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Glycemic load, glycemic index, and carbohydrate intake in relation to pancreatic cancer risk in a large US cohort

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Abstract

Background

Consumption of diets with high glycemic load has been hypothesized to increase pancreatic cancer risk by raising postprandial glucose levels and insulin secretion.

Methods

The authors analyzed data from the American Cancer Society Cancer Prevention Study II (CPS-II) Nutrition Cohort to examine the association between pancreatic cancer and glycemic load, glycemic index (GI), and intake of carbohydrates. Diet was assessed among 124,907 men and women who were cancer-free and non-diabetic at baseline in 1992 using a validated 68-item food frequency questionnaire (FFQ). During 9 years of follow-up, 401 incident pancreatic cancer cases were identified. Cox proportional hazards modeling was used to compute hazard rate ratios (RR) adjusted for potential confounding factors.

Results

We found no association between glycemic load, GI, or carbohydrate intake and risk of pancreatic cancer in this population. The hazard rate ratio (RR) was 1.01 (95% CI 0.75–1.37, trend P = 0.80) for glycemic load, 0.92 (95% CI 0.68–1.24) for GI, and 1.10 (95% CI 0.80–1.51) for carbohydrate intake among men and women in the highest quintile compared to the lowest quintile of each measure. We also found no significant association between these measures and pancreatic cancer risk among individuals who show a greater susceptibility towards insulin insensitivity, such as those who are overweight or more sedentary.

Conclusion

Overall, our data do not support the hypothesis that glycemic load or index, or carbohydrate intake are associated with a substantial increase in pancreatic cancer risk; however, a weak positive association cannot be ruled out.

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Abbreviations

RR:

rate ratio

CI:

confidence interval

CPS-II:

Cancer Prevention Study II

ICD:

International Classification of Diseases

NDI:

National Death Index

GI:

glycemic index

GL:

glycemic load

CHO:

carbohydrates

BMI:

body mass index

MET:

metabolic equivalent

SE:

standard error

References

  1. American Cancer Society (2006) Cancer Facts & Figures. Atlanta, GA: American Cancer Society

    Google Scholar 

  2. Calle EE, Murphy TK, Rodriguez C, Thun MJ, Jr. CWH (1998) Diabetes mellitus and pancreatic cancer mortality in a prospective cohort of United States adults. Cancer Causes Control 9:403–410

    Article  PubMed  CAS  Google Scholar 

  3. Coughlin SS, Calle EE, Patel AV, Thun MJ (2000) Predictors of pancreatic cancer mortality among a large cohort of United States adults. Cancer Causes Control 11:915–923

    Article  PubMed  CAS  Google Scholar 

  4. Everhart J, Wright D (1995) Diabetes mellitus as a risk factor for pancreatic cancer. JAMA 273:1605–1609

    Article  PubMed  CAS  Google Scholar 

  5. IARC (2002) IARC handbooks on cancer prevention: weight control and physical activity. Lyon: IARC Press

    Google Scholar 

  6. Lund-Nilsen TI, Vateen LJ (2000) A prospective study of lifestyle factors and the risk of pancreatic cancer in Nord-Trondelag, Norway. Cancer Causes Control 11:645–652

    Article  Google Scholar 

  7. Villeneuve PJ, Johnson KC, Hanley AJG, Mao Y (2000) Canadian cancer registries epidemiology research group. Alcohol, tobacco, and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case-control project. Eur J Cancer Prev 9:49

    Article  PubMed  CAS  Google Scholar 

  8. Patel AV, Rodriguez C, Bernstein L, Chao A, Thun MJ, Calle EE (2005) Obesity, recreational physical activity, and risk of pancreatic cancer in a large US cohort. Cancer Epidemiol Biomarkers Prev 14:459–466

