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Higher dietary glycemic intake increased risk for colon cancer recurrence
Increased dietary glycemic load and total carbohydrate intake are associated with an increased risk for cancer recurrence or even death in patients with stage III colon cancer, according to results of a prospective observational study.
Prior research suggested that hyperinsulinemia may play an important role in the development of colorectal cancer. Previous investigations also showed a direct association between host factors that lead to hyperinsulinemia and cancer recurrences and mortality in colorectal cancer survivors.
The influence of glycemic load on survival among patients with colon cancer remains unclear, according to background information in the study.
Jeffrey A. Meyerhardt
In the current study, Jeffrey A. Meyerhardt, MD, MPH, of the Dana-Farber Cancer Institute in Boston, and colleagues examined the influence of glycemic load, glycemic index, fructose and carbohydrate intakes on cancer recurrence and mortality in patients with stage III colon cancer.
Meyerhardt and colleagues evaluated 1,011 patients with stage III colon cancer.
The patients reported their dietary intake and lifestyle habits via questionnaire midway through (Q1) and 6 months after (Q2) participating in the multicenter Cancer and Leukemia Group B (CALGB) adjuvant chemotherapy trial.
DFS — defined as time from completion of Q1 to tumor recurrence, occurrence of new colon primary tumor or death from any cause — served as the primary endpoint.
Patients with stage III colon cancer in the highest quintile of dietary glycemic load experienced an adjusted HR for DFS of 1.79 (95% CI, 1.29-2.48) compared with those in the lowest quintile (P<.001), study results showed.
Higher glycemic load was associated with similar inferiority in recurrence-free survival (P<.001) and OS (P<.001).
These associations differed significantly by BMI (P=.01). Glycemic load was not associated with DFS in patients with BMI <25 kg/m², but higher glycemic load was associated with worse DFS among overweight or obese participants with a BMI ≥25 kg/m² (HR=2.26; 95% CI, 1.53-3.32).
Increasing total carbohydrate intake was similarly associated with lower DFS, recurrence-free survival and OS (P<.001 across all quintiles), study results showed.
“Given that patients who consume high glycemic loads or carbohydrates after cancer diagnosis may have consumed a similar diet before diagnosis, we cannot exclude the possibility that individuals with these dietary exposures acquire tumors that are biologically more aggressive,” Meyerhardt and colleagues wrote.
Still, researchers did not observe a statistically significant association between dietary habits and tumor-related characteristics associated with cancer recurrence, the researchers said.
Although the findings are not authoritative, they are in line with previous research, Neal J. Meropol, MD, and Nathan A. Berger, MD, both of the hematology and oncology division at University Hospitals Case Medical Center in Cleveland, wrote in an accompanying editorial.
“Although not definitive regarding their impact on colorectal cancer recurrence, the convergence of clinical observations and biology provides a compelling justification to test hypothesis-driven interventions in prospective randomized clinical trials,” Meropol and Berger wrote. “These interventions should include behavioral modifications (dietary modification and exercise), as well as more traditional pharmacologic approaches that target pathways involved in glucose metabolism.”
Disclosure: The researchers report no relevant financial disclosures.
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