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BMC Cancer
Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Insulins | Research

Carbohydrate quality indices and colorectal cancer risk: a case-control study

Authors: Masoud Amini Kahrizsangi, Zohreh Ebrahimi, Zainab Shateri, Fatemeh Mansouri, Ali Zangene, Milad Rajabzadeh-Dehkordi, Mehran Nouri, Bahram Rashidkhani

Published in: BMC Cancer | Issue 1/2023

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Abstract

Background

Colorectal cancer (CRC) is the fourth and third most common cancer in Iran and the world, respectively. Carbohydrates can lead to the proliferation of cancer cells, including CRC. The current study aimed to investigate the association between glycemic load (GL), insulin load (IL), glycemic index (GI), insulin index (II), low-carbohydrate diet score (LCDS), and carbohydrate quality index (CQI) with CRC odds.

Methods

The present case-control study was performed on 71 CRC cases and 142 controls in the Hospital Cancer Organization and three general hospitals in Tehran, Iran. We calculated the dietary GI, GL, IL, II, CQI, and LCDS by a validated food frequency questionnaire.

Results

The results indicated that people who were in the highest tertile of the GI had higher odds of CRC compared to the lower tertile (in the adjusted model: odds ratio (OR) = 3.89; 95% confidence interval (CI): 1.71–8.84). On the contrary, people who were in the highest tertile of the CQI and LCDS had significantly lower odds of CRC compared to the lower tertile (in the adjusted model: tertile (T) 2-OR = 0.24; 95% CI: 0.11–0.53 and T3-OR = 0.15; 95% CI: 0.06–0.39 for CQI and T2-OR = 0.33; 95% CI: 0.13–0.79 and T3-OR = 0.28; 95% CI: 0.10–0.82 for LCDS). Also, IL was positively associated with the odds of CRC after adjusting for confounding factors (T2-OR = 2.46; CI: 1.08–5.61 and T3- OR = 2.80; 95% CI: 1.07–7.31). Regarding the GL, only individuals who were in the second tertile had significantly higher odds of CRC compared to the first tertile (OR = 2.42; CI: 1.07–5.47).

