Dietary insulin index and insulin load in relation to endometrial cancer risk in the Nurses' Health Study.
Dietary insulin index and insulin load in relation to endometrial cancer risk in the Nurses' Health Study.
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DOI：
10.1158/1055-9965.epi-14-0157
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
De Vivo I
中科院分区：
文献类型：
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作者：
Prescott J;Bao Y;Viswanathan AN;Giovannucci EL;Hankinson SE;De Vivo I
虽然未对抗的雌激素暴露被认为是子宫内膜癌发生的主要驱动因素，但与胰岛素抵抗和高胰岛素血症状态相关的因素与子宫内膜癌风险独立相关。在前瞻性护士健康研究中，我们使用饮食胰岛素负荷和胰岛素指数评分来代表总体饮食的估计胰岛素需求，并评估其与子宫内膜癌风险的相关性。我们使用考克斯比例风险模型估计浸润性子宫内膜癌风险的发病率比（RR）和95%置信区间（CI）。在基线饮食问卷（1980年）和2010年之间，我们在1，417，167人-年的随访中共确定了798例侵袭性上皮性子宫内膜腺癌。膳食胰岛素评分与子宫内膜癌的总体风险无关。比较最高和最低五分位数的妇女，累积平均膳食胰岛素负荷的子宫内膜癌多变量校正RR为1.07（95%CI：0.84，1.35），累积平均膳食胰岛素指数为1.03（95%CI：0.82，1.31）。研究结果没有因饮酒、总膳食纤维摄入量或BMI和/或体力活动而发生实质性变化（P异质性≥ 0.10）。在这项大型前瞻性研究中，摄入预计会刺激餐后高胰岛素反应的饮食与子宫内膜癌风险无关。考虑到导致高胰岛素血症的饮食、生活方式和遗传因素的复杂相互作用，单独的饮食措施可能不足以捕获绝对的长期胰岛素暴露。这项研究是第一次调查饮食胰岛素评分与子宫内膜癌风险的关系。
While unopposed estrogen exposure is considered the main driver of endometrial carcinogenesis, factors associated with states of insulin resistance and hyperinsulinemia are independently associated with endometrial cancer risk. We used dietary insulin load and insulin index scores to represent the estimated insulin demand of overall diets and assessed their association with endometrial cancer risk in the prospective Nurses’ Health Study. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CI) for risk of invasive endometrial cancer using Cox proportional hazards models. Between the baseline dietary questionnaire (1980) and 2010, we identified a total of 798 incident invasive epithelial endometrial adenocarcinomas over 1,417,167 person-years of follow-up. Dietary insulin scores were not associated with overall risk of endometrial cancer. Comparing women in the highest to the lowest quintile, the multivariable-adjusted RRs of endometrial cancer were 1.07 (95% CI: 0.84, 1.35) for cumulative average dietary insulin load and 1.03 (95% CI: 0.82, 1.31) for cumulative average dietary insulin index. Findings did not vary substantially by alcohol consumption, total dietary fiber intake, or BMI and/or physical activity (Pheterogeneity ≥ 0.10). Intake of a diet predicted to stimulate a high postprandial insulin response was not associated with endometrial cancer risk in this large prospective study. Considering the complex interplay of diet, lifestyle and genetic factors contributing to the hyperinsulinemic state, dietary measures alone may not sufficiently capture absolute long-term insulin exposure. This study is the first to investigate dietary insulin scores in relation to endometrial cancer risk.