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American Journal of Epidemiology Advance Access originally published online on August 1, 2007
American Journal of Epidemiology 2007 166(8):912-923; doi:10.1093/aje/kwm161
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Dietary Carbohydrates, Glycemic Index, Glycemic Load, and Endometrial Cancer Risk within the European Prospective Investigation into Cancer and Nutrition Cohort

Anne E. Cust1,2,3, Nadia Slimani1, Rudolf Kaaks1,4, Marit van Bakel1, Carine Biessy1, Pietro Ferrari1, Martine Laville3,5, Anne Tjønneland6, Anja Olsen6, Kim Overvad7, Martin Lajous8,9, Francoise Clavel-Chapelon8, Marie-Christine Boutron-Ruault8, Jakob Linseisen4, Sabine Rohrmann4, Ute Nöthlings10, Heiner Boeing10, Domenico Palli11, Sabina Sieri12, Salvatore Panico13, Rosario Tumino14, Carlotta Sacerdote15, Guri Skeie16, Dagrun Engeset16, Inger Torhild Gram16, J. Ramón Quirós17, Paula Jakszyn18, María José Sánchez19, Nerea Larrañaga20, Carmen Navarro21, Eva Ardanaz22, Elisabet Wirfält23, Göran Berglund24, Eva Lundin25, Göran Hallmans26, H. Bas Bueno-de-Mesquita27, Huaidong Du27, Petra H. M. Peeters28, Sheila Bingham29,30, Kay-Tee Khaw31, Naomi E. Allen32, Timothy J. Key32, Mazda Jenab1 and Elio Riboli33

1 Nutrition and Hormones Unit, International Agency for Research on Cancer, Lyon, France
2 School of Public Health, University of Sydney, Sydney, Australia
3 Center for Research in Human Nutrition Rhône-Alpes, Université Lyon 1, Lyon, France
4 Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
5 UMR Inserm U449/INRA 1235, Lyon, France
6 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
7 Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark
8 Inserm ERI 20, Paris-Sud University EA4045, and Institut Gustave Roussy, Villejuif, France
9 National Institute of Public Health, Center for Investigation on Population Health, Cuernavaca, Mexico
10 German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
11 Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy
12 Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy
13 Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
14 Cancer Registry, Azienda Ospedaliera "Civile M. P. Arezzo," Ragusa, Italy
15 CPO-Piemonte, Torino, Italy
16 Faculty of Medicine, Institute of Community Medicine, University of Tromsø, Tromsø, Norway
17 Public Health and Health Planning Directorate, Asturias, Spain
18 Department of Epidemiology and Cancer Registry, Catalan Institute of Oncology, Barcelona, Spain
19 Andalusian School of Public Health, Granada, Spain
20 Public Health Department of Gipuzkoa, Basque Government, San Sebastian, Spain
21 Epidemiology Department, Murcia Health Council, Murcia, Spain
22 Public Health Institute of Navarra, Pamplona, Spain
23 Nutrition Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
24 Department of Medicine, Lund University, Malmö University Hospital, Malmö, Sweden
25 Department of Medical Biosciences, Umeå University, Umeå, Sweden
26 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
27 Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
28 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
29 MRC Dunn Human Nutrition Unit, Cambridge, United Kingdom
30 MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
31 Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
32 Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom
33 Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom

Correspondence to Anne Cust, Level 2, K25 - Medical Foundation Building, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia (e-mail: annec{at}health.usyd.edu.au).

Received for publication December 20, 2006. Accepted for publication April 27, 2007.

The associations of dietary total carbohydrates, overall glycemic index, total dietary glycemic load, total sugars, total starch, and total fiber with endometrial cancer risk were analyzed among 288,428 women in the European Prospective Investigation into Cancer and Nutrition cohort (1992–2004), including 710 incident cases diagnosed during a mean 6.4 years of follow-up. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals. There were no statistically significant associations with endometrial cancer risk for increasing quartile intakes of any of the exposure variables. However, in continuous models calibrated by using 24-hour recall values, the multivariable relative risks were 1.61 (95% confidence interval: 1.06, 2.45) per 100 g/day of total carbohydrates, 1.40 (95% confidence interval: 0.99, 1.99) per 50 units/day of total dietary glycemic load, and 1.36 (95% confidence interval: 1.05, 1.76) per 50 g/day of total sugars. These associations were stronger among women who had never used postmenopausal hormone therapy compared with ever users (total carbohydrates pheterogeneity = 0.04). Data suggest no association of overall glycemic index, total starch, and total fiber with risk, and a possible modest positive association of total carbohydrates, total dietary glycemic load, and total sugars with risk, particularly among never users of hormone replacement therapy.

cohort studies; diet; dietary carbohydrates; dietary fiber; endometrial neoplasms; glycemic index; insulin; nutrition assessment

Abbreviations: EPIC, European Prospective Investigation into Cancer and Nutrition; HRT, hormone replacement therapy


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