法国女性前瞻性研究中碳水化合物摄入量、血糖生成指数、血糖负荷与绝经后乳腺癌风险

Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women.

作者信息

Lajous Martin, Boutron-Ruault Marie-Christine, Fabre Alban, Clavel-Chapelon Françoise, Romieu Isabelle

机构信息

INSERM, ERI 20, EA 4045, and Institut Gustave Roussy, Villejuif, France.

出版信息

Am J Clin Nutr. 2008 May;87(5):1384-91. doi: 10.1093/ajcn/87.5.1384.

DOI:10.1093/ajcn/87.5.1384

PMID:18469262

Abstract

BACKGROUND

Diets high in carbohydrates may result in chronically elevated insulin concentrations and may affect breast cancer risk by stimulation of insulin receptors or through insulin-like growth factor I (IGF-I)-mediated mitogenesis. Insulin response to carbohydrate intake is increased in insulin-resistant states such as obesity.

OBJECTIVE

We sought to evaluate carbohydrate intake, glycemic index (GI), and glycemic load (GL) and subsequent overall and hormone-receptor-defined breast cancer risk among postmenopausal women.

DESIGN

A prospective cohort analysis of dietary carbohydrate and fiber intakes was conducted among 62 739 postmenopausal women from the E3N French study who had completed a validated dietary history questionnaire in 1993. During a 9-y period, 1812 cases of pathology-confirmed breast cancer were documented through follow-up questionnaires. Nutrients were categorized into quartiles and energy-adjusted with the regression-residual method. Cox model-derived relative risks (RRs) were adjusted for known determinants in breast cancer.

RESULTS

Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk. Among overweight women, we observed an association between GI and breast cancer (RR(Q1-Q4): 1.35; 95% CI: 1.00, 1.82; P for trend = 0.04). For women in the highest category of waist circumference, the RR(Q1-Q4) was 1.28 (95% CI: 0.98, 1.67; P for trend = 0.10) for carbohydrates, 1.35 (95% CI: 1.04, 1.75; P for trend = 0.01) for GI, and 1.37 (95% CI: 1.05, 1.77; P for trend = 0.003) for GL. We also observed a direct association between carbohydrate intake, GL, and estrogen receptor-negative breast cancer risk.

CONCLUSIONS

Rapidly absorbed carbohydrates are associated with postmenopausal breast cancer risk among overweight women and women with large waist circumference. Carbohydrate intake may also be associated with estrogen receptor-negative breast cancer.

摘要

背景

高碳水化合物饮食可能导致胰岛素浓度长期升高，并可能通过刺激胰岛素受体或通过胰岛素样生长因子I（IGF-I）介导的有丝分裂影响乳腺癌风险。在肥胖等胰岛素抵抗状态下，碳水化合物摄入后的胰岛素反应会增强。

目的

我们试图评估绝经后女性的碳水化合物摄入量、血糖生成指数（GI）和血糖负荷（GL）以及随后的总体乳腺癌风险和激素受体定义的乳腺癌风险。

设计

对来自法国E3N研究的62739名绝经后女性进行了膳食碳水化合物和纤维摄入量的前瞻性队列分析，这些女性在1993年完成了一份经过验证的饮食史问卷。在9年期间，通过随访问卷记录了1812例经病理证实的乳腺癌病例。营养素被分为四分位数，并采用回归残差法进行能量调整。Cox模型得出的相对风险（RRs）针对乳腺癌的已知决定因素进行了调整。

结果

膳食碳水化合物和纤维摄入量与总体乳腺癌风险无关。在超重女性中，我们观察到GI与乳腺癌之间存在关联（RR（Q1-Q4）：1.35；95%CI：1.00，1.82；趋势P = 0.04）。对于腰围最高组的女性，碳水化合物的RR（Q1-Q4）为1.28（95%CI：0.98，1.67；趋势P = 0.10），GI为1.35（95%CI：1.04，1.75；趋势P = 0.01），GL为1.37（95%CI：1.05，1.77；趋势P = 0.003）。我们还观察到碳水化合物摄入量、GL与雌激素受体阴性乳腺癌风险之间存在直接关联。