Limits...
A case-control study of glycemic index, glycemic load and dietary fiber intake and risk of adenocarcinomas and squamous cell carcinomas of the esophagus: the Australian Cancer Study.

Lahmann PH, Ibiebele TI, Webb PM, Nagle CM, Whiteman DC, Australian Cancer Stu - BMC Cancer (2014)

Bottom Line: Higher GL was not associated with risk of EAC and EGJAC, but was inversely associated with risk of ESCC (adjusted model, p(trend) = 0.006), specifically among men where we observed a 58% reduced risk of ESCC in the highest versus the lowest quartile.Fiber intake was strongly and inversely associated with risk of EAC, EGJAC and ESCC (all p(trend) ≤ 0.001), indicating risk reductions of 28%-37% per 10 g/day.In addition, increased fiber intake appears to be associated with lower risk of all histological types of esophageal cancer.

View Article: PubMed Central - PubMed

Affiliation: Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD 4006, Australia. plahmann@gmx.de.

ABSTRACT

Background: Glycemic index (GI) and glycemic load (GL) have been investigated as etiologic factors for some cancers, but epidemiological data on possible associations between dietary carbohydrate intake and esophageal cancer are scant. This study examined the association between GI, GL, and other dietary carbohydrate components and risk of adenocarcinomas and squamous cell carcinoma of the esophagus accounting for established risk factors.

Methods: We analyzed data from a population-based Australian case-control study (2002-05) comprising 299 adenocarcinoma (EAC), 337 gastro-esophageal junction adenocarcinoma (EGJAC), 245 squamous cell carcinoma (ESCC), and 1507 controls sampled from a population registry. Dietary information was obtained using a 135-item food frequency questionnaire (FFQ); GI and GL were derived from an Australian GI database. Multivariable logistic regression models were used to derive odds ratios (ORs).

Results: All three case groups tended to have a lower intake of fiber, and significantly higher intake of fat, total energy, and alcohol (ESCC only) compared to controls. GI was unrelated to all histological types. Higher GL was not associated with risk of EAC and EGJAC, but was inversely associated with risk of ESCC (adjusted model, p(trend) = 0.006), specifically among men where we observed a 58% reduced risk of ESCC in the highest versus the lowest quartile. Increased intake of total carbohydrates and starch was related to similarly large risk reductions of ESCC. Fiber intake was strongly and inversely associated with risk of EAC, EGJAC and ESCC (all p(trend) ≤ 0.001), indicating risk reductions of 28%-37% per 10 g/day.

Conclusions: This study suggests a reduced risk of esophageal SCC with higher GL level particularly in men, but provides no evidence for the role of GI in the development of esophageal cancer. In addition, increased fiber intake appears to be associated with lower risk of all histological types of esophageal cancer.

Show MeSH

Related in: MedlinePlus

Multivariable-adjusted odds ratios (ORs, CI 95%) of esophageal squamous cell carcinoma (plotted on logarithmic scale) are illustrated for men and women according to quartiles of Glycemic Load (sex-specific quartile cut-off points: men 106, 121, 136; women 102, 117, 132).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4255966&req=5

Fig1: Multivariable-adjusted odds ratios (ORs, CI 95%) of esophageal squamous cell carcinoma (plotted on logarithmic scale) are illustrated for men and women according to quartiles of Glycemic Load (sex-specific quartile cut-off points: men 106, 121, 136; women 102, 117, 132).

Mentions: To assess potential effect modification of the GI/GL-esophageal cancer association by selected covariates, interaction terms for each glycemic/carbohydrate factor with sex, BMI, smoking status or alcohol consumption were tested. None of the tested interactions were statistically significant with few exceptions. We observed that the association between GL and ESCC was modified by sex (p interaction = 0.02) presented in Figure 1. The inverse risk pattern was confined to men only (OR, 95%CI; quartile 2: 0.48, 0.28-0.80; quartile 3: 0.34, 0.19-0.63; quartile 4: 0.42, 0.24-0.74), while no clear association became apparent among women (OR, 95%CI; quartile 2: 1.13, 0.53-2.38; quartile 3: 1.61, 0.77-3.39; quartile 4: 1.07, 0.50-2.32) as shown in sex-specific Additional file 2: Table S2 and Additional file 3: Table S3. Similar to GL, the carbohydrates and starch associations differed by sex (total carbohydrates: p interaction = 0.02; starch: p interaction = 0.03). The decreased risk of ESCC was accentuated in men only (Additional file 2: Table S2 and Additional file 3: Table S3). Further, we examined the potential effect modification of the GI/GL/carbohydrate component-esophageal cancer association by red meat intake and saturated fat intake (data not shown). There was no evidence that these dietary factors modified the association between GI or GL and any subtype. For ESCC only, in stratified analysis, the inverse total carbohydrates association remained only among those with high red meat intake (median split: >91 g/d, p trend = 0.0005), while the inverse fiber association was confined to those with low fat intake (median split: <26.5 g/d, p trend <0.0001).Figure 1


A case-control study of glycemic index, glycemic load and dietary fiber intake and risk of adenocarcinomas and squamous cell carcinomas of the esophagus: the Australian Cancer Study.

