Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis
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The relationship between habitual consumption of foods with a high glycemic index (GI) and/or a diet with a high glycemic load (GL) and risk of endometrial cancer is uncertain, and relatively few studies have investigated these associations. The objectives of this study were to examine the association between GI/GL and risk of endometrial cancer using data from an Australian population-based case–control study and systematically review all the available evidence to quantify the magnitude of the association using meta-analysis.
The case–control study included 1,290 women aged 18–79 years with newly diagnosed, histologically confirmed endometrial cancer and 1,436 population controls. Controls were selected to match the expected Australian state of residence and age distribution (in 5-year bands) of cases. For the systematic review, relevant studies were identified by searching PubMed and Embase databases through to July 2011. Random-effects models were used to calculate the summary risk estimates, overall and dose–response.
In our case–control study, we observed a modest positive association between high dietary GI (OR 1.43, 95 % CI 1.11–1.83) and risk of endometrial cancer, but no association with high dietary GL (OR 1.15, 95 % CI 0.90–1.48). For the meta-analysis, we collated information from six cohort and two case–control studies, involving a total of 5,569 cases. The pooled OR for the highest versus the lowest intake category of GI was 1.15 (0.95–1.40); however, there was significant heterogeneity (p 0.004) by study design (RR 1.00 [95 % CI 0.87–1.14] for cohort studies and 1.56 [95 % CI 1.21–2.02] for case–control studies). There was no association in the dose–response meta-analysis of GI (RR per 5 unit/day increment of GI 1.00, 95 % CI 0.97–1.03). GL was positively associated with endometrial cancer. The pooled RR for the highest versus the lowest GL intake was 1.21 (95 % CI 1.09–1.33) and 1.06 (95 % CI 1.01–1.11) per 50 unit/day increment of GL in the dose–response meta-analysis.
The pooled results from observational studies, including our case–control results, provide evidence of a modest positive association between high GL, but not GI, and endometrial cancer risk.
KeywordsGlycemic load Glycemic index Case–control Dose–response meta-analysis Endometrial cancer
We thank all the women who participated in the study. We gratefully acknowledge the cooperation of the following institutions: NSW: John Hunter Hospital, Liverpool Hospital, Mater Misericordiae Hospital (Sydney), Mater Misericordiae Hospital (Newcastle), Newcastle Private Hospital, North Shore Private Hospital, Royal Hospital for Women, Royal Prince Alfred Hospital, Royal North Shore Hospital, Royal Prince Alfred Hospital, St George Hospital; Westmead Hospital, Westmead Private Hospital; Qld: Brisbane Private Hospital, Greenslopes Hospital, Mater Misericordiae Hospitals, Royal Brisbane and Women’s Hospital, Wesley Hospital, Queensland Cancer Registry; SA: Adelaide Pathology Partners, Burnside Hospital, Calvary Hospital, Flinders Medical Centre, Queen Elizabeth Hospital, Royal Adelaide Hospital, South Australian Cancer Registry; Tas: Launceston Hospital, North West Regional Hospitals, Royal Hobart Hospital; Vic: Freemasons Hospital, Melbourne Pathology Services, Mercy Hospital for Women, Royal Women’s Hospital, Victorian Cancer Registry; WA: King Edward Memorial Hospital, St John of God Hospitals Subiaco & Murdoch, Western Australian Cancer Registry. We also thank the authors of previously published studies who contributed information for the dose–response meta-analysis: Xiaohui Cui, Anne Cust, Aaron Folsom and Stephanie George. These analyses were supported by The Cancer Council Queensland [#496680]. The Australian National Endometrial Cancer Study was supported by the National Health and Medical Research Council (NHMRC) of Australia (#339435) and Cancer Council Tasmania (#403031 and 457636). CM Nagle, PM Webb and AB Spurdle are funded by NHMRC Fellowships.
