Article

Dietary glycemic load, carbohydrate, sugar, and colorectal cancer risk in men and women

Harvard School of Public Health, Kresge 920, 677 Huntington Avenue, Boston, MA 02115, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.32). 02/2005; 14(1):138-47.
Source: PubMed

ABSTRACT Hyperinsulinemia may explain excess colorectal cancer among individuals who are overweight or inactive. Recent studies have observed elevated colorectal cancer risk among individuals with elevated insulin levels 2 hours after oral glucose challenge or with elevated plasma C-peptide levels. The effect of consuming a high glycemic diet on colorectal risk, however, remains uncertain. Two prospective cohort studies, the Nurses' Health Study and the Health Professionals Follow-up Study, contributed up to 20 years of follow-up. After exclusions, 1,809 incident colorectal cancers were available for analyses. Dietary glycemic load (GL) was calculated as a function of glycemic index (postprandial blood glucose response as compared with a reference food), carbohydrate content, and frequency of intake of individual foods reported on food frequency questionnaires. Multivariable Cox proportional hazards models were used to adjust for potential confounders. Intakes of dietary carbohydrate, GL, overall glycemic index, sucrose, and fructose were not associated with colorectal cancer risk in women. A small increase in risk was observed in men with high dietary GL (multivariate relative risk, 1.32; 95% confidence interval, 0.98-1.79; highest versus lowest quintile), sucrose or fructose (multivariate relative risk, 1.37; 95% confidence interval, 1.05-1.78; highest versus lowest quintile of fructose, P = 0.008). Associations were slightly stronger among men with elevated body mass index (> or =25 kg/m(2)). Results among women were similar after stratifying by body mass index or physical activity. High intakes of GL, fructose, and sucrose were related to an elevated colorectal cancer risk among men. For women, however, these factors did not seem to increase the risk of colorectal cancer.

