Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T09:15:21.811Z Has data issue: false hasContentIssue false
  • English
  • Français

Glycaemic index, glycaemic load and risk of endometrial cancer: a prospective cohort study

Published online by Cambridge University Press:  02 January 2007

Stephanie AN Silvera ,
Thomas E Rohan ,
Meera Jain ,
Paul D Terry ,
Geoffrey R Howe  and
Anthony B Miller
Stephanie AN Silvera*
Affiliation:
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Room 1301, Bronx, NY 10461, USA
Thomas E Rohan
Affiliation:
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Room 1301, Bronx, NY 10461, USA
Meera Jain
Affiliation:
Department of Public Health Sciences, University of Toronto, Toronto, Canada
Paul D Terry
Affiliation:
National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, NC, USA
Geoffrey R Howe
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
Anthony B Miller
Affiliation:
Department of Public Health Sciences, University of Toronto, Toronto, Canada
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

High-glycaemic-load diets may increase endometrial cancer risk by increasing circulating insulin levels and, as a consequence, circulating oestrogen levels. Given the paucity of epidemiological data regarding the relationship between dietary glycaemic index and glycaemic load and endometrial cancer risk, we sought to examine these associations using data from a prospective cohort study.

Design, setting and subjects

We examined the association between dietary glycaemic load and endometrial cancer risk in a cohort of 49 613 Canadian women aged between 40 and 59 years at baseline who completed self-administered food-frequency questionnaires between 1982 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000.

Results

During a mean of 16.4 years of follow-up, we observed 426 incident cases of endometrial cancer. Hazard ratios for the highest versus the lowest quartile level of overall glycaemic index and glycaemic load were 1.47 (95% confidence interval (CI) = 0.90–2.41; P for trend = 0.14) and 1.36 (95% CI = 1.01–1.84; P for trend = 0.21), respectively. No association was observed between total carbohydrate or total sugar consumption and endometrial cancer risk. Among obese women (body mass index > 30 kg m−2) the hazard ratio for the highest versus the lowest quartile level of glycaemic load was 1.88 (95% CI = 1.08–3.29; P for trend = 0.54) and there was a 55% increased risk for the highest versus the lowest quartile level of glycaemic load among premenopausal women. There was also evidence to support a positive association between glycaemic load and endometrial cancer risk among postmenopausal women who had used hormone replacement therapy.

Conclusions

Our data suggest that diets with high glycaemic index or high glycaemic load may be associated with endometrial cancer risk overall, and particularly among obese women, premenopausal women and postmenopausal women who use hormone replacement therapy.

Keywords

Glycaemic indexGlycaemic loadEndometrial neoplasmsProspective cohortNational Breast Screening Study
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 7 , October 2005 , pp. 912 - 919
Copyright
Copyright © The Authors 2005

