Gerash University of Medical Sciences, Gerash, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Department of Nutrition, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Clin Nutr. 2020 Jun;39(6):1681-1691. doi: 10.1016/j.clnu.2019.08.001. Epub 2019 Aug 19.
Data on the association of dietary intake of total carbohydrates as well as dietary glycemic index (GI) and glycemic load (GL) with risk of endometrial cancer are contradictory. Therefore, we conducted a systematic review and dose-response meta-analysis of observational studies to summarize available findings in this field.
The online databases were searched for relevant publications to May 2018 using relevant keywords.
Overall, eight prospective cohort and five case-control studies with a total sample size of 734,765 individuals, aged ≥18 years, and 8466 cases of endometrial cancer were included. Although the overall association between dietary intake of total carbohydrates and risk of endometrial cancer was non-significant, we found a significant positive association in some subgroups of cohort studies including those with ≥10 years' duration of follow-up (combined effect size: 1.29, 95% CI: 1.09-1.53, P = 0.003) and studies with sample size of ≥50,000 participants (combined effect size: 1.24, 95% CI: 1.08-1.43, P = 0.002). In addition, a non-linear dose-response relationship was found in this regard after considering the estimates from cohort studies (P = 0.002). Combining effect sizes from case-control studies showed a significant positive association between dietary GI and risk of endometrial cancer; such that a-10 unit increase in GI was associated with a 4% greater risk of endometrial cancer (combined effect size: 1.04, 95% CI: 1.02-1.05, P < 0.001). There was also a significant positive association between dietary GL and risk of endometrial cancer in some subgroups of cohort studies and also in non-linear dose-response analysis.
Although the overall associations of dietary total carbohydrate intake, GI, and GL with risk of endometrial cancer were not significant, there were significant positive associations in some subgroups of the included studies, particularly those with high quality. There was also a dose-response association between dietary total carbohydrate intake, GI and GL, and risk of endometrial cancer.
关于总碳水化合物摄入量以及膳食血糖指数（GI）和血糖负荷（GL）与子宫内膜癌风险之间的关联的数据存在矛盾。因此，我们进行了系统评价和剂量反应荟萃分析，以总结该领域的现有研究结果。
使用相关的关键词，在线数据库搜索了截至 2018 年 5 月的相关文献。
总体而言，纳入了八项前瞻性队列研究和五项病例对照研究，总样本量为 734765 名年龄≥18 岁的个体，共 8466 例子宫内膜癌病例。尽管总碳水化合物摄入量与子宫内膜癌风险之间的总体关联没有统计学意义，但我们在一些队列研究的亚组中发现了显著的正相关，包括随访时间≥10 年的研究（合并效应大小：1.29，95%置信区间：1.09-1.53，P=0.003）和样本量≥50000 名参与者的研究（合并效应大小：1.24，95%置信区间：1.08-1.43，P=0.002）。此外，在考虑了队列研究的估计值后，发现了这方面的非线性剂量反应关系（P=0.002）。综合病例对照研究的效应大小表明，膳食 GI 与子宫内膜癌风险之间存在显著的正相关；GI 每降低 10 个单位，子宫内膜癌的风险就会增加 4%（合并效应大小：1.04，95%置信区间：1.02-1.05，P<0.001）。在一些队列研究的亚组中，以及在非线性剂量反应分析中，也发现膳食 GL 与子宫内膜癌风险之间存在显著的正相关。
尽管总碳水化合物摄入量、GI 和 GL 与子宫内膜癌风险之间的总体关联没有统计学意义，但在纳入研究的一些亚组中存在显著的正相关，尤其是那些质量较高的研究。膳食总碳水化合物摄入量、GI 和 GL 与子宫内膜癌风险之间也存在剂量反应关系。
