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Carbohydrate, glycemic index, and glycemic load and colorectal adenomas in the Prostate, Lung, Colorectal, and Ovarian Screening Study^1,2,3

¹ From the University of Minnesota, Minneapolis, MN (AF and TRC); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (AF, NC, AS, and RBH); the Fred Hutchinson Cancer Research Center, Seattle, WA (UP); the University of Washington, Seattle, WA (UP); the University of Toronto, Toronto, Canada (DJAJ); the Division of Cancer Control and Population Sciences (AFS), Henry Ford Hospital, Detroit, MI (RB); and the University of Pittsburgh, Pittsburgh, PA (JLW)

Background: It is possible that high-glycemic-load diets, through their hyperinsulinemic effects, can increase the risk of colorectal cancer.

Objective: We analyzed data from a cancer screening study to determine whether persons with high-glycemic-load diets would be at an increased risk of distal adenomas.

Design: We included subjects with no prior adenoma or cancer from the Prostate, Lung, Colorectal, and Ovarian screening trial and whose results from flexible sigmoidoscopy exams indicated either no lesions (n = 34 817) or 1 distal adenoma (n = 3696). We used a 137-item food-frequency questionnaire to assess usual dietary intake over the preceding 12 mo. Using logistic regression analysis, we calculated, separately for men and women, prevalence odds ratios (ORs) and 95% CIs of sigmoidoscopy-detected, distal adenomas for quintiles of energy-adjusted dietary carbohydrate, glycemic index, and glycemic load.

Results: ORs decreased with increasing intakes of carbohydrate for both the men and the women in unadjusted models, but these associations were attenuated in multivariate-adjusted models. Among the men, the association remained significant after adjustment (OR: 0.71; 95% CI 0.60, 0.84; P for trend < 0.0001), but in the women it did not (OR: 0.89; 95% CI: 0.73, 1.10; P for trend = 0.30). The results for glycemic index showed no associations in either men or women. Results for glycemic load closely mirrored those for carbohydrate.

Conclusion: Despite expectations that increasing glycemic load and glycemic index would increase the risk of adenoma, we observed no association in women and even an inverse association in men.

Key Words: Colorectal adenoma • glycemic index • glycemic load • carbohydrate • insulin resistance • fiber

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