Dietary glycemic index, glycemic load, and the risk of breast cancer in an Italian prospective cohort study

Sieri, Sabina; Pala, Valeria; Brighenti, Furio; Pellegrini, Nicoletta; Muti, Paola; Micheli, Andrea; Evangelista, Alberto Gonçalves; Grioni, Sara; Contiero, Paolo; Berrino, Franco; Krogh, Vittorio

doi:10.1093/ajcn/86.4.1160

Cited by 83 publications

(83 citation statements)

References 48 publications

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“…Four articles were multiple publications from the same study and one further article did not provide sufficient information on their results, and hence were excluded. Of the remaining studies, 14 specifically referred to breast cancer risk (Augustin et al, 2001;Levi et al, 2002;Cho et al, 2003;Jonas et al, 2003;Frazier et al, 2004;Higginbotham et al, 2004;Holmes et al, 2004;Lajous et al, 2005Lajous et al, , 2008Nielsen et al, 2005;Silvera et al, 2005;Giles et al, 2006;McCann et al, 2007;Sieri et al, 2007), the characteristics of which are summarised in Table 1. Cohort studies accounted for 10, one of which was a retrospective design, and the remaining 4 publications were case -control studies.…”

Section: Resultsmentioning

confidence: 99%

“…Food Frequency Questionnaires (FFQs) were used in all studies to assess habitual dietary intake, and two cohorts repeated dietary assessment at multiple time points and subsequently were able to calculate cumulative average GI/GL intakes (Cho et al, 2003;Holmes et al, 2004). Most studies sourced GI and GL values from International Tables (Foster-Powell and Miller, 1995;Foster-Powell et al, 2002), with the exception of Sieri et al (2007), who primarily used GI and GL values calculated from their local Italian foods. The majority of studies included age, BMI and energy intake in their adjusted analysis and all that were included in meta-analyses adjusted for women's reproductive and menstrual histories (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Studies categorised intake by quartiles (McCann et al, 2007;Sieri et al, 2007;Lajous et al, 2008) or quintiles (Augustin et al, 2001;Cho et al, 2003;Jonas et al, 2003;Frazier et al, 2004;Higginbotham et al, 2004;Holmes et al, 2004;Lajous et al, 2005;Silvera et al, 2005). Two studies could not be included in meta-analyses, as GI/GL intakes were only examined as continuous variables (Nielsen et al, 2005;Giles et al, 2006), and another study was excluded, as it did not present results separately by menopausal status (Levi et al, 2002).…”

Section: Methodsmentioning

confidence: 99%

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Dietary glycaemic index, glycaemic load and breast cancer risk: a systematic review and meta-analysis

et al. 2008

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This systematic review aimed to examine if an association exists between dietary glycaemic index (GI) and glycaemic load (GL) intake and breast cancer risk. A systematic search was conducted in Medline and Embase and identified 14 relevant studies up to May 2008. Adjusted relative risk estimates comparing breast cancer risk for the highest versus the lowest category of GI/GL intake were extracted from relevant studies and combined in meta-analyses using a random-effects model. Combined estimates from six cohort studies show non-significant increased breast cancer risks for premenopausal women (relative risk (RR) 1.14, 95% CI 0.95 -1.38) and postmenopausal women (RR 1.11, 95% CI 0.99 -1.25) consuming the highest versus the lowest category of GI intake. Evidence of heterogeneity hindered analyses of GL and premenopausal risk, although most studies did not observe any significant association. Pooled cohort study results indicated no association between postmenopausal risk and GL intake (RR 1.03, 95% CI 0.94 -1.12). Our findings do not provide strong support of an association between dietary GI and GL and breast cancer risk. British Journal of Cancer (2008) Glycaemic index (GI) values classify foods according to the 2-h blood glucose response after consuming a portion of the food containing 50 g of available carbohydrate, compared with the equivalent amount from a standard food, such as glucose or white bread (Jenkins et al, 1981). The glycaemic load (GL) concept was later developed to better reflect the blood glucose response and insulin demand of a food by taking into account the total amount of carbohydrate usually consumed in addition to its GI value (Salmeron et al, 1997).Habitual consumption of a high GI or GL diet may promote carcinogenesis by inducing hyperglycaemia and hyperinsulinaemia (Brand-Miller, 2003), potentially acting through the insulin-like growth factor (IGF) axis (Biddinger and Ludwig, 2005). A recent meta-analysis illustrated that IGF-1 levels were associated with premenopausal but not postmenopausal breast cancer risk (Renehan et al, 2006). Additionally, high GI diets may promote weight gain . High body fatness contributes to an increased risk of postmenopausal, yet a reduced risk of premenopausal, breast cancer (Renehan et al, 2008). There has been a recent surge in research of the effect of GI and GL intake on breast cancer risk; however, results to date have been conflicting (Augustin et al, 2001;Key and Spencer, 2007;McCann et al, 2007). This may not be surprising, given the disparities between the biologically plausible mechanisms suggested above.In this systematic review, we had the aim of clarifying any association between dietary GI, GL and breast cancer risk, and of determining if risk varies according to menopausal status or body fatness. MATERIALS AND METHODSOvid Medline, including Medline In-Process (US National Library of Medicine, Bethesda, MD, USA), and Embase (Reed Elsevier PLC, Amsterdam, Netherlands) databases were systematically searched for relevant studies published up t...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Dietary glycaemic index, glycaemic load and breast cancer risk: a systematic review and meta-analysis

et al. 2008

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“…The associations were observed in pre-and postmenopausal women, and were consistent across strata of major covariates identified. Furthermore, a prospective investigation conducted in northern Italy between 1987 and 1992, including 289 women with breast cancer found increased risks for women with high dietary GI (relative risk (RR) 5 1?57 for the highest v. lowest quintile) and GL (RR 5 2?53) (37) . Therefore, these studies support the hypothesis of a possible role of hyperinsulinaemia/insulin resistance in selected female cancers.…”

Section: Glycaemic Index and Glycaemic Loadmentioning

confidence: 99%

Diet and cancer in Mediterranean countries: carbohydrates and fats

Bosetti

Pelucchi

Vecchia

2009

Public Health Nutr.

