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
American Cancer Society (2006) Cancer Facts & Figures. Atlanta, GA: American Cancer Society
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
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
Everhart J, Wright D (1995) Diabetes mellitus as a risk factor for pancreatic cancer. JAMA 273:1605–1609
IARC (2002) IARC handbooks on cancer prevention: weight control and physical activity. Lyon: IARC Press
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
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
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
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
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
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
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
Gapstur SM, Gann PH, Lowe W, Liu K, Colangelo L, Dyer A (2000) Abnormal glucose metabolism and pancreatic cancer mortality. JAMA 283:2552–2558
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
Stolzenberg-Solomon RZ, Graubard BI, Chari S, et al. (2005) Insulin, glucose, insulin resistance, and pancreatic cancer in male smokers. JAMA 294:2872–2878
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
Bjorck I, Elmstahl HL (2003) The glycaemic index: importance of dietary fibre and other food properties. Proc Nutr Soc 62:201–206
Salmeron J, Ascherio A, Rimm EB, et al. (1997) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20:545–550
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
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
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
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
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
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
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
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
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
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
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
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
Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB (1999) High glycemic index foods, overeating, and obesity. Pediatrics 103:E26
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
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
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
World Health Organization (1992) International statistical classification of diseases and related health problems tenth revision, 10th ed., WHO, Geneva
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
Block G, Hartman AM, Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiology 1:58–64
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
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
Foster-Powell K, Brand Miller J (1995) International tables of glycemic index. Am J Clin Nutr 62:871S–893S
Pennington JAT (1983) Revision of the total diet study food list and diets. J Am Diet Assoc 82:166–173
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
Willett WC, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 24:17–27
Cox D (1972) Regression models and life tables. J R Stat Soc 34:187–220
Liu S (1998) Insulin resistance, hyperglycemia and risk of major chronic diseases-a dietary perspective. Proc Nutr Soc 22:140–150
Kleinbaum G, Kupper L, Morgenstern H (1982) Epidemiologic research: principles and quantitative methods. New York: Van Nostrand Reinhold Co
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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