Association of dietary insulinemic potential and colorectal cancer risk in men and women.

Background Insulin response may be important in colorectal cancer development. Diet modulates insulin response and may be a modifiable factor in colorectal cancer prevention. Objective We examined associations between hyperinsulinemic diets and colorectal cancer risk with the use of an empirical dietary index for hyperinsulinemia (EDIH), a food-based index that characterizes dietary insulinemic potential on the basis of circulating C-peptide concentrations. Design Diet was assessed every 4 y with food-frequency questionnaires in 46,210 men (Health Professionals Follow-Up Study, 1986-2012) and 74,191 women (Nurses' Health Study, 1984-2012) to calculate EDIH scores. Multivariable-adjusted Cox regression was used to calculate HRs and 95% CIs for colorectal, proximal/distal colon, and rectal cancer risk. Results During 26 y of follow-up, we documented 2683 incident colorectal cancer cases. Comparing participants in the highest with those in the lowest quintiles, higher EDIH scores were associated with 33% (men: HR: 1.33; 95% CI: 1.11, 1.61; P-trend = 0.0005), 22% (women: HR: 1.22; 95% CI: 1.03, 1.45; P-trend = 0.01), and 26% (men and women: pooled HR: 1.26; 95% CI: 1.12, 1.42; P-trend <0.0001) higher risk of developing colorectal cancer. The positive associations were limited to the distal colon and rectum in men and to the distal and proximal colon in women; however, combined risk estimates were significant for all anatomic locations except for the rectum. For example, comparing participants in extreme EDIH quintiles, there was no significant association for proximal colon cancer in men (HR: 1.15; 95% CI: 0.84, 1.57; P-trend = 0.32), but the risk was elevated for distal colon (HR: 1.63; 95% CI: 1.14, 2.32; P-trend = 0.002) and rectal (HR: 1.63; 95% CI: 1.09, 2.44; P-trend = 0.01) cancer. Among women, the risk was elevated for proximal (HR: 1.28; 95% CI: 1.00, 1.63; P-trend = 0.03) and distal (HR: 1.46; 95% CI: 1.05, 2.03; P-trend = 0.03) colon cancer but not for rectal cancer (HR: 0.88; 95% CI: 0.60, 1.29; P-trend = 0.61). Conclusion The findings suggest that the insulinemic potential of diet may partly underlie the influence of dietary intake on colorectal cancer development. This observational study was registered at www.clinicaltrials.gov as NCT03364582.

[1]  L. Liang,et al.  An Empirical Dietary Inflammatory Pattern Score Is Associated with Circulating Inflammatory Biomarkers in a Multi-Ethnic Population of Postmenopausal Women in the United States. , 2018, The Journal of nutrition.

[2]  F. Hu,et al.  Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women , 2018, JAMA oncology.

[3]  A. Jemal,et al.  Cancer statistics, 2018 , 2018, CA: a cancer journal for clinicians.

[4]  J. Manson,et al.  Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. , 2017, Journal of the American College of Cardiology.

[5]  David A. Drew,et al.  Dietary Patterns and Risk of Colorectal Cancer: Analysis by Tumor Location and Molecular Subtypes. , 2017, Gastroenterology.

[6]  E. Giovannucci.  A framework to understand diet, physical activity, body weight, and cancer risk , 2017, Cancer Causes & Control.

[7]  W. Willett,et al.  Development and validation of empirical indices to assess the insulinaemic potential of diet and lifestyle , 2016, British Journal of Nutrition.

[8]  J. Manson,et al.  Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies , 2016, PLoS medicine.

[9]  J. Manson,et al.  Multiple Healthful Dietary Patterns and Type 2 Diabetes in the Women's Health Initiative. , 2016, American journal of epidemiology.

[10]  Melonie P. Heron.  Deaths: Leading Causes for 2011. , 2015, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[11]  A. Jemal,et al.  Global cancer statistics, 2012 , 2015, CA: a cancer journal for clinicians.

[12]  W. Willett,et al.  Alternate Healthy Eating Index 2010 and risk of chronic obstructive pulmonary disease among US women and men: prospective study , 2015, BMJ : British Medical Journal.

[13]  P. Cavicchia,et al.  A Healthy Lifestyle Index Is Associated With Reduced Risk of Colorectal Adenomatous Polyps Among Non-Users of Non-Steroidal Anti-Inflammatory Drugs , 2015, The Journal of Primary Prevention.

[14]  F. Hu,et al.  A dietary pattern that is associated with C-peptide and risk of colorectal cancer in women , 2011, Cancer Causes & Control.

[15]  W. Willett,et al.  Interactions between Plasma Levels of 25-Hydroxyvitamin D, Insulin-Like Growth Factor (IGF)-1 and C-Peptide with Risk of Colorectal Cancer , 2011, PloS one.

[16]  W. Willett,et al.  Dietary insulin index and insulin load in relation to biomarkers of glycemic control, plasma lipids, and inflammation markers. , 2011, The American journal of clinical nutrition.

[17]  B. Shields,et al.  Urine C-Peptide Creatinine Ratio Is a Noninvasive Alternative to the Mixed-Meal Tolerance Test in Children and Adults With Type 1 Diabetes , 2011, Diabetes Care.

[18]  E. Giovannucci.  Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. , 2007, The American journal of clinical nutrition.

[19]  F. Clavel-Chapelon,et al.  Serum C‐peptide, IGFBP‐1 and IGFBP‐2 and risk of colon and rectal cancers in the European Prospective Investigation into Cancer and Nutrition , 2007, International journal of cancer.

[20]  Matthias Briel,et al.  Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. , 2006, Archives of internal medicine.

[21]  S. Hankinson,et al.  A Prospective Study of C-Peptide, Insulin-like Growth Factor-I, Insulin-like Growth Factor Binding Protein-1, and the Risk of Colorectal Cancer in Women , 2005, Cancer Epidemiology Biomarkers & Prevention.

[22]  M. Stampfer,et al.  A prospective study of plasma C-peptide and colorectal cancer risk in men. , 2004, Journal of the National Cancer Institute.

[23]  E. Giovannucci.  Insulin and colon cancer , 1995, Cancer Causes & Control.

[24]  W. Willett,et al.  Major dietary patterns and the risk of colorectal cancer in women. , 2003, Archives of internal medicine.

[25]  E. Giovannucci.  Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidence. , 2003, Journal of women's health.

[26]  N Rifai,et al.  Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. , 2001, The American journal of clinical nutrition.

[27]  D Feskanich,et al.  Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. , 1999, The American journal of clinical nutrition.

[28]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[29]  W C Willett,et al.  Adjustment for total energy intake in epidemiologic studies. , 1997, The American journal of clinical nutrition.

[30]  E. Rimm,et al.  Reproducibility and Validity of a Self‐Administered Physical Activity Questionnaire for Male Health Professionals , 1996, Epidemiology.

[31]  M Lunn,et al.  Applying Cox regression to competing risks. , 1995, Biometrics.

[32]  G A Colditz,et al.  Reproducibility and validity of a self-administered physical activity questionnaire. , 1994, International journal of epidemiology.

[33]  D Feskanich,et al.  Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. , 1993, Journal of the American Dietetic Association.

[34]  G A Colditz,et al.  Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. , 1992, American journal of epidemiology.

[35]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[36]  T. Wolever,et al.  Glycemic index of foods: a physiological basis for carbohydrate exchange. , 1981, The American journal of clinical nutrition.