Lahmann PH, Ibiebele TI, Webb PM, Nagle CM, Whiteman DC, Australian Cancer Stu - BMC Cancer (2014)

Multivariable-adjusted odds ratios (ORs, CI 95%) of esophageal squamous cell carcinoma (plotted on logarithmic scale) are illustrated for men and women according to quartiles of Glycemic Load (sex-specific quartile cut-off points: men 106, 121, 136; women 102, 117, 132).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4255966&req=5

Fig1: Multivariable-adjusted odds ratios (ORs, CI 95%) of esophageal squamous cell carcinoma (plotted on logarithmic scale) are illustrated for men and women according to quartiles of Glycemic Load (sex-specific quartile cut-off points: men 106, 121, 136; women 102, 117, 132).
Mentions: To assess potential effect modification of the GI/GL-esophageal cancer association by selected covariates, interaction terms for each glycemic/carbohydrate factor with sex, BMI, smoking status or alcohol consumption were tested. None of the tested interactions were statistically significant with few exceptions. We observed that the association between GL and ESCC was modified by sex (p interaction = 0.02) presented in Figure 1. The inverse risk pattern was confined to men only (OR, 95%CI; quartile 2: 0.48, 0.28-0.80; quartile 3: 0.34, 0.19-0.63; quartile 4: 0.42, 0.24-0.74), while no clear association became apparent among women (OR, 95%CI; quartile 2: 1.13, 0.53-2.38; quartile 3: 1.61, 0.77-3.39; quartile 4: 1.07, 0.50-2.32) as shown in sex-specific Additional file 2: Table S2 and Additional file 3: Table S3. Similar to GL, the carbohydrates and starch associations differed by sex (total carbohydrates: p interaction = 0.02; starch: p interaction = 0.03). The decreased risk of ESCC was accentuated in men only (Additional file 2: Table S2 and Additional file 3: Table S3). Further, we examined the potential effect modification of the GI/GL/carbohydrate component-esophageal cancer association by red meat intake and saturated fat intake (data not shown). There was no evidence that these dietary factors modified the association between GI or GL and any subtype. For ESCC only, in stratified analysis, the inverse total carbohydrates association remained only among those with high red meat intake (median split: >91 g/d, p trend = 0.0005), while the inverse fiber association was confined to those with low fat intake (median split: <26.5 g/d, p trend <0.0001).Figure 1

Bottom Line: Higher GL was not associated with risk of EAC and EGJAC, but was inversely associated with risk of ESCC (adjusted model, p(trend) = 0.006), specifically among men where we observed a 58% reduced risk of ESCC in the highest versus the lowest quartile.Fiber intake was strongly and inversely associated with risk of EAC, EGJAC and ESCC (all p(trend) ≤ 0.001), indicating risk reductions of 28%-37% per 10 g/day.In addition, increased fiber intake appears to be associated with lower risk of all histological types of esophageal cancer.

View Article: PubMed Central - PubMed

Affiliation: Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD 4006, Australia. plahmann@gmx.de.

ABSTRACT

Background: Glycemic index (GI) and glycemic load (GL) have been investigated as etiologic factors for some cancers, but epidemiological data on possible associations between dietary carbohydrate intake and esophageal cancer are scant. This study examined the association between GI, GL, and other dietary carbohydrate components and risk of adenocarcinomas and squamous cell carcinoma of the esophagus accounting for established risk factors.

Methods: We analyzed data from a population-based Australian case-control study (2002-05) comprising 299 adenocarcinoma (EAC), 337 gastro-esophageal junction adenocarcinoma (EGJAC), 245 squamous cell carcinoma (ESCC), and 1507 controls sampled from a population registry. Dietary information was obtained using a 135-item food frequency questionnaire (FFQ); GI and GL were derived from an Australian GI database. Multivariable logistic regression models were used to derive odds ratios (ORs).

Results: All three case groups tended to have a lower intake of fiber, and significantly higher intake of fat, total energy, and alcohol (ESCC only) compared to controls. GI was unrelated to all histological types. Higher GL was not associated with risk of EAC and EGJAC, but was inversely associated with risk of ESCC (adjusted model, p(trend) = 0.006), specifically among men where we observed a 58% reduced risk of ESCC in the highest versus the lowest quartile. Increased intake of total carbohydrates and starch was related to similarly large risk reductions of ESCC. Fiber intake was strongly and inversely associated with risk of EAC, EGJAC and ESCC (all p(trend) ≤ 0.001), indicating risk reductions of 28%-37% per 10 g/day.

Conclusions: This study suggests a reduced risk of esophageal SCC with higher GL level particularly in men, but provides no evidence for the role of GI in the development of esophageal cancer. In addition, increased fiber intake appears to be associated with lower risk of all histological types of esophageal cancer.

Show MeSH
Related in: MedlinePlus