Conclusion

According to the findings, it is recommended to use a diet with high-quality carbohydrates and low GI and GL to minimize the odds of developing CRC. People should also be encouraged to have a balanced carbohydrate intake.
Literature
1.
Aglago EK, Mayén A-L, Knaze V, Freisling H, Fedirko V, Hughes DJ, Jiao L, Eriksen AK, Tjønneland A, Boutron-Ruault M-C. Dietary advanced glycation end-products and colorectal cancer risk in the european prospective investigation into cancer and nutrition (EPIC) study. Nutrients. 2021;13(9):3132.PubMedPubMedCentralCrossRef
2.
Shadmani FK, Ayubi E, Khazaei S, Sani M, Hanis SM, Khazaei S, Soheylizad M, Mansori K. Geographic distribution of the incidence of colorectal cancer in Iran: a population-based study.Epidemiology and health2017,39.
3.
Rafiemanesh H, Pakzad R, Abedi M, Kor Y, Moludi J, Towhidi F, Makhsosi BR, Salehiniya H. Colorectal cancer in Iran: epidemiology and morphology trends. EXCLI J. 2016;15:738.PubMedPubMedCentral
4.
Keskin H, Wang S-M, Etemadi A, Fan J-H, Dawsey SM, Abnet CC, Qiao Y-L, Taylor PR. Colorectal cancer in the Linxian China Nutrition intervention trial: risk factors and intervention results. PLoS ONE. 2021;16(9):e0255322.PubMedPubMedCentralCrossRef
5.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209–49.CrossRef
6.
Skibbe K, Brethack A-K, Sünderhauf A, Ragab M, Raschdorf A, Hicken M, Schlichting H, Preira J, Brandt J, Castven D. Colorectal cancer progression is potently reduced by a glucose-free, high-protein diet: comparison to anti-EGFR therapy. Cancers. 2021;13(22):5817.PubMedPubMedCentralCrossRef
7.
Deng Y, Wei B, Zhai Z, Zheng Y, Yao J, Wang S, Xiang D, Hu J, Ye X, Yang S. Dietary risk related colorectal cancer burden: Estimates from 1990 to 2019.Frontiers in nutrition2021:568.
8.
El Kinany K, Huybrechts I, Gunter M, Hatime Z, Boudouaya H, Benslimane A, Nejjari C, El Abkari M, Badre W, El Feydi A. Consumption of meat, traditional and modern processed meat and colorectal cancer risk among the moroccan population: a large-scale case-control study. Int J Cancer. 2019;146(5):1333–45.PubMed
9.
Jamali Z, Nouri M, Ghiasvand R, Esmaillzadeh A, Feizi A, Keikha M, Askari GR. Relation between Food Intake, Food Insecurity, and body composition in patients with colorectal Cancer. J Health Syst Res. 2020;16(1):46–53.
10.
Marbini MH, Amiri F, Hezaveh ZS. Dietary glycemic index, glycemic load, insulin index, insulin load and risk of diabetes-related cancers: a systematic review of cohort studies. Clin Nutr ESPEN. 2021;42:22–31.CrossRef
11.
Sieri S, Krogh V. Dietary glycemic index, glycemic load and cancer: an overview of the literature. Nutr Metabolism Cardiovasc Dis. 2017;27(1):18–31.CrossRef
12.
Li H-L, Yang G, Shu X-O, Xiang Y-B, Chow W-H, Ji B-T, Zhang X, Cai H, Gao J, Gao Y-T. Dietary glycemic load and risk of colorectal cancer in chinese women. Am J Clin Nutr. 2011;93(1):101–7.PubMedCrossRef
13.
Burger KN, Beulens JW, van der Schouw YT, Sluijs I, Spijkerman AM, Sluik D, Boeing H, Kaaks R, Teucher B, Dethlefsen C. Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus. 2012.
14.
Hosseini F, Imani H, Sheikhhossein F, Majdi M, Ghanbari M, Shab-Bidar S. Dietary carbohydrate quality and quantity and risk of breast Cancer among iranian women. Nutr Cancer. 2022;74(3):916–26.PubMedCrossRef
15.
Mulyo GPE, Kaffah ZS, Mutiyani M, Ayuhastuti A. Fruit and Vegetable Effect Changes in Blood Sugar levels and Food Glycemic Index. Open Access Macedonian Journal of Medical Sciences. 2022;10(A):38–44.CrossRef
16.
Majdi M, Imani H, Bazshahi E, Hosseini F, Djafarian K, Lesani A, Akbarzade Z, Shab-Bidar S. Habitual-and Meal-Specific Carbohydrate Quality Index and Their Relation to Metabolic Syndrome in a Sample of Iranian Adults.Frontiers in nutrition2022,9.
17.
Song M, Wu K, Meyerhardt JA, Yilmaz O, Wang M, Ogino S, Fuchs CS, Giovannucci EL, Chan AT. Low-carbohydrate diet score and macronutrient intake in relation to survival after colorectal cancer diagnosis. JNCI cancer spectrum. 2018;2(4):pky077.PubMedCrossRef
18.
Runchey SS, Pollak MN, Valsta LM, Coronado GD, Schwarz Y, Breymeyer KL, Wang C, Wang C-Y, Lampe JW, Neuhouser ML. Glycemic load effect on fasting and post-prandial serum glucose, insulin, IGF-1 and IGFBP-3 in a randomized, controlled feeding study. Eur J Clin Nutr. 2012;66(10):1146–52.PubMedPubMedCentralCrossRef
19.
Bao J, De Jong V, Atkinson F, Petocz P, Brand-Miller JC. Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals. Am J Clin Nutr. 2009;90(4):986–92.PubMedCrossRef
20.