    Article  PubMed  Google Scholar 

  9. Sasco AJ, Secretan MB, Straif K (2004) Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer 45(Supp. 2):S3–S9

    Article  PubMed  Google Scholar 

  10. Kaaks R, Lukanova A (2001) Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proc Nutr Soc 60:91–106

    Article  PubMed  CAS  Google Scholar 

  11. Kazakoff K, Cardesa T, Liu J, et al. (1996) Effects of voluntary physical exercise on high-fat-diet-promoted pancreatic carcinogenesis in the hamster model. Nutr Cancer 26:265–279

    Article  PubMed  CAS  Google Scholar 

  12. Batty GD, Shipley MJ, Marmot M, Smith GD (2004) Diabetes status and post-load plasma glucose concentration in relation to site-specific cancer mortality: findings from the original Whitehall study. Cancer Causes Control 15:873–881

    Article  PubMed  Google Scholar 

  13. Gapstur SM, Gann PH, Lowe W, Liu K, Colangelo L, Dyer A (2000) Abnormal glucose metabolism and pancreatic cancer mortality. JAMA 283:2552–2558

    Article  PubMed  CAS  Google Scholar 

  14. Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM (2005) Fasting serum glucose level and cancer risk in Korean men and women. JAMA 293:194–202

    Article  PubMed  CAS  Google Scholar 

  15. Stolzenberg-Solomon RZ, Graubard BI, Chari S, et al. (2005) Insulin, glucose, insulin resistance, and pancreatic cancer in male smokers. JAMA 294:2872–2878

    Article  PubMed  CAS  Google Scholar 

  16. Foster-Powell K, Holt SH, Brand-Miller JC (2002) International table of glycemic index and glycemic load values. Am J Clin Nutr 76:5–56

    PubMed  CAS  Google Scholar 

  17. Bjorck I, Elmstahl HL (2003) The glycaemic index: importance of dietary fibre and other food properties. Proc Nutr Soc 62:201–206

    Article  PubMed  CAS  Google Scholar 

  18. Salmeron J, Ascherio A, Rimm EB, et al. (1997) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20:545–550

    PubMed  CAS  Google Scholar 

  19. Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC (1997) Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 277:472–477

    Article  PubMed  CAS  Google Scholar 

  20. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB (2004) Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 80:348–356

    PubMed  CAS  Google Scholar 

  21. Johnson KJ, Anderson KE, Harnack L, Hong C, Folsom AR (2005) No association between dietary glycemic index or load and pancreatic cancer incidence in postmenopausal women. Cancer Epidemiol Biomarkers Prev 14:1574–5

    Article  PubMed  Google Scholar 

  22. Michaud DS, Liu S, Giovannucci E, Willett WC, Colditz GA, Fuchs CS (2002) Dietary sugar, glycemic load, and pancreatic cancer risk in a prospective study. J Nat Cancer Inst 4:1293–1300

    Google Scholar 

  23. Silvera SAN, Rohan TE, Jain M, Terry PD, Howe GR, Miller AB (2005) Glycemic index, glycemic load, and pancreatic cancer risk (Canada). Cancer Causes Control 16:431–436

    Article  PubMed  Google Scholar 

  24. Howe GR, Jain M, Miller AB (1990) Dietary factors and risk of pancreatic cancer: results of a Canadian population-based case-control study. Int J Cancer 45:604–608

    Article  PubMed  CAS  Google Scholar 

  25. Lyon JL, Slattery ML, Mahoney AW, Robison LM (1993) Dietary intake as a risk factor for cancer of the exocrine pancreas. Cancer Epidemiol Biomarkers Prev 2:513–518

    PubMed  CAS  Google Scholar 

  26. Kalapothaki V, Tzonou A, Hsieh C, et al. (1993) Nutrient intake and cancer of the pancreas: a case-control study in Athens, Greece. Cancer Causes Control 4:383–389

    Article  PubMed  CAS  Google Scholar 

  27. Olsen GW, Mandel JS, Gibson RW, Wattenberg LW, Schuman LM (1991) Nutrients and pancreatic cancer: a population-based case-control study. Cancer Causes Control 2:291–297

    Article  PubMed  CAS  Google Scholar 

  28. Silverman DT, Swanson CA, Gridley G, et al. (1998) Dietary and nutritional factors and pancreatic cancer: a case-control study based on direct interviews. J Nat Cancer Inst 90:1710–1719

