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.
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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.
The details of The Australian National Endometrial Cancer Study Group and The Australian Ovarian Cancer Study Group are given “Appendix”.
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The ANECS Group comprises: AB Spurdle, P Webb, J Young (Queensland Institute of Medical Research); Consumer representative: L McQuire; Clinical Collaborators: NSW: S Baron-Hay, D Bell, A Bonaventura, A Brand, S Braye, J Carter, F Chan, C Dalrymple, A Ferrier (deceased), G Gard, N Hacker, R Hogg, R Houghton, D Marsden, K McIlroy, G Otton, S Pather, A Proietto, G Robertson, J Scurry, R Sharma, G Wain, F Wong; Qld: J Armes, A Crandon, M Cummings, R Land, J Nicklin, L Perrin, A Obermair, B Ward; SA: M Davy, T Dodd, J Miller, M Oehler, S Paramasivum, J Pierides, F Whitehead; Tas: P Blomfield, D Challis; Vic: D Neesham, J Pyman, M Quinn, R Rome, M Weitzer; WA: B Brennan, I Hammond, Y Leung, A McCartney, C Stewart, J Thompson; Project Managers: S O’Brien, S Moore; Laboratory Manager: K Ferguson; Pathology Support: M Walsh; Admin Support: R Cicero, L Green, J Griffith, L Jackman, B Ranieri; Laboratory Assistants: M O’Brien, P Schultz; Research Nurses: B Alexander, C Baxter, H Croy, A Fitzgerald, E Herron, C Hill, M Jones, J Maidens, A Marshall, K Martin, J Mayhew, E Minehan, D Roffe, H Shirley, H Steane, A Stenlake, A Ward, S Webb, J White. Full membership of the Australian Ovarian Cancer Study Group is listed at http://www.aocstudy.org/.
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Nagle, C.M., Olsen, C.M., Ibiebele, T.I. et al. Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis. Eur J Nutr 52, 705–715 (2013). https://doi.org/10.1007/s00394-012-0376-7
- Glycemic load
- Glycemic index
- Dose–response meta-analysis
- Endometrial cancer