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    • "In the present study, alcohol use and body mass index were positively associated with colorectal cancer [15] [28], and light smoking was associated with a decreased risk [29]. Only one previous study addressed the effect modifications of lifestyle factors and reported that a positive association with sucrose intake was more evident among individuals with high alcohol consumption ( ‡20 g/day) and among those with high body mass index ( ‡25.0 kg/m 2 ) especially in men [25]. Contrary to the previous observation, the present study showed a positive association with sugars or sucrose intake only among male non-alcohol drinkers and failed to find an effect modification of body mass index. "
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    ABSTRACT: Objective A diet high in sugars may promote colorectal carcinogenesis, but it remains uncertain whether high intake of sugars or sucrose confers increased risk of colorectal cancer. The authors investigated the associations of sugars and sucrose intake with colorectal cancer risk in a community-based case–control study in Japan. Methods The study subjects comprised 816 incident cases of colorectal cancer and 815 community controls. Consumption frequencies and portion sizes of 148 food and beverage items were ascertained by a computer-assisted interview. The authors used the consumption of 29 food items to estimate sugars and sucrose intake. The odds ratios of colorectal cancer risk according to intake categories were obtained using a logistic regression model with adjustment for potential confounding variables. Results Overall, intakes of sugars and sucrose were not related to colorectal cancer risk either in men or women. The association between sugars intake and colorectal cancer risk differed by smoking status and alcohol use in men, but not in women. In men, sugars intake tended to be associated with colorectal cancer risk inversely among never-smokers and positively among male ever-smokers (interaction p = 0.01). Sugars intake was associated with an increased risk among men with no alcohol consumption, but was unrelated to the risk among male alcohol drinkers (interaction p = 0.02). Body mass index did not modify the association with sugars intake in either men or women. Conclusion Sugars intake was associated with increased risk of colorectal cancer among smokers and non-alcohol drinkers in men selectively.
    Scandinavian Journal of Gastroenterology 04/2014; 49(5). DOI:10.3109/00365521.2013.822091 · 2.33 Impact Factor
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    • "Population M, F Franceschi et al, 2001 (53) Italy CC 1953 4154 Hospital M, F Levi et al, 2002 (54) Switzerland CC 323 661 Hospital M, F Terry et al, 2003 (63) Canada Cohort NBSS 616 49124 F Higginbotham et al, 2004 (64) USA Cohort WHS 174 38451 F Michaud et al, 2005 (20) USA Cohort HPFS, NHSI 1809 131349 M, F Larsson et al, 2007 (65) Sweden Cohort SMC 870 61433 F McCarl et al, 2006 (40) USA Cohort IWHS 954 35197 F Murtaugh et al, 2006 (29) USA CC KPMCP 1698 1861 Population M, F Strayer et al, 2007 (55) USA Cohort BCDDP 490 45561 F Weijenberg et al, 2007 (56) Netherlands Cohort NCS 1643 120852 M, F Pancreas Michaud et al, 2002 (36) USA Cohort NHS 180 88802 F Johnson et al, 2005 (42) USA Cohort IWHS 190 34699 F Silvera et al, 2005 (66) "
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    ABSTRACT: Factors linked to glucose metabolism play an important role in the development of cancers, and both glycemic index (GI) and glycemic load (GL) have been investigated as potential etiologic factors. A meta-analysis was performed to explore the association between GI and GL and cancer risk from published studies. A comprehensive, systematic bibliographic search of the medical literature was conducted to identify relevant studies. Case-control and cohort studies published before October 2007 that reported cancer risk estimates for GI and GL were included. Pooled relative risks (RRs) were estimated for breast, colorectal, endometrial, and pancreatic cancer. Thirty-nine studies were included in the meta-analysis. The interquantile ranges of GL were significantly wider in case-control studies, most of which were conducted in European countries, than in cohort studies. Cohort studies that presented lower ranges of GL also reported lower risk estimates. Overall, both GL and GI were significantly associated with a greater risk of colorectal (summary RR = 1.26; 95% CI: 1.11, 1.44 and RR = 1.18; 95% CI: 1.05, 1.34, respectively) and endometrial (RR = 1.36; 95% CI: 1.14, 1.62 and RR = 1.22; 95% CI: 1.01, 1.49) cancer than of breast and pancreatic cancer. There was, however, a significant between-study heterogeneity for colorectal cancer (P < 0.0001). The association between GL and breast cancer disappeared when publication bias was taken into account. No association was found for pancreatic cancer. This comprehensive meta-analysis of GI and GL and cancer risk suggested an overall direct association with colorectal and endometrial cancer.
    American Journal of Clinical Nutrition 07/2008; 87(6):1793-801. · 6.92 Impact Factor
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    • "(See Figures 1, 2, and 3) Notably, the risk of type 2 diabetes, CHD, and stroke is not significantly elevated with increasing glycemic load among lean populations; while in contrast among overweight individuals, results show >50% increase in RR with higher intake of GL for type 2 diabetes [35], and >2-fold RR for CHD and stroke [39,40]. Moreover, similar patterns have also been repeated observed for GL and cancer risk, where high GL is more strongly associated with colorectal cancer incidence among those with higher BMI [76,77], and high-glycemic sugar-sweetened beverages more strongly linked with pancreatic cancer among those with low physical activity and/or greater adiposity [78]. "
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    ABSTRACT: As China is undergoing dramatic development, it is also experiencing major societal changes, including an emerging obesity epidemic, with the prevalence of overweight and obesity doubling in the past decade. However, the implications of a high glycemic index (GI) and glycemic load (GL) traditional Chinese diet are adversely changing in modern times, as a high-glycemic diet is becoming a greater contributor to diabetes and cardiovascular risks in a population with rising obesity and decreasing physical activity. Specifically, a high GI diet adversely impacts metabolism and appetite control regulation, and notably confers substantially greater risk of weight gain, type 2 diabetes, cardiovascular disease, and certain cancers among overweight and obese individuals (P<0.05 for all); leading to an emerging vicious cycle of compounding adverse health risks. Notably, while no elevated risk of cardiovascular disease and type 2 diabetes were observed with higher GL intake among normal weight individuals, among overweight individuals, higher GL was strongly associated with higher risk of coronary heart disease (RR=2.00, 95%CI: 1.31-2.96), stroke (RR=2.13, 1.28-3.53), and type 2 diabetes (RR=1.52, 1.22-1.89 among Chinese). Additionally, the influx of Western-diets rich in saturated fats and high-glycemic sugar-sweetened beverages also threaten the health of the population. This review highlights the emerging adverse convergence of a high-glycemic Asian diet with a Chinese society experiencing an emerging obesity epidemic, and the important implications of these combined factors on compounding cardiometabolic risks. Potential policy directions in China are also discussed.
    Globalization and Health 02/2008; 4:4. DOI:10.1186/1744-8603-4-4 · 1.83 Impact Factor
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