V Fedirko1, A Lukanova2, C Bamia3, A Trichopolou4, E Trepo5, U Nöthlings6, S Schlesinger6, K Aleksandrova7, P Boffetta8, A Tjønneland9, N F Johnsen9, K Overvad10, G Fagherazzi11, A Racine11, M C Boutron-Ruault11, V Grote2, R Kaaks2, H Boeing7, A Naska3, G Adarakis12, E Valanou12, D Palli13, S Sieri14, R Tumino15, P Vineis16, S Panico17, H B As Bueno-de-Mesquita18, P D Siersema19, P H Peeters20, E Weiderpass21, G Skeie22, D Engeset22, J R Quirós23, R Zamora-Ros24, M J Sánchez25, P Amiano26, J M Huerta27, A Barricarte28, D Johansen29, B Lindkvist30, M Sund31, M Werner32, F Crowe33, K T Khaw34, P Ferrari35, I Romieu35, S C Chuang36, E Riboli36, M Jenab35. 1. Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France. Electronic address: fedirkov@iarc.fr. 2. Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany. 3. WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens. 4. WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens; Hellenic Health Foundation, Athens, Greece. 5. Centre de Bioloqie Republique, Lyon, France. 6. Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel. 7. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany. 8. Institute for Translational Epidemiology, Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, USA. 9. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen. 10. Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark. 11. Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France. 12. Hellenic Health Foundation, Athens, Greece. 13. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence. 14. Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan. 15. Cancer Registry and Histopathology Unit, "Civile M.P.Arezzo" Hospital, Ragusa, Italy. 16. School of Public Health, Imperial College, London, UK; HuGeF Foundation, Turin. 17. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy. 18. Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht. 19. Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht. 20. Department of Epidemiology Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; School of Public Health, Imperial College, London, UK. 21. Department of Community Medicine, University of Tromsø, Tromsø; Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Samfundet Folkhälsan, Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland. 22. Department of Community Medicine, University of Tromsø, Tromsø. 23. Public Health Directorate, Health and Health Care Services Council, Asturias. 24. Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona. 25. Andalusian School of Public Health, Granada; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada. 26. Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department ofHealth of the regional Government of the Basque Country, San Sebastian; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada. 27. Department of Epidemiology, Murcia Regional Health Council, Murcia; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada. 28. Navarre Public Health Institute, Pamplona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada. 29. Skånes Universitetssjukhus, Malmö. 30. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg. 31. Department of Surgical and Perioperative Sciences, Umea University. 32. Department of Public Health and Clinical Medicine, Umea University, Sweden. 33. Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford. 34. Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK. 35. Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France. 36. School of Public Health, Imperial College, London, UK.
Abstract
BACKGROUND: The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. PATIENTS AND METHODS: The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. RESULTS: Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. CONCLUSIONS: Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.
BACKGROUND: The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. PATIENTS AND METHODS: The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. RESULTS: Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. CONCLUSIONS: Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.
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