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Glycemic index, carbohydrate and fiber intakes and risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma

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Abstract

Objective

To examine the association between dietary glycemic index (GI), glycemic load (GL), total carbohydrate, sugars, starch, and fiber intakes and the risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma.

Methods

In an all-Ireland study, dietary information was collected from patients with esophageal adenocarcinoma (n = 224), long-segment Barrett’s esophagus (n = 220), reflux esophagitis (n = 219), and population-based controls (n = 256). Multiple logistic regression analysis examined the association between dietary variables and disease risk by tertiles of intake and as continuous variables, while adjusting for potential confounders.

Results

Reflux esophagitis risk was positively associated with starch intake and negatively associated with sugar intake. Barrett’s esophagus risk was significantly reduced in people in the highest versus the lowest tertile of fiber intake (OR 0.44 95%CI 0.25–0.80). Fiber intake was also associated with a reduced risk of esophageal adenocarcinoma, as was total carbohydrate intake (OR 0.45 95%CI 0.33–0.61 per 50 g/d increase). However, an increased esophageal adenocarcinoma risk was detected per 10 unit increase in GI intake (OR 1.42 95%CI 1.07–1.89).

Conclusions

Our findings suggest that fiber intake is inversely associated with Barrett’s esophagus and esophageal adenocarcinoma risk. Esophageal adenocarcinoma risk is inversely associated with total carbohydrate consumption but positively associated with high GI intakes.

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References

  1. Suter M, Dorta G, Giusti V, Calmes JM (2004) Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14:959–966. doi:10.1381/0960892041719581

    Article  PubMed  CAS  Google Scholar 

  2. Prach AT, MacDonald TA, Hopwood DA, Johnston DA (1997) Increasing incidence of Barrett’s oesophagus: education, enthusiasm, or epidemiology? Lancet 350:933. doi:10.1016/S0140-6736(05)63269-2

    Article  PubMed  CAS  Google Scholar 

  3. Bosetti C, Levi F, Ferlay J et al (2008) Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer 122:1118–1129. doi:10.1002/ijc.23232

    Article  PubMed  CAS  Google Scholar 

  4. Pera M, Manterola C, Vidal O, Grande L (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92:151–159. doi:10.1002/jso.20357

    Article  PubMed  Google Scholar 

  5. Fitzgerald RC (2004) Review article: Barrett’s oesophagus and associated adenocarcinoma—a UK perspective. Aliment Pharmacol Ther 20(suppl 8):45–49. doi:10.1111/j.1365-2036.2004.02229.x

    Article  PubMed  Google Scholar 

  6. Key TJ, Spencer EA (2007) Carbohydrates and cancer: an overview of the epidemiological evidence. Eur J Clin Nutr 61(suppl 1):112–121. doi:10.1038/sj.ejcn.1602941

    Article  CAS  Google Scholar 

  7. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. AICR, Washington, DC

    Google Scholar 

  8. Gallus S, La Vecchia C (2007) Is there a link between diet and esophageal cancer? Nat Clin Pract Gastroenterol Hepatol 4:2–3. doi:10.1038/ncpgasthep0697

    Article  PubMed  Google Scholar 

  9. 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 

  10. Higginbotham S, Zhang ZF, Lee IM et al (2004) Dietary glycemic load and risk of colorectal cancer in the Women’s Health Study. J Natl Cancer Inst 96:229–233

    Article  PubMed  CAS  Google Scholar 

  11. Larsson SC, Bergkvist L, Wolk A (2006) Glycemic load, glycemic index and carbohydrate intake in relation to risk of stomach cancer: a prospective study. I J Cancer 118:3167–3169. doi:10.1002/ijc.21753

    Article  CAS  Google Scholar 

  12. Strayer L, Jacobs DR Jr, Schairer C, Schatzkin A, Flood A (2007) Dietary carbohydrate, glycemic index, and glycemic load and the risk of colorectal cancer in the BCDDP cohort. Cancer Causes Control 18:853–863. doi:10.1007/s10552-007-9030-8

    Article  PubMed  Google Scholar 

  13. Augustin LS, Gallus S, Franceschi S et al (2003) Glycemic index and load and risk of upper aero-digestive tract neoplasms (Italy). Cancer Causes Control 14:657–662. doi:10.1023/A:1025676907942

    Article  PubMed  Google Scholar 

  14. Anderson LA, Murphy SJ, Johnston BT et al (2008) Relationship between Helicobacter pylori infection and gastric atrophy and the stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence: results from the FINBAR case-control study. Gut 57:734–739. doi:10.1136/gut.2007.132662

    Article  PubMed  CAS  Google Scholar 

  15. Wu AH, Tseng CC, Hankin J, Bernstein L (2007) Fiber intake and risk of adenocarcinomas of the esophagus and stomach. Cancer Causes Control 18:713–722. doi:10.1007/s10552-007-9014-8

    Article  PubMed  Google Scholar 

  16. Anderson LA, Johnston BT, Watson RG et al (2006) Nonsteroidal anti-inflammatory drugs and the esophageal inflammation-metaplasia-adenocarcinoma sequence. Cancer Res 66:4975–4982. doi:10.1158/0008-5472.CAN-05-4253

    Article  PubMed  CAS  Google Scholar 

  17. Day N, Oakes S, Luben R et al (1999) EPIC-Norfolk: study design and characteristics of the cohort. European prospective investigation of cancer. Br J Cancer 80(suppl 1):95–103

    PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  19. Mendosa D (2002) Revised international table of glycemic index (GI) and glycemic load (GL) values—2002. [Homepage on the Internet]. http://www.mendosa.com/gilists.htm Accessed Nov 2005

  20. University of Sydney. Glycaemic index database. [Homepage on the Internet]. http://www.glycaemicindex.com Accessed Nov 2005

