Glycemic Index and Glycemic Load Dietary Patterns and the Associated Risk of Breast Cancer: A Case-control Study

  • Woo, Hae Dong (Cancer Epidemiology Branch, National Cancer Center) ;
  • Park, Ki-Soon (Cancer Epidemiology Branch, National Cancer Center) ;
  • Shin, Aesun (Cancer Epidemiology Branch, National Cancer Center) ;
  • Ro, Jungsil (Center for Breast Cancer, National Cancer Center) ;
  • Kim, Jeongseon (Cancer Epidemiology Branch, National Cancer Center)
  • Published : 2013.09.30


The glycemic index (GI) and glycemic load (GL) have been considered risk factors for breast cancer, but association studies of breast cancer risk using simple GI and GL might be affected by confounding effects of the overall diet. A total of 357 cases and 357 age-matched controls were enrolled, and dietary intake was assessed using a validated food frequency questionnaire (FFQ) with 103 food items. GI and GL dietary patterns were derived by reduced rank regression (RRR) method. The GI and GL pattern scores were positively associated with breast cancer risk among postmenopausal women [OR (95%CI): 3.31 (1.06-10.39), p for trend=0.031; 9.24 (2.93-29.14), p for trend<0.001, respectively], while the GI pattern showed no statistically significant effects on breast cancer risk, and the GL pattern was only marginally significant, among premenopausal women (p for trend=0.043). The GI and GL pattern scores were positively associated with the risk of breast cancer in subgroups defined by hormone receptor status in postmenopausal women. The GI and GL patterns based on all food items consumed were positively associated with breast cancer.


