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Dietary carbohydrates, glycemic index, glycemic load and endometrial cancer risk: a systematic review and meta-analysis of prospective studies

Published online by Cambridge University Press:  19 October 2012

D. Aune ,
D. Navarro Rosenblatt ,
D. S. M. Chan ,
A. R. Vieira ,
R. Vieira  and
T. Norat
D. Aune
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
D. Navarro Rosenblatt
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
D. S. M. Chan
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
A. R. Vieira
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
R. Vieira
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
T. Norat
Affiliation:
School of Public Heath, Departament of Epidemiology & Biostatistics, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1P, UK
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Abstract

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Proceedings of the Nutrition Society , Volume 71 , Issue OCE2: Summer Meeting hosted by the Irish Section, 16–19 July 2012, Translational nutrition: integrating research, practice and policy , 2012 , E170
Copyright
Copyright © The Authors 2012

Endometrial cancer is the 5th most common cancer among women worldwide with 287 000 new cases diagnosed in 2008, accounting for 4.8% of all female cancer cases( Reference Ferlay 1 ). Insulin resistance may play a role in the etiology of endometrial cancer based on the observation that several risk factors for endometrial cancer including adiposity( 2 ), low physical activity( 2 ), elevated levels of blood glucose( Reference Stocks 3 ) and C-peptide( Reference Cust 4 ), and diabetes( Reference Friberg 5 ) are linked to insulin resistance. Carbohydrates are the main dietary component affecting an individual's insulin secretion, therefore glycemic response is also relevant in this topic( Reference Brand-Miller 6 ). Both glycemic index (GI) and glycemic load (GL) are used to rank foods according to their effects on blood glucose concentration. High GI and GL have been associated with increased risk of type 2 diabetes, obesity, and metabolic syndrome in several studies( Reference Brand-Miller 6 ). The objective of this study was to review and quantitatively summarize in a meta-analysis the evidence for an association between GI, GL and carbohydrates intake with the incidence of endometrial cancer in prospective cohort studies.

PubMed database was searched for prospective studies of carbohydrates intake, GI, and GL and endometrial cancer risk, up to December 2011. A pre-specified protocol, which includes details of the search terms used, for the review was followed (http://www.dietandcancerreport.org/cancer_resource_center/cup_protocols.php). We computed 95% Confidence Intervals (CIs) from the natural logs of the Relative Risks (RRs) and CIs across categories of carbohydrate, and GI and GL intake. Overall RRs were estimated by use of a random effects model.

Six cohort studies met the eligibility criteria for inclusion in the meta-analysis of carbohydrates, GI, GL and endometrial cancer risk. The summary RR for high vs. low intake was 1.17 (95% CI: 1.03–1.34) for carbohydrate intake, 1.00 (95% CI: 0.87–1.14) for GI, and 1.22 (95% CI: 1.09–1.37) for GL. In the dose-response analysis the summary RR was 1.18 (95% CI: 1.02–1.37) per 100 grams of carbohydrates per day and 1.15 (95% CI: 1.06–1.25) per 50 GL units. The summary RR was 1.21 (95% CI: 1.05–1.38) for high vs. low total sugar intake and 1.07 (95% CI: 1.01–1.13) per 25 g/d.

In this meta-analysis of prospective studies we found that a higher intake of carbohydrates, as well as a high GL were predictors of an increased risk of endometrial cancer. There was no evidence of an association between endometrial cancer and GI. Our results provide further support for the hypothesis that dietary carbohydrate, glycemic load and total sugars may increase the risk of endometrial cancer.

References

1. Ferlay, J et al. (2010) Int J Cancer. 127, 2893–917.CrossRefGoogle Scholar
2. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Washington DC: AICR.Google Scholar
3. Stocks, T et al. (2009) PLoS Med 6, e1000201.CrossRefGoogle Scholar
4. Cust, AE et al. (2007) Int J Cancer 120, 2656–64.CrossRefGoogle Scholar
5. Friberg, E et al. (2007) Diabetologia 50, 1365–74.CrossRefGoogle Scholar
6. Brand-Miller, JC et al. (2004) Am J Clin Nutr 80, 243–4.CrossRefGoogle Scholar