  21. Food Standards Agency (2002) McCance and Widdowson’s the composition of foods, 6th edn. Royal Society of Chemistry, Suffolk, UK

    Google Scholar 

  22. El-Serag HB, Satia JA, Rabeneck L (2005) Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut 54:11–17. doi:10.1136/gut.2004.040337

    Article  PubMed  CAS  Google Scholar 

  23. Englyst KN, Liu S, Englyst HN (2007) Nutritional characterization and measurement of dietary carbohydrates. Eu J Clin Nutr 61(suppl 1):S19–S39. doi:10.1038/sj.ejcn.1602937

    Article  CAS  Google Scholar 

  24. De Stefani E, Boffetta P, Deneo-Pellegrini H, Mendilaharsu M, Carzoglio JC, Ronco A (1999) Carbohydrates and risk of stomach cancer in Uruguay. Int J Cancer 82:618–621. doi:10.1002/(SICI)1097-0215(19990812)82:4<618::AID-IJC25>3.0.CO;2-2

    Article  PubMed  Google Scholar 

  25. Mayne ST, Risch HA, Dubrow R et al (2001) Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev 10:1055–1062

    PubMed  CAS  Google Scholar 

  26. Chen H, Tucker KL, Graubard BI et al (2002) Nutrient intakes and adenocarcinoma of the esophagus and distal stomach. Nutr Cancer 42:33–40. doi:10.1207/S15327914NC421_5

    Article  PubMed  Google Scholar 

  27. Brown LM, Swanson CA, Gridley G et al (1995) Adenocarcinoma of the esophagus: role of obesity and diet. J Natl Cancer Inst 87:104–109. doi:10.1093/jnci/87.2.104

    Article  PubMed  CAS  Google Scholar 

  28. Zhang ZF, Kurtz RC, Yu GP et al (1997) Adenocarcinomas of the esophagus and gastric cardia: the role of diet. Nutr Cancer 27:298–309

    Article  PubMed  CAS  Google Scholar 

  29. Kabat GC, Ng SK, Wynder EL (1993) Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia. Cancer Causes Control 4:123–132. doi:10.1007/BF00053153

    Article  PubMed  CAS  Google Scholar 

  30. Tzonou A, Lipworth L, Garidou A et al (1996) Diet and risk of esophageal cancer by histologic type in a low-risk population. Int J Cancer 68:300–304. doi:10.1002/(SICI)1097-0215(19961104)68:3<300::AID-IJC6>3.0.CO;2-5

    Article  PubMed  CAS  Google Scholar 

  31. Terry P, Lagergren J, Ye W, Wolk A, Nyren O (2001) Inverse association between intake of cereal fiber and risk of gastric cardia cancer. Gastroenterology 120:387–391. doi:10.1053/gast.2001.21171

    Article  PubMed  CAS  Google Scholar 

  32. McFadden DW, Riggs DR, Jackson BJ, Cunningham C (2008) Corn-derived carbohydrate inositol hexaphosphate inhibits Barrett’s adenocarcinoma growth by pro-apoptotic mechanisms. Oncol Rep 19:563–566

    PubMed  CAS  Google Scholar 

  33. Ma Y, Hebert JR, Li W et al (2008) Association between dietary fiber and markers of systemic inflammation in the women’s health initiative observational study. Nutrition 24:941–949. doi:10.1016/j.nut.2008.04.005

    Article  PubMed  CAS  Google Scholar 

  34. Slavin JL (2000) Mechanisms for the impact of whole grain foods on cancer risk. J Am Coll Nutr 19:300–307

    Google Scholar 

  35. Burley VJ, Paul AW, Blundell JE (1993) Influence of a high-fibre food (myco-protein) on appetite: effects on satiation (within meals) and satiety (following meals). Eur J Clin Nutr 47:409–418

    PubMed  CAS  Google Scholar 

  36. Gerstein DE, Woodward-Lopez G, Evans AE, Kelsey K, Drewnowski A (2004) Clarifying concepts about macronutrients’ effects on satiation and satiety. J Am Diet Assoc 104:1151–1153. doi:10.1016/j.jada.2004.04.027

    Article  PubMed  Google Scholar 

  37. Brand-Miller JC, Holt SH, Pawlak DB, McMillan J (2002) Glycemic index and obesity. Am J Clin Nutr 76:281S–285S

    PubMed  CAS  Google Scholar 

  38. Anderson LA, Watson RG, Murphy SJ et al (2007) Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol 13:1585–1594

    PubMed  Google Scholar 

  39. Giovannucci E (2001) Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr 131:3109S–3120S

    PubMed  CAS  Google Scholar 

  40. Renehan AG, Frystyk J, Flyvbjerg A (2006) Obesity and cancer risk: the role of the insulin-IGF axis. Trends Endocrinol Metab 17:328–336. doi:10.1016/j.tem.2006.08.006

    Article  PubMed  CAS  Google Scholar 

  41. Pi-Sunyer FX (2002) Glycemic index and disease. Am J Clin Nutr 76:290S–298S

    PubMed  CAS  Google Scholar 

  42. Harrington KE, McGowan MJ, Kiely M et al (2001) Macronutrient intakes and food sources in Irish adults: findings of the North/South Ireland food consumption survey. Public Health Nutr 4:1051–1060

    PubMed  CAS  Google Scholar 

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Correspondence to Helen G. Mulholland.

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Mulholland, H.G., Cantwell, M.M., Anderson, L.A. et al. Glycemic index, carbohydrate and fiber intakes and risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. Cancer Causes Control 20, 279–288 (2009). https://doi.org/10.1007/s10552-008-9242-6

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  • DOI: https://doi.org/10.1007/s10552-008-9242-6

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