    Article  PubMed  CAS  Google Scholar 

  29. Polonsky KS, Sturis J, Bell GI (1996) Seminars in medicine of the beth Israel hospital, Boston. Non-insulin-dependent diabetes mellitus—a genetically programmed failure of the beta cell to compensate for insulin resistance. N Eng J Med 334:777–783

    Article  CAS  Google Scholar 

  30. Wolever T, Bolognesi C (1992) Prediction of glucose and insulin responses of normal subjects after consuming mixed meals varying in energy, protein, fat, carbohydrate, and glycemic index. Nutrition 126:2807–2812

    Google Scholar 

  31. Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB (1999) High glycemic index foods, overeating, and obesity. Pediatrics 103:E26

    Article  PubMed  CAS  Google Scholar 

  32. Calle EE, Rodriguez C, Jacobs EJ, et al. (2002) The American Cancer Society Cancer Prevention Study II Nutrition Cohort-rational, study design, and baseline characteristics. Cancer 94:500–511

    Article  PubMed  Google Scholar 

  33. Calle EE, Terrell DD (1993) Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol 137:235–241

    PubMed  CAS  Google Scholar 

  34. World Health Organization (1977) International classification of diseases ninth revision. Manual of the international statistical classification of disease, injuries, and causes of death, 9th rev. ed., WHO, Geneva

    Google Scholar 

  35. World Health Organization (1992) International statistical classification of diseases and related health problems tenth revision, 10th ed., WHO, Geneva

    Google Scholar 

  36. Bergmann M, Calle E, Mervis C, Miracle-McMahill H, Thun M, Heath C (1998) Validity of self-reported cancers in a prospective cohort study in comparison to data from state cancer registries. Am J Epidemiol 147:556–562

    PubMed  CAS  Google Scholar 

  37. Block G, Hartman AM, Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiology 1:58–64

    Article  PubMed  CAS  Google Scholar 

  38. Flagg EW, Coates RJ, Calle EE, Potischman N, Thun MJ (2000) Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire. Epidemiology 11:462–468

    Article  PubMed  CAS  Google Scholar 

  39. Wolever TMS, Jenkins DJA (1986) The use of the glycemic index in predicting the blood glucose to mixed meals. Am J Clin Nutr 43:167–172

    PubMed  CAS  Google Scholar 

  40. Foster-Powell K, Brand Miller J (1995) International tables of glycemic index. Am J Clin Nutr 62:871S–893S

    PubMed  CAS  Google Scholar 

  41. Pennington JAT (1983) Revision of the total diet study food list and diets. J Am Diet Assoc 82:166–173

    PubMed  CAS  Google Scholar 

  42. Jonas CR, McCullough ML, Teras LR, Walker-Thurmond KA, Thun MJ, Calle EE (2003) Dietary glycemic index, glycemic load, and risk of incident breast cancer in postmenopausal women. Cancer Epidemiol Biomarkers Prev 12:573–577

    PubMed  CAS  Google Scholar 

  43. Willett WC, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 24:17–27

    Google Scholar 

  44. Cox D (1972) Regression models and life tables. J R Stat Soc 34:187–220

    Google Scholar 

  45. Liu S (1998) Insulin resistance, hyperglycemia and risk of major chronic diseases-a dietary perspective. Proc Nutr Soc 22:140–150

    Google Scholar 

  46. Kleinbaum G, Kupper L, Morgenstern H (1982) Epidemiologic research: principles and quantitative methods. New York: Van Nostrand Reinhold Co

    Google Scholar 

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Correspondence to Alpa V. Patel.

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Patel, A.V., McCullough, M.L., Pavluck, A.L. et al. Glycemic load, glycemic index, and carbohydrate intake in relation to pancreatic cancer risk in a large US cohort. Cancer Causes Control 18, 287–294 (2007). https://doi.org/10.1007/s10552-006-0081-z

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  • DOI: https://doi.org/10.1007/s10552-006-0081-z

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