title: Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803.
abstract: BACKGROUND
  The influence of glycemic load and related measures on survival among colon cancer patients remains largely unknown.
  
  
  METHODS
  We conducted a prospective, observational study of 1011 stage III colon cancer patients reporting dietary intake during and 6 months after participation in an adjuvant chemotherapy trial. We examined the influence of glycemic load, glycemic index, fructose, and carbohydrate intakes on cancer recurrence and mortality using Cox proportional hazards regression; all tests of statistical significance were two-sided.
  
  
  RESULTS
  Stage III colon cancer patients in the highest quintile of dietary glycemic load experienced an adjusted hazard ratio (HR) for disease-free survival of 1.79 (95% confidence interval [CI] = 1.29 to 2.48), compared with those in the lowest quintile (P (trend) across quintiles <.001). Increased glycemic load was associated with similar detriments in recurrence-free (P (trend) across quintiles <.001) and overall survival (P (trend) across quintiles <.001). These associations differed statistically significant by body mass index (BMI) (P (interaction) =.01). Whereas glycemic load was not associated with disease-free survival in patients with BMI < 25kg/m(2), higher glycemic load was statistically significant associated with worse disease-free survival among overweight or obese participants (BMI ≥ 25kg/m(2); HR = 2.26; 95% CI = 1.53 to 3.32; P (trend) across quintiles <.001). Increasing total carbohydrate intake was similarly associated with inferior disease-free, recurrence-free, and overall survival (P (trend) across quintiles <.001).
  
  
  CONCLUSIONS
  Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality in stage III colon cancer patients. These findings support the role of energy balance factors in colon cancer progression and may offer potential opportunities to improve patient survival.
authors.affiliation: Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. jmeyerhardt@partners.org
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Meyerhardt
authors.forename: Kaori
authors.initials: K
authors.lastname: Sato
authors.forename: Donna
authors.initials: D
authors.lastname: Niedzwiecki
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ye
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mayer
authors.forename: Rex B
authors.initials: RB
authors.lastname: Mowat
authors.forename: Renaud
authors.initials: R
authors.lastname: Whittom
authors.forename: Alexander
authors.initials: A
authors.lastname: Hantel
authors.forename: Al
authors.initials: A
authors.lastname: Benson
authors.forename: Devin S
authors.initials: DS
authors.lastname: Wigler
authors.forename: Alan
authors.initials: A
authors.lastname: Venook
authors.forename: Charles S
authors.initials: CS
authors.lastname: Fuchs
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003110:Colonic Neoplasms / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D019422:Dietary Sucrose / Q000008:administration & dosage* / Q000009:adverse effects*; D018572:Disease-Free Survival; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000008:administration & dosage; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D019422:Dietary Sucrose; D005632:Fructose