Influence of dietary insulin scores on survival in colorectal cancer patients

Abstract

Background:Although hyperinsulinemia is hypothesised to be involved in colorectal carcinogenesis, it remains unclear whether a diet inducing an elevated insulin response influences colorectal cancer (CRC) survival.Methods:We examined the association of post-diagnosis dietary insulin scores with survival among 2006 patients from two large prospective cohorts who were diagnosed with CRC from 1976 to 2010. Dietary insulin load was calculated as a function of the food insulin index. Dietary insulin index was calculated by dividing insulin load by total energy intake. Cox proportional hazards models were used to calculate hazard ratios (HRs) for CRC-specific mortality and overall mortality, adjusted for other risk factors for cancer survival.Results:The adjusted HRs for CRC-specific mortality comparing the highest to the lowest quintiles were 1.82 (95% CI: 1.20–2.75, Ptrend=0.006) for dietary insulin load and 1.66 (95% CI: 1.10–2.50, Ptrend=0.004) for dietary insulin index. We also observed an increased risk for overall mortality, with adjusted HRs of 1.33 (95% CI: 1.03–1.72, Ptrend=0.03) for dietary insulin load and 1.32 (95% CI: 1.02–1.71, Ptrend=0.02) for dietary insulin index, comparing extreme quintiles. The increase in CRC-specific mortality associated with higher dietary insulin scores was more apparent among patients with body mass index (BMI)⩾25 kg m−2 than BMI<25 kg m−2 (Pinteraction=0.01).Conclusions:Higher dietary insulin scores after CRC diagnosis were associated with a statistically significant increase in CRC-specific and overall mortality.

Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance)

“…Overweight and obese patients in our series might have had elevated basal levels of circulating insulin that were further increased by high dietary insulin load, resulting in higher plasma insulin than a lean patient following the same diet. We recently reported similar findings in patients from two large prospective cohorts in the United States diagnosed with all-stage colorectal cancer (CRC) (31). Consistent with our results, high dietary insulin load and index were associated with high CRC-specific and overall mortality, and the association was more evident among patients who were overweight or obese.…”

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“…64 3174 (36) 77 (38) 66 (32) 66 (32) 67 (33) 71 (35) 78 (38) 64 (31) 67 (33) Physical activity, median (range), MET h/wk † invasion through the bowel wall (T1-T2, T3-T4, unknown), number of positive lymph nodes (1-3, !4, unknown), tumor grade (well-, moderately, poorly differentiated/undifferentiated, unknown), baseline performance status (0, 1-2, unknown), treatment group (5-FU/LV, IFL), body mass index (<25, 25-29.9, !30 kg/m 2 ), physical activity (continuous), cereal fiber (continuous), and alcohol intake (continuous). We conducted linear trend tests across quintiles of dietary insulin load and dietary insulin index by assigning each subject the median value for their corresponding quintile and modeling it as a continuous variable (1).…”

Post-diagnosis dietary insulinemic potential and survival outcomes among colorectal cancer patients

“…Both the insulin index and glycemic index assess the postprandial (short-term) effects of the diet, unlike the EDIH score which predicts integrated insulin exposure (i.e., both fasting and non-fasting), based on habitual (long-term) dietary intake [18]. Post-diagnosis insulin index and insulin load have been linked to higher risk of dying from colorectal cancer [32,33]. Higher dietary insulin load and insulin index after diagnosis of colorectal cancer were associated with increased risk of colorectal cancer-specific and overall mortality [33].…”

“…Post-diagnosis insulin index and insulin load have been linked to higher risk of dying from colorectal cancer [ 32 , 33 ]. Higher dietary insulin load and insulin index after diagnosis of colorectal cancer were associated with increased risk of colorectal cancer-specific and overall mortality [ 33 ]. The association of post-diagnosis glycemic indices with colorectal cancer prognosis has been inconsistent.…”