Mirmiran P, Esfandiari S, Bahadoran Z, Tohidi M, Azizi F. Dietary insulin load and insulin index are associated with the risk of insulin resistance: a prospective approach in tehran lipid and glucose study. J Diabetes Metabolic Disorders. 2015;15(1):1–7.CrossRef
21.
Huang J, Fang Y-J, Xu M, Luo H, Zhang N-Q, Huang W-Q, Pan Z-Z, Chen Y-M, Zhang C-X. Carbohydrate, dietary glycaemic index and glycaemic load, and colorectal cancer risk: a case–control study in China. Br J Nutr. 2018;119(8):937–48.PubMedCrossRef
22.
Abe SK, Inoue M, Sawada N, Ishihara J, Iwasaki M, Yamaji T, Shimazu T, Sasazuki S, Tsugane S. Glycemic index and glycemic load and risk of colorectal cancer: a population-based cohort study (JPHC Study). Cancer Causes Control. 2016;27(4):583–93.PubMedCrossRef
23.
Howarth NC, Murphy SP, Wilkens LR, Henderson BE, Kolonel LN. The association of glycemic load and carbohydrate intake with colorectal cancer risk in the multiethnic cohort study. Am J Clin Nutr. 2008;88(4):1074–82.PubMedCrossRef
24.
Nimptsch K, Meyerhardt J, Chan AT, Ng K, Michaud DS, Brand-Miller JC, Willett WC, Giovannucci E, Fuchs CS. Dietary insulin load, dietary insulin index, and colorectal cancer.Cancer Epidemiology and Prevention Biomarkers2010.
25.
Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H, Holmberg L, Wolk A. Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst. 2001;93(7):525–33.PubMedCrossRef
26.
Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr. 2010;13(5):654–62.PubMedCrossRef
27.
Ghaffarpour M, Houshiar-Rad A, Kianfar H. The manual for household measures, cooking yields factors and edible portion of foods. Tehran: Nashre Olume Keshavarzy. 1999;7(213):42–58.
28.
Nutritionist I. N-squared computing. Silverton: Nutritionist IV 1998.
29.
Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76(1):5–56.PubMedCrossRef
30.
Hermansen K. Diet, blood pressure and hypertension. Br J Nutr. 2000;83(S1):113–S119.CrossRef
31.
Holt S, Miller J, Petocz P. An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr. 1997;66(5):1264–76.PubMedCrossRef
32.
Nimptsch K, Brand-Miller JC, Franz M, Sampson L, Willett WC, Giovannucci E. Dietary insulin index and insulin load in relation to biomarkers of glycemic control, plasma lipids, and inflammation markers. Am J Clin Nutr. 2011;94(1):182–90.PubMedPubMedCentralCrossRef
33.
Zazpe I, Santiago S, Gea A, Ruiz-Canela M, Carlos S, Bes-Rastrollo M, Martínez-González M. Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project. Nutr Metabolism Cardiovasc Dis. 2016;26(11):1048–56.CrossRef
34.
Farazi M, Jayedi A, Noruzi Z, Firouzabadi FD, Asgari E, Djafarian K, Shab-Bidar S. The association between carbohydrate quality index and nutrient adequacy in iranian adults. Nutrition & Food Science; 2021.
35.
Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355(19):1991–2002.PubMedCrossRef
36.
Waterland RA, Travisano M, Tahiliani K, Rached M, Mirza S. Methyl donor supplementation prevents transgenerational amplification of obesity. Int J Obes. 2008;32(9):1373–9.CrossRef
37.
Biernat E, Stupnicki R, Lebiedziński B, Janczewska L. Assessment of physical activity by applying IPAQ questionnaire. Phys Educ Sport. 2008;52(2):83–9.
38.
Parohan M, Anjom-Shoae J, Nasiri M, Khodadost M, Khatibi SR, Sadeghi O. Dietary total antioxidant capacity and mortality from all causes, cardiovascular disease and cancer: a systematic review and dose–response meta-analysis of prospective cohort studies. Eur J Nutr. 2019;58(6):2175–89.PubMedCrossRef
39.
Sadeghi A, Sadeghi O, Khodadost M, Pirouzi A, Hosseini B, Saedisomeolia A. Dietary glycemic index and glycemic load and the risk of prostate cancer: an updated systematic review and dose–response meta-analysis. Nutr Cancer. 2020;72(1):5–14.PubMedCrossRef
40.
Brand-Miller J, Thomas M, Swan V, Ahmad Z, Petocz P, Colagiuri S. Physiological validation of the concept of glycemic load in lean young adults. J Nutr. 2003;133(9):2728–32.PubMedCrossRef
41.
Choi Y, Giovannucci E, Lee JE. Glycaemic index and glycaemic load in relation to risk of diabetes-related cancers: a meta-analysis. Br J Nutr. 2012;108(11):1934–47.PubMedCrossRef
42.
Sieri S, Krogh V, Agnoli C, Ricceri F, Palli D, Masala G, Panico S, Mattiello A, Tumino R, Giurdanella M. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study. Int J Cancer. 2015;136(12):2923–31.PubMedCrossRef
43.
Vidal AC, Lund PK, Hoyo C, Galanko J, Burcal L, Holston R, Massa B, Omofoye O, Sandler RS, Keku TO. Elevated C-peptide and insulin predict increased risk of colorectal adenomas in normal mucosa. BMC Cancer. 2012;12(1):1–8.CrossRef
44.