References

1Holt, S, Miller, JC, Petocz, P. An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. American Journal of Clinical Nutrition 1997; 66: 1264–86.CrossRefGoogle ScholarPubMed
2Ionescu-Tirgoviste, C, Popa, E, Sintu, E, Mihalache, N, Cheta, D, Mincu, I. Blood glucose and plasma insulin responses to various carbohydrates in type 2 (non-insulin-dependent diabetes). Diabetologia 1983; 24: 80–4.CrossRefGoogle ScholarPubMed
3Jenkins, D, Kendall, CW, Augustin, LS, Franceschi, S, Hamidi, M, Marchie, A, et al. Glycemic index: overview of implications in health and disease. American Journal of Clinical Nutrition 2002; 76: 266S–73S.CrossRefGoogle ScholarPubMed
4Foster-Powell, K, Holt, SH, Brand-Miller, JC. International table of glycemic index and glycemic load values. American Journal of Clinical Nutrition 2002; 76: 5–56.CrossRefGoogle ScholarPubMed
5Brynes, S, Miller, JCB, Denyer, GS. Amylopectin starch promotes the development of insulin resistance in rats. Journal of Nutrition 1995; 125: 1430–7.Google Scholar
6Ludwig, D. Dietary glycemic index and obesity. Journal of Nutrition 2000; 130: 280S–3S.CrossRefGoogle ScholarPubMed
7Plymate, S, Jones, RE, Matej, LA, Friedl, KE. Regulation of sex hormone binding globulin (SHBG) production in Hep G2 cells by insulin. Steroids 1988; 52: 339–40.CrossRefGoogle ScholarPubMed
8Preziosi, P, Barrett-Connor, E, Papoz, L, Roger, M, Saint-Paul, M, Nahoul, K, et al. Interrelation between plasma sex hormone-binding globulin and plasma insulin in healthy adult women: the Telecom study. Journal of Clinical Endocrinology and Metabolism 1993; 76: 283–7.Google ScholarPubMed
9Kaaks, R, Lukanova, A, Kurzer, MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiology, Biomarkers & Prevention 2002; 11: 1531–43.Google Scholar
10Lukanova, A, Zeleniuch-Jacquotte, A, Lundin, E, Micheli, A, Arslan, AA, Rinaldi, S, et al. Prediagnostic levels of C-peptide, IGF-1, IGFBP-1, -2, and -3 and risk of endometrial cancer. International Journal of Cancer 2004; 108: 262–8.CrossRefGoogle ScholarPubMed
11Kaaks, R, Lukanova, A. Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proceedings of the Nutrition Society 2001; 60: 91–106.CrossRefGoogle ScholarPubMed
12Henderson, B, Feigelson, HS. Hormonal carcinogenesis. Carcinogensis 2000; 21: 427–33.CrossRefGoogle ScholarPubMed
13Deligdisch, L. Hormonal pathology of the endometrium. Modern Pathology 2000; 13: 285–94.CrossRefGoogle ScholarPubMed
14Augustin, L, Gallus, S, Bosetti, C, Levi, F, Negri, E, Franceschi, S, et al. Glycemic index and glycemic load in endometrial cancer. International Journal of Cancer 2003; 105: 404–7.CrossRefGoogle ScholarPubMed
15Folsom, AR, Demissie, Z, Harnack, L. Glycemic index, glycemic load, and incidence of endometrial cancer: The Iowa Women's Health Study. Nutrition and Cancer 2003; 46: 119–24.CrossRefGoogle ScholarPubMed
16Jenkins, DJ, Wolever, TM, Buckley, G, Lam, KY, Guidici, S, Kalmusky, J, et al. Low-glycemic-index starchy foods in the diabetic diet. American Journal of Clinical Nutrition 1988; 48: 248–54.CrossRefGoogle ScholarPubMed
17Terry, P, Miller, AB, Rohan, TE. Obesity and colorectal cancer risk in women. Gut 2002; 51: 191–4.CrossRefGoogle ScholarPubMed
18Miller, AB, Baines, CJ, To, T, Wall, C. Canadian National Breast Screening Study. I. Breast cancer detection and death rates among women aged 4–49 years. II. Breast cancer detection and death rates among women aged 5–59 years. Canadian Medical Association Journal 1992; 147: 1459–88.Google Scholar
19Jain, M, Harrison, L, Howe, GR, Miller, AB. Evaluation of a self-administered dietary questionnaire for use in a cohort study. American Journal of Clinical Nutrition 1982; 36: 931–5.CrossRefGoogle ScholarPubMed
20Morgan, AB, Jain, M, Miller, AB, Choi, NW, Matthews, V, Munan, L, et al. A comparison of dietary methods in epidemiologic studies. American Journal of Epidemiology 1978; 107: 488–98.CrossRefGoogle ScholarPubMed
21Liu, S, Manson, JE, Stampfer, MJ, Holmes, MD, Hu, FB, Hankinson, SE, et al. Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. American Journal of Clinical Nutrition 2001; 73: 560–6.CrossRefGoogle ScholarPubMed
22Terry, PD, Jain, M, Miller, AB, Rohan, TE. Glycemic load, carbohydrate intake, and risk of colorectal cancer in women: a prospective cohort study. Journal of the National Cancer Institute 2003; 95: 914–6.CrossRefGoogle ScholarPubMed
23Willett, W, Stampfer, MJ. Total energy intake: implications for epidemiologic analyses. American Journal of Epidemiology 1986; 124: 17–27.CrossRefGoogle ScholarPubMed
24Rothman, KJ, Greenland, S. Modern Epidemiology, 2nd ed. Philadelphia, PA: Lipincott-Raven, 1998; 319.Google Scholar
25Jain, M, Miller, AB. Tumor characteristics and survival of breast cancer patients in relation to premorbid diet and body size. Breast Cancer Research and Treatment 1997; 42: 43–55.CrossRefGoogle ScholarPubMed
26Rohan, TE, Hartwick, W, Miller, AB, Kandel, RA. Immunohistochemical detection of c-erbB-2 and p-53 in benign breast disease and breast cancer risk. Journal of the National Cancer Institute 1998; 90: 1262–9.CrossRefGoogle Scholar
27Jain, M, Rohan, TE, Howe, GR, Miller, AB. A cohort study of nutritional factors and endometrial cancer. European Journal of Epidemiology 2000; 16: 899–905.CrossRefGoogle ScholarPubMed
28Kaaks, RLA. Effects of weight control and physical activity in cancer prevention: role endogenous hormone metabolism. Annals of the New York Academy of Sciences 2002; 963: 268–81.CrossRefGoogle ScholarPubMed
29Kelley, DGB. Effects of physical activity on insulin action and glucose tolerance in obesity. Medicine and Science in Sports and Exercise 1999; 31: 619S–23S.CrossRefGoogle ScholarPubMed
30Giovannucci, E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. Journal of Nutrition 2001; 131: 3109S–20S.CrossRefGoogle ScholarPubMed
31Borghouts, LKH. Exercise and insulin insensitivity: a review. International Journal of Sports Medicine 2000; 21: 1–12.CrossRefGoogle ScholarPubMed
32Persson, I, Adami, HO. Endometrial cancer. In: Adami, HO, Hunter, D, Trichopoulos, D, eds. Textbook of Cancer Epidemiology. Oxford: Oxford University Press, 2002; 359–77.Google Scholar
33American Diabetes Association. Principles of nutrition and dietary recommendations for individuals with diabetes mellitus. Diabetes 1979; 28: 1027.CrossRefGoogle Scholar
34Statement on nutrition and your health: dietary guidelines for Americans. Journal of the American Dietetic Association 1986; 86: 107–8.CrossRefGoogle Scholar
35Willett, W. Nutritional Epidemiology. New York: Oxford University Press, 1998.CrossRefGoogle Scholar
36Robles, SC, Marrett, LD, Clarke, EA, Risch, EA. An application of capture–recapture methods to the estimation of completeness of cancer registration. Journal of Clinical Epidemiology 1988; 41: 495–501.CrossRefGoogle Scholar
37Shannon, HS, Jamieson, E, Walsh, C, Julian, JA, Fair, ME, Buffet, A. Comparison of individual follow-up and computerized record linkage using the Canadian Mortality Data Base. Canadian Journal of Public Health 1989; 80: 54–7.Google ScholarPubMed