Case-control study;glycemic index (GI);glycemic load (GL);breast cancer


  1. Ahn Y, Kwon E, Shim J, et al (2007). Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr, 61, 1435-41.
  2. Bao Y, Nimptsch K, Meyerhardt JA, et al (2010). Dietary insulin load, dietary insulin index, and colorectal cancer. Cancer Epidemiol Biomarkers Prev, 19, 3020-6.
  3. Belle FN, Kampman E, McTiernan A, et al (2011). Dietary fiber, carbohydrates, glycemic index and glycemic load in relation to breast cancer prognosis in the HEAL cohort. Cancer Epidemiol Biomarkers Prev, 20, 890-9.
  4. Gnagnarella P, Gandini S, La Vecchia C, Maisonneuve P (2008). Glycemic index, glycemic load, and cancer risk: a metaanalysis. Am J Clin Nutr, 87, 1793-801.
  5. Butler LM, Wu AH, Wang R, et al (2010). A vegetable-fruitsoy dietary pattern protects against breast cancer among postmenopausal Singapore Chinese women. Am J Clin Nutr, 91, 1013-9.
  6. Edefonti V, Randi G, La Vecchia C, Ferraroni M, Decarli A (2009). Dietary patterns and breast cancer: a review with focus on methodological issues. Nutr Rev, 67, 297-314.
  7. Foster-Powell K, Holt SHA, Brand-Miller JC (2002). International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr, 76, 5-56.
  8. Hoffmann K, Schulze MB, Schienkiewitz A, Nothlings U, Boeing H (2004). Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol, 159, 935-44.
  9. Jenkins DJA, Kendall CWC, Augustin LSA, et al (2002). Glycemic index: overview of implications in health and disease. Am J Clin Nutr, 76, 266S-73.
  10. Jiao L, Flood A, Subar AF, et al (2009). Glycemic index, carbohydrates, glycemic load, and the risk of pancreatic cancer in a prospective cohort study. Cancer Epidemiol Biomarkers Prev, 18, 1144-51.
  11. Kaaks R (1996). Nutrition, hormones, and breast cancer: is insulin the missing link? Cancer Causes Control, 7, 605-25.
  12. Key TJ, Appleby PN, Reeves GK, et al (2010). Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies. Lancet Oncol, 11, 530-42.
  13. Larsson SC, Bergkvist L, Wolk A (2009). Glycemic load, glycemic index and breast cancer risk in a prospective cohort of Swedish women. Int J Cancer, 125, 153-7.
  14. Lajous M, Boutron-Ruault MC, Fabre A, Clavel-Chapelon F, Romieu I (2008). Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women. Am J Clin Nutr, 87, 1384-91.
  15. Lajous M, Willett W, Lazcano-Ponce E, et al (2005). Glycemic load, glycemic index, and the risk of breast cancer among Mexican women. Cancer Causes and Control, 16, 1165-9.
  16. Lanzino M, Morelli C, Garofalo C, et al (2008). Interaction between estrogen receptor alpha and insulin/IGF signaling in breast cancer. Curr Cancer Drug Targets, 8, 597-610.
  17. Mawson A, Lai A, Carroll JS, et al (2005). Estrogen and insulin/ IGF-1 cooperatively stimulate cell cycle progression in MCF-7 breast cancer cells through differential regulation of c-Myc and cyclin D1. Mol Cell Endocrinol, 229, 161-73.
  18. McCann SE, McCann WE, Hong CC, et al (2007). Dietary patterns related to glycemic index and load and risk of premenopausal and postmenopausal breast cancer in the Western New York exposure and breast cancer study. Am J Clin Nutr, 86, 465-71.
  19. Mulholland H, Murray L, Cardwell C, Cantwell M (2008). Dietary glycaemic index, glycaemic load and breast cancer risk: a systematic review and meta-analysis. Br J Cancer, 99, 1170-5.
  20. Nielsen TG, Olsen A, Christensen J, Overvad K, Tjonneland A (2005). Dietary carbohydrate intake is not associated with the breast cancer incidence rate ratio in postmenopausal Danish women. J Nutr, 135, 124-8.
  21. Richardson A, Hamilton N, Davis W, Brito C, De Leon D (2011). Insulin-like growth factor-2 (IGF-2) activates estrogen receptor-$\alpha$ and-$\beta$ vir the IGF-1 and the insulin feceptors in breast cancer cells. Growth Factors, 29, 82-93.
  22. Patel AV, McCullough ML, Pavluck AL, et al (2007). Glycemic load, glycemic index, and carbohydrate intake in relation to pancreatic cancer risk in a large US cohort. Cancer Causes Control, 18, 287-94.
  23. Pierce JP, Natarajan L. Caan BJ, et al (2007). Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer. JAMA, 298, 289-98.
  24. Regitnig P, Reiner A, Dinges HP, et al (2002). Quality assurance for detection of estrogen and progesterone receptors by immunohistochemistry in Austrian pathology laboratories. Virchows Arch, 441, 328-34.
  25. Shikany JM, Redden DT, Neuhouser ML, et al (2011). Dietary glycemic load, glycemic index, and carbohydrate and risk of breast cancer in the women's health initiative. Nutr Cancer, 63, 899-907.
  26. Sieri S, Pala V, Brighenti F, et al (2007). Dietary glycemic index, glycemic load, and the risk of breast cancer in an Italian prospective cohort study. Am J Clin Nutr, 86, 1160-6.
  27. Wang L, Xie K, Huo H, et al (2012). Luteolin inhibits proliferation induced by IGF-1 pathway dependent ERq in human breast cancer MCFS7 cells. Asian Pac J Cancer Prev, 13, 1431-7.
  28. Wen W, Shu XO, Li H, et al (2009). Dietary carbohydrates, fiber, and breast cancer risk in Chinese women. Am J Clin Nutr, 89, 283-9.
  29. Willett W, Stampfer MJ (1986). Total energy intake: implications for epidemiologic analyses. Am J Epidemiol, 124, 17-27.
  30. Yee D, Lee AV (2000). Crosstalk between the insulin-like growth factors and estrogens in breast cancer. J Mammary Gland Biol Neoplasia, 5, 107-15.
  31. Zeng YW, Yang JZ, Pu XY, et al (2013). Strategies of functional food for cancer prevention in human beings. Asian Pac J Cancer Prev, 14, 1585-92.
  32. Zhang CX, Ho SC, Chen YM, et al (2009). Greater vegetable and fruit intake is associated with a lower risk of breast cancer among Chinese women. Int J Cancer, 125, 181-8.

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