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Objective: Several aspects of the diet characteristic of the Mediterranean countries are considered favourable not only on cardiovascular disease, but also on cancer risk. We considered some aspects of the Mediterranean diet (including, in particular, the consumption of olive oil and carbohydrates) on cancer risk. Design, Setting and Subjects: Data were derived from a series of case-control studies, conducted in Italy since the early 1990s, on over 10 000 cases of thirteen cancer sites and over 17 000 controls. Results: Olive oil, and other mono-and unsaturated fats, appear to be favourable indicators of breast, ovarian, colorectal, but mostly of upper aero-digestive tract cancers. Whole grain foods are also related to reduced risk of upper aero-digestive tract and various other cancers. In contrast, refined grain intake and, consequently, glycaemic index and glycaemic load were associated to increased risk for several cancer sites. Fish, and hence a diet rich in n-3 polyunsaturated fatty acids, tended to be another favourable diet indicator, while frequent red meat intake was directly related to some common neoplasms. An a priori defined Mediterranean diet score was inversely related to upper digestive and respiratory tract cancers. Conclusions: These data provide additional evidence that major characteristics of the Mediterranean diet favourably affect cancer risk.

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“…There is a growing recognition that breast cancer may be promoted by hyperinsulinemia and insulin resistance, which may favour a metabolic environment 21.01.2009 10 promoting tumor growth (38). Additionally, insulin resistance and elevated serum steroid levels often coexist because of insulin up-regulation of ovarian steroid secretion (39).…”

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confidence: 99%

Influence of birth weight and adult body composition on 17β-estradiol levels in young women

Finstad

Emaus

Potischman

et al. 2008

Cancer Causes Control

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Background: Birth weight and adult body weight have independently been associated with breast cancer risk. Thus, we hypothesize that low birth weight, in combination with adult overweight, may influence premenopausal hormonal levels over an entire menstrual cycle.Methods: Among 204 healthy women, aged 25-35 years, who participated in the Norwegian EBBA-I Study, birth weight and age at menarche, were assessed. Levels of 17!-estradiol were measured in daily saliva samples over one menstrual cycle using radioimmunoassay (RIA). Measurements of body composition; waist circumference (cm), body mass index (BMI, kg/m 2 ) and total fat percentage (DEXA, %) were assessed. Fasting blood samples were drawn, and serum concentrations of lipids and hormones determined. Results:The participating women had mean birth weight of 3389 g and age at menarche 13.1 years. Women within the highest tertile of birth weight had the lowest 17!-estradiol throughout the menstrual cycle (p=0.03), and they tended to have a later age at menarche (p= 0.06). When we looked into birth weight in combination with adult attained weight, we found that women with lower birth weights, combined with excess weight during adulthood, had higher levels of free 17!-estradiol over an entire menstrual cycle compared with women with high birth weights and adult overweight. Women with birth weights < 3530 g, who later developed excess body weight (waist " 84 cm), showed 33% higher 17!-estradiol concentrations over a menstrual cycle compared with women with higher birth weights (" 3530 g) and adult excess body weight (p = 0.03). The association was even more pronounced in women with birth weights < 3220 g, early age at menarche (< 12 years) and adult overweight. Conclusion:Our findings support variation of premenopausal levels of 17!-estradiol in response to birth weight and energy status in adult life, suggesting that women with low birth weight in combination with adult overweight are put at risk for higher estradiol levels throughout menstrual cycles, of possible importance for breast cancer risk. 2 IntroductionSeveral studies have observed a strong relationship between birth weight and later risk of chronic diseases, indicating that fetal conditions may influence later susceptibility to adult disease ('Forsdahl-Barker hypothesis') (1), (2), (3). Thus, women with low birth weight may have different set points for their physiological ovarian responsiveness to changes in energy balance later in life compared with women with higher birth weight.Furthermore, the westernization of society including high levels of available energy combined with low overall energy expenditure, could provide new challenges for normal physiology and response, not only during the fetal period and early childhood, but also throughout life. It has been observed that birth size, a marker of fetal growth and intrauterine environment (4), together with later growth pattern and availability of energy, may influence later risk of chronic diseases, as for example diabetes or breast cancer (5), (6...

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Dietary glycemic index, glycemic load, and the risk of breast cancer in an Italian prospective cohort study

Abstract: A high-GL diet may increase the risk of breast cancer in Italian women. The effect is particularly evident in premenopausal women and those with BMI < 25.

Cited by 83 publications

References 48 publications

Dietary glycaemic index, glycaemic load and breast cancer risk: a systematic review and meta-analysis

Dietary glycaemic index, glycaemic load and breast cancer risk: a systematic review and meta-analysis

Diet and cancer in Mediterranean countries: carbohydrates and fats

Influence of birth weight and adult body composition on 17β-estradiol levels in young women

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