title: Dietary insulin index and insulin load in relation to endometrial cancer risk in the Nurses' Health Study.
abstract: BACKGROUND
  Although unopposed estrogen exposure is considered the main driver of endometrial carcinogenesis, factors associated with states of insulin resistance and hyperinsulinemia are independently associated with endometrial cancer risk. We used dietary insulin load and insulin index scores to represent the estimated insulin demand of overall diets and assessed their association with endometrial cancer risk in the prospective Nurses' Health Study.
  
  
  METHODS
  We estimated incidence rate ratios (RR) and 95% confidence intervals (CI) for risk of invasive endometrial cancer using Cox proportional hazards models. Between the baseline dietary questionnaire (1980) and 2010, we identified a total of 798 incident-invasive epithelial endometrial adenocarcinomas over 1,417,167 person-years of follow-up.
  
  
  RESULTS
  Dietary insulin scores were not associated with overall risk of endometrial cancer. Comparing women in the highest with the lowest quintile, the multivariable-adjusted RRs of endometrial cancer were 1.07 (95% CI, 0.84-1.35) for cumulative average dietary insulin load and 1.03 (95% CI, 0.82-1.31) for cumulative average dietary insulin index. Findings did not vary substantially by alcohol consumption, total dietary fiber intake, or body mass index and/or physical activity (P(heterogeneity) ≥ 0.10).
  
  
  CONCLUSIONS
  Intake of a diet predicted to stimulate a high postprandial insulin response was not associated with endometrial cancer risk in this large prospective study. Considering the complex interplay of diet, lifestyle, and genetic factors contributing to the hyperinsulinemic state, dietary measures alone may not sufficiently capture absolute long-term insulin exposure.
  
  
  CONCLUSIONS
  This study is the first to investigate dietary insulin scores in relation to endometrial cancer risk.
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health; nhjxp@channing.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Prescott
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School;
authors.forename: Ying
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School;
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston; and.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Division of Biostatistics and Epidemiology, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hankinson
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health;
authors.forename: Immaculata
authors.initials: I
authors.lastname: De Vivo
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000328:Adult; D004032:Diet; D004034:Diet Surveys; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007328:Insulin; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D007328:Insulin