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A pooled analysis of dietary sugar/carbohydrate intake and esophageal and gastric cardia adenocarcinoma incidence and survival in the USA
- Source :
- International Journal of Epidemiology. 46:1836-1846
- Publication Year :
- 2017
- Publisher :
- Oxford University Press (OUP), 2017.
-
Abstract
- Background During the past 40 years, esophageal/gastric cardia adenocarcinoma (EA/GCA) incidence increased in Westernized countries, but survival remained low. A parallel increase in sugar intake, which may facilitate carcinogenesis by promoting hyperglycaemia, led us to examine sugar/carbohydrate intake in association with EA/GCA incidence and survival. Methods We pooled 500 EA cases, 529 GCA cases and 2027 controls from two US population-based case-control studies with cases followed for vital status. Dietary intake, assessed by study-specific food frequency questionnaires, was harmonized and pooled to estimate 12 measures of sugar/carbohydrate intake. Multivariable-adjusted odds ratios (ORs) and hazard ratios [95% confidence intervals (CIs)] were calculated using multinomial logistic regression and Cox proportional hazards regression, respectively. Results EA incidence was increased by 51-58% in association with sucrose (ORQ5vs.Q1 = 1.51, 95% CI = 1.01-2.27), sweetened desserts/beverages (ORQ5vs.Q1 = 1.55, 95% CI = 1.06-2.27) and the dietary glycaemic index (ORQ5vs.Q1 = 1.58, 95% CI = 1.13-2.21). Body mass index (BMI) and gastro-esophageal reflux disease (GERD) modified these associations (Pmultiplicative-interaction ≤ 0.05). For associations with sucrose and sweetened desserts/beverages, respectively, the OR was elevated for BMI < 25 (ORQ4-5vs.Q1-3 = 1.79, 95% CI = 1.26-2.56 and ORQ4-5vs.Q1-3 = 1.45, 95% CI = 1.03-2.06), but not BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.05, 95% CI = 0.76-1.44 and ORQ4-5vs.Q1-3 = 0.85, 95% CI = 0.62-1.16). The EA-glycaemic index association was elevated for BMI ≥ 25 (ORQ4-5vs.Q1-3 = 1.38, 95% CI = 1.03-1.85), but not BMI < 25 (ORQ4-5vs.Q1-3 = 0.88, 95% CI = 0.62-1.24). The sucrose-EA association OR for GERD < weekly was 1.58 (95% CI = 1.16-2.14), but for GERD ≥ weekly was 1.01 (95% CI = 0.70-1.47). Sugar/carbohydrate measures were not associated with GCA incidence or EA/GCA survival. Conclusions If confirmed, limiting intake of sucrose (e.g. table sugar), sweetened desserts/beverages, and foods that contribute to a high glycaemic index, may be plausible EA risk reduction strategies.
- Subjects :
- Blood Glucose
Male
medicine.medical_specialty
Esophageal Neoplasms
Epidemiology
Population
Adenocarcinoma
Gastroenterology
Body Mass Index
03 medical and health sciences
0302 clinical medicine
Dietary Sucrose
Risk Factors
Stomach Neoplasms
Internal medicine
Dietary Carbohydrates
medicine
Humans
030212 general & internal medicine
education
Cancer
Aged
Proportional Hazards Models
education.field_of_study
business.industry
Incidence
Incidence (epidemiology)
Hazard ratio
General Medicine
Odds ratio
Middle Aged
medicine.disease
Gastric Cardia Adenocarcinoma
United States
Confidence interval
Logistic Models
Nutrition Assessment
Case-Control Studies
030220 oncology & carcinogenesis
Multivariate Analysis
Gastroesophageal Reflux
GERD
Female
business
Body mass index
Subjects
Details
- ISSN :
- 14643685 and 03005771
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- International Journal of Epidemiology
- Accession number :
- edsair.doi.dedup.....e7ad67828cb7e5f28311c13b67584f64