistent. This study examined the association between dietary intake of protein, fats, cholesterol and carbohydrates, and the risk of colon cancer. Mailed questionnaires were completed by 1731 individuals with histologically confirmed cases of colon cancer and 3097 population controls between 1994 and 1997 in seven Canadian provinces. Measurements included socio-economic status, lifestyle habits and diet. A 69-item food frequency questionnaire was used to provide data on eating habits from two years before the study. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression. The nutrients were categorized by quartiles based on the distributions among the controls. Intake of polyunsaturated fat, trans-fat and cholesterol were significantly associated with the risk of colon cancer; the ORs for the highest quartiles were 1.36 (95% CI, 1.02–1.80), 1.37 (95% CI, 1.10–1.71) and 1.42 (95% CI, 1.10–1.84), respectively. The association was stronger with proximal colon cancer (PCC). An increased risk was also observed with increasing intake of sucrose for both proximal and distal colon cancers; the ORs for the highest quartiles were 1.67 (95% CI, 1.22–2.29) for PCC and 1.58 (95% CI, 1.18–2.10) for distal colon cancer (DCC). An elevated risk of PCC was also found with increased lactose intake. Our findings provide evidence that a diet low in fat and sucrose could reduce the risk of various colon cancers.
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George SM, Mayne ST, Leitzmann MF, Park Y, Schatzkin A, Flood A, Hollenbeck A, Subar AF. Dietary glycemic index, glycemic load, and risk of cancer: a prospective cohort study. Am J Epidemiol 2009; 169:462-72. [PMID: 19095757 DOI: 10.1093/aje/kwn347] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Previous studies have provided limited evidence for a harmful effect of high glycemic index and dietary glycemic load on cancer. The authors analyzed associations among glycemic index, glycemic load, and risk of cancer in women and men in the National Institutes of Health-AARP Diet and Health Study. Published glycemic index values were assigned to 225 foods/food groups. Glycemic load was calculated by multiplying the glycemic index, carbohydrate content, and intake frequency of individual foods reported on a food frequency questionnaire. From 1995 through 2003, the authors identified 15,215 and 33,203 cancer cases in women and men, respectively. Cox proportional hazards models were used to estimate multivariate relative risks and 95% confidence intervals. For women and men, respectively, the relative risks for total cancer for high versus low glycemic index were 1.03 (P(trend)=0.217) and 1.04 (P(trend)=0.012) and, for glycemic load, were 0.90 (P(trend)=0.024) and 0.93 (P(trend)=0.01). Associations with total cancer held only among the overweight for glycemic index and among those of healthy weight for glycemic load. These findings suggest that glycemic index and glycemic load are not strong predictors of cancer incidence. The direction and small magnitude of associations might be explained by the manner in which high glycemic index and glycemic load track with overall diet and lifestyle patterns.
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Mulholland HG, Murray LJ, Cardwell CR, Cantwell MM. Glycemic index, glycemic load, and risk of digestive tract neoplasms: a systematic review and meta-analysis. Am J Clin Nutr 2009; 89:568-76. [PMID: 19088152 DOI: 10.3945/ajcn.2008.26823] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Habitual consumption of diets with a high glycemic index (GI) and a high glycemic load (GL) may influence cancer risk via hyperinsulinemia and the insulin-like growth factor axis. OBJECTIVE The objective was to conduct a systematic review to assess the association between GI, GL, and risk of digestive tract cancers. DESIGN Medline and Embase were searched for relevant publications from inception to July 2008. When possible, adjusted results from a comparison of cancer risk of the highest compared with the lowest category of GI and GL intake were combined by using random-effects meta-analyses. RESULTS Cohort and case-control studies that examined the risk between GI or GL intake and colorectal cancer (n = 12) and adenomas (n = 2), pancreatic cancer (n = 6), gastric cancer (n = 2), and squamous-cell esophageal carcinoma (n = 1) were retrieved. Most case-control studies observed positive associations between GI and GL intake and these cancers. However, pooled cohort study results showed no associations between colorectal cancer risk and GI intake [relative risk (RR): 1.04; 95% CI: 0.92, 1.12; n = 7 studies] or GL intake (RR: 1.06; 95% CI: 0.95, 1.17; n = 8 studies). Furthermore, no significant associations were observed in meta-analyses of cohort study results of colorectal cancer subsites and GI and GL intake. Similarly, no significant associations emerged between pancreatic cancer risk and GI intake (RR: 0.99; 95% CI: 0.83, 1.19; n = 5 studies) or GL intake (RR: 1.01; 95% CI: 0.86, 1.19; n = 6 studies) in combined cohort studies. CONCLUSIONS The findings from our meta-analyses indicate that GI and GL intakes are not associated with risk of colorectal or pancreatic cancers. There were insufficient data available regarding other digestive tract cancers to make any conclusions about GI or GL intake and risk.
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Affiliation(s)
- Helen G Mulholland
- Cancer Epidemiology & Prevention Research Group, Centre for Clinical & Population Sciences, Queen's University Belfast, Mulhouse Building, Royal Victoria Hospital Site, Belfast, Northern Ireland.
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