Ma J, Giovannucci E, Pollak M, Leavitt A, Tao Y, Gaziano JM, Stampfer MJ. A prospective study of plasma C-peptide and colorectal cancer risk in men. J Natl Cancer Inst. 2004;96(7):546–53.PubMedCrossRef
45.
Bell KJ, Petocz P, Colagiuri S, Brand-Miller JC. Algorithms to improve the prediction of postprandial insulinaemia in response to common foods. Nutrients. 2016;8(4):210.PubMedPubMedCentralCrossRef
46.
Sung K-C, Lee MY, Kim Y-H, Huh J-H, Kim J-Y, Wild SH, Byrne CD. Obesity and incidence of diabetes: Effect of absence of metabolic syndrome, insulin resistance, inflammation and fatty liver. Atherosclerosis. 2018;275:50–7.PubMedCrossRef
47.
Teymoori F, Mokhtari E, Bahrami A, Farhadnejad H, Azadi M, Nazarzadeh M, Vafa M. The association of dietary insulin load and index with the risk of cancer and cancer mortality: a systematic review and meta-analysis.Journal of Diabetes & Metabolic Disorders2022:1–14.
48.
Yuan C, Bao Y, Sato K, Nimptsch K, Song M, Brand-Miller JC, Morales-Oyarvide V, Zoltick ES, Keum N, Wolpin BM. Influence of dietary insulin scores on survival in colorectal cancer patients. Br J Cancer. 2017;117(7):1079–87.PubMedPubMedCentralCrossRef
49.
Morales-Oyarvide V, Yuan C, Babic A, Zhang S, Niedzwiecki D, Brand-Miller JC, Sampson-Kent L, Ye X, Li Y, Saltz LB. Dietary insulin load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803 (Alliance). JNCI: J Natl Cancer Inst. 2019;111(2):170–9.PubMedCrossRef
50.
Allen BG, Bhatia SK, Anderson CM, Eichenberger-Gilmore JM, Sibenaller ZA, Mapuskar KA, Schoenfeld JD, Buatti JM, Spitz DR, Fath MA. Ketogenic diets as an adjuvant cancer therapy: history and potential mechanism. Redox Biol. 2014;2:963–70.PubMedPubMedCentralCrossRef
51.
Sasanfar B, Toorang F, Esmaillzadeh A, Zendehdel K. Adherence to the low carbohydrate diet and the risk of breast Cancer in Iran. Nutr J. 2019;18(1):1–9.CrossRef
52.
Cai H, Sobue T, Kitamura T, Ishihara J, Nanri A, Mizoue T, Iwasaki M, Yamaji T, Inoue M, Tsugane S. Low-carbohydrate diet and risk of cancer incidence: the Japan Public Health Center‐based prospective study. Cancer Sci. 2022;113(2):744.PubMedCrossRef
53.
Song M, Wu K, Meyerhardt J, Yilmaz O, Ogino S, Fuchs C, Giovannucci E, Chan AT. Association of low-carbohydrate diet and macronutrient intake with colorectal cancer survival. Cancer Res. 2017;77(13Supplement):3270–0.CrossRef
54.
Peng F, Hu D, Lin X, Chen G, Liang B, Zhang H, Ji K, Huang J, Lin J, Zheng X. Preoperative metabolic syndrome and prognosis after radical resection for colorectal cancer: the Fujian prospective investigation of cancer (FIESTA) study. Int J Cancer. 2016;139(12):2705–13.PubMedCrossRef
55.
Yang I-P, Tsai H-L, Huang C-W, Lu C-Y, Miao Z-F, Chang S-F, Juo S-HH, Wang J-Y. High blood sugar levels significantly impact the prognosis of colorectal cancer patients through down-regulation of microRNA-16 by targeting myb and VEGFR2. Oncotarget. 2016;7(14):18837.PubMedPubMedCentralCrossRef
56.
Wolpin BM, Meyerhardt JA, Chan AT, Ng K, Chan JA, Wu K, Pollak MN, Giovannucci EL, Fuchs CS. Insulin, the insulin-like growth factor axis, and mortality in patients with nonmetastatic colorectal cancer. J Clin Oncol. 2009;27(2):176.PubMedPubMedCentralCrossRef
57.
Solomon TP, Haus JM, Kelly KR, Cook MD, Filion J, Rocco M, Kashyap SR, Watanabe RM, Barkoukis H, Kirwan JP. A low–glycemic index diet combined with exercise reduces insulin resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responses in obese, prediabetic humans. Am J Clin Nutr. 2010;92(6):1359–68.PubMedPubMedCentralCrossRef
58.
Giovannucci E. Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr. 2007;86(3):836S–42.CrossRef
59.
Sasanfar B, Toorang F, Mohebbi E, Zendehdel K, Azadbakht L. Dietary carbohydrate quality and risk of breast cancer among women. Nutr J. 2021;20(1):1–8.CrossRef
60.
Suara SB, Siassi F, Saaka M, Foroshani AR, Sotoudeh G. Association between Carbohydrate Quality Index and general and abdominal obesity in women: a cross-sectional study from Ghana. BMJ open. 2019;9(12):e033038.PubMedPubMedCentralCrossRef
61.
Fernandez-Lazaro CI, Zazpe I, Santiago S, Toledo E, Barbería-Latasa M, Martínez-González M. Association of carbohydrate quality and all-cause mortality in the SUN Project: a prospective cohort study. Clin Nutr. 2021;40(4):2364–72.PubMedCrossRef
Metadata
Title
Carbohydrate quality indices and colorectal cancer risk: a case-control study
Authors
Masoud Amini Kahrizsangi
Zohreh Ebrahimi
Zainab Shateri
Fatemeh Mansouri
Ali Zangene
Milad Rajabzadeh-Dehkordi
Mehran Nouri
Bahram Rashidkhani
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-10786-6

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