- 1.Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev 11(12):1531–1543Google Scholar
- 2.Cust AE, Allen NE, Rinaldi S, Dossus L, Friedenreich C, Olsen A, Tjonneland A, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Linseisen J, Chang-Claude J, Boeing H, Schulz M, Benetou V, Trichopoulou A, Trichopoulos D, Palli D, Berrino F, Tumino R, Mattiello A, Vineis P, Quiros JR, Agudo A, Sanchez MJ, Larranaga N, Navarro C, Ardanaz E, Bueno-de-Mesquita HB, Peeters PH, van Gils CH, Bingham S, Khaw KT, Key T, Slimani N, Riboli E, Kaaks R (2007) Serum levels of C-peptide, IGFBP-1 and IGFBP-2 and endometrial cancer risk; results from the European prospective investigation into cancer and nutrition. Int J Cancer 120(12):2656–2664. doi: 10.1002/ijc.22578 CrossRefGoogle Scholar
- 3.Lukanova A, Zeleniuch-Jacquotte A, Lundin E, Micheli A, Arslan AA, Rinaldi S, Muti P, Lenner P, Koenig KL, Biessy C, Krogh V, Riboli E, Shore RE, Stattin P, Berrino F, Hallmans G, Toniolo P, Kaaks R (2004) Prediagnostic levels of C-peptide, IGF-I, IGFBP -1, -2 and -3 and risk of endometrial cancer. Int J Cancer 108(2):262–268. doi: 10.1002/ijc.11544 CrossRefGoogle Scholar
- 5.Bjorck I, Granfeldt Y, Liljeberg H, Tovar J, Asp NG (1994) Food properties affecting the digestion and absorption of carbohydrates. Am J Clin Nutr 59(3 Suppl):699S–705SGoogle Scholar
- 6.Brand-Miller J, McMillan-Price J, Steinbeck K, Caterson I (2009) Dietary glycemic index: health implications. J Am Coll Nutr 28(Suppl):446S–449SGoogle Scholar
- 11.Cust AE, Slimani N, Kaaks R, van Bakel M, Biessy C, Ferrari P, Laville M, Tjonneland A, Olsen A, Overvad K, Lajous M, Clavel-Chapelon F, Boutron-Ruault MC, Linseisen J, Rohrmann S, Nothlings U, Boeing H, Palli D, Sieri S, Panico S, Tumino R, Sacerdote C, Skeie G, Engeset D, Gram IT, Quiros JR, Jakszyn P, Sanchez MJ, Larranaga N, Navarro C, Ardanaz E, Wirfalt E, Berglund G, Lundin E, Hallmans G, Bueno-de-Mesquita HB, Du H, Peeters PH, Bingham S, Khaw KT, Allen NE, Key TJ, Jenab M, Riboli E (2007) Dietary carbohydrates, glycemic index, glycemic load, and endometrial cancer risk within the European prospective investigation into cancer and nutrition cohort. Am J Epidemiol 166(8):912–923CrossRefGoogle Scholar
- 15.Gnagnarella P, Gandini S, La Vecchia C, Maisonneuve P (2008) Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 87(6):1793–1801Google Scholar
- 17.Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, Brand-Miller JC (2008) Glycemic index, glycemic load, and chronic disease risk–a meta-analysis of observational studies. Am J Clin Nutr 87(3):627–637Google Scholar
- 18.Mulholland HG, Murray LJ, Cantwell MM (2008) Glycemic index, glycemic load, and chronic disease risk. Am J Clin Nutr 88 (2):475–476; author reply 476–477Google Scholar
- 21.Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE (1985) Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122(1):51–65Google Scholar
- 25.Silverberg S, Kurman RJ, Nogales F et al (eds) (2003) Tumours of the uterine corpus. World Health Organization classification of tumours. Pathology and genetics of tumours of the breast and female genital organs. IRAC Press, LyonGoogle Scholar
- 27.Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135(11):1301–1309Google Scholar
- 28.Orsini N, Bellocco R, Greenland S (2006) Generalized least squares for trend estimation of summarized dose-response data. Stata J 6:40–57Google Scholar
- 31.Foster-Powell K, Holt SH, Brand-Miller JC (2002) International table of glycemic index and glycemic load values. Am J Clin Nutr 76(1):5–56Google Scholar
- 34.Howlett J, Ashwell M (2008) Glycemic response and health: summary of a workshop. Am J Clin Nutr 87(1):212S–216SGoogle Scholar
- 36.Esfahani A, Wong JM, Mirrahimi A, Srichaikul K, Jenkins DJ, Kendall CW (2009) The glycemic index: physiological significance. J Am Coll Nutr 28(Suppl):439S–445SGoogle Scholar
- 39.Lukanova A, Kaaks R (2005) Endogenous hormones and ovarian cancer: epidemiology and current hypotheses. Cancer Epidemiol Biomarkers Prev 14(1):98–107Google Scholar
- 41.Kashima H, Shiozawa T, Miyamoto T, Suzuki A, Uchikawa J, Kurai M, Konishi I (2009) Autocrine stimulation of IGF1 in estrogen-induced growth of endometrial carcinoma cells: involvement of the mitogen-activated protein kinase pathway followed by up-regulation of cyclin D1 and cyclin E. Endocr Relat Cancer 16(1):113–122CrossRefGoogle Scholar
- 44.Jeppesen J, Schaaf P, Jones C, Zhou MY, Chen YD, Reaven GM (1997) Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. Am J Clin Nutr 65(4):1027–1033Google Scholar
- 45.Marks GC, Hughes MC, van der Pols JC (2006) Relative validity of food intake estimates using a food frequency questionnaire is associated with sex, age, and other personal characteristics. The Journal of nutrition 136(2):459–465Google Scholar