Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer

Findings From CALGB 89803 (Alliance)

Vicente Morales-Oyarvide, Chen Yuan, Ana Babic, Sui Zhang, Donna Niedzwiecki, Jennie C. Brand-Miller, Laura Sampson-Kent, Xing Ye, Yanping Li, Leonard B. Saltz, Robert J. Mayer, Rex B. Mowat, Renaud Whittom, Alexander Hantel, Al B Benson III, Daniel Atienza, Michael Messino, Hedy Kindler, Alan Venook, Shuji Ogino & 7 others Kana Wu, Walter C. Willett, Edward L. Giovannucci, Brian M. Wolpin, Jeffrey A. Meyerhardt, Charles S. Fuchs, Kimmie Ng

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS: We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS: High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS: Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.

Original languageEnglish (US)
Pages (from-to)170-179
Number of pages10
JournalJournal of the National Cancer Institute
Volume111
Issue number2
DOIs
StatePublished - Feb 1 2019

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Colonic Neoplasms
Insulin
Recurrence
Survival
Neoplasms
Disease-Free Survival
Confidence Intervals
Diet
Microsatellite Instability
Mortality
Hyperinsulinism
Adjuvant Chemotherapy
Observational Studies
Body Mass Index
Obesity
Prospective Studies
Drug Therapy
Mutation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Morales-Oyarvide, Vicente ; Yuan, Chen ; Babic, Ana ; Zhang, Sui ; Niedzwiecki, Donna ; Brand-Miller, Jennie C. ; Sampson-Kent, Laura ; Ye, Xing ; Li, Yanping ; Saltz, Leonard B. ; Mayer, Robert J. ; Mowat, Rex B. ; Whittom, Renaud ; Hantel, Alexander ; Benson III, Al B ; Atienza, Daniel ; Messino, Michael ; Kindler, Hedy ; Venook, Alan ; Ogino, Shuji ; Wu, Kana ; Willett, Walter C. ; Giovannucci, Edward L. ; Wolpin, Brian M. ; Meyerhardt, Jeffrey A. ; Fuchs, Charles S. ; Ng, Kimmie. / Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer : Findings From CALGB 89803 (Alliance). In: Journal of the National Cancer Institute. 2019 ; Vol. 111, No. 2. pp. 170-179.
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title = "Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance)",
abstract = "BACKGROUND: Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS: We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS: High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95{\%} confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95{\%} CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95{\%} CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS: Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.",
author = "Vicente Morales-Oyarvide and Chen Yuan and Ana Babic and Sui Zhang and Donna Niedzwiecki and Brand-Miller, {Jennie C.} and Laura Sampson-Kent and Xing Ye and Yanping Li and Saltz, {Leonard B.} and Mayer, {Robert J.} and Mowat, {Rex B.} and Renaud Whittom and Alexander Hantel and {Benson III}, {Al B} and Daniel Atienza and Michael Messino and Hedy Kindler and Alan Venook and Shuji Ogino and Kana Wu and Willett, {Walter C.} and Giovannucci, {Edward L.} and Wolpin, {Brian M.} and Meyerhardt, {Jeffrey A.} and Fuchs, {Charles S.} and Kimmie Ng",
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Morales-Oyarvide, V, Yuan, C, Babic, A, Zhang, S, Niedzwiecki, D, Brand-Miller, JC, Sampson-Kent, L, Ye, X, Li, Y, Saltz, LB, Mayer, RJ, Mowat, RB, Whittom, R, Hantel, A, Benson III, AB, Atienza, D, Messino, M, Kindler, H, Venook, A, Ogino, S, Wu, K, Willett, WC, Giovannucci, EL, Wolpin, BM, Meyerhardt, JA, Fuchs, CS & Ng, K 2019, 'Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance)', Journal of the National Cancer Institute, vol. 111, no. 2, pp. 170-179. https://doi.org/10.1093/jnci/djy098

Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer : Findings From CALGB 89803 (Alliance). / Morales-Oyarvide, Vicente; Yuan, Chen; Babic, Ana; Zhang, Sui; Niedzwiecki, Donna; Brand-Miller, Jennie C.; Sampson-Kent, Laura; Ye, Xing; Li, Yanping; Saltz, Leonard B.; Mayer, Robert J.; Mowat, Rex B.; Whittom, Renaud; Hantel, Alexander; Benson III, Al B; Atienza, Daniel; Messino, Michael; Kindler, Hedy; Venook, Alan; Ogino, Shuji; Wu, Kana; Willett, Walter C.; Giovannucci, Edward L.; Wolpin, Brian M.; Meyerhardt, Jeffrey A.; Fuchs, Charles S.; Ng, Kimmie.

In: Journal of the National Cancer Institute, Vol. 111, No. 2, 01.02.2019, p. 170-179.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer

T2 - Findings From CALGB 89803 (Alliance)

AU - Morales-Oyarvide, Vicente

AU - Yuan, Chen

AU - Babic, Ana

AU - Zhang, Sui

AU - Niedzwiecki, Donna

AU - Brand-Miller, Jennie C.

AU - Sampson-Kent, Laura

AU - Ye, Xing

AU - Li, Yanping

AU - Saltz, Leonard B.

AU - Mayer, Robert J.

AU - Mowat, Rex B.

AU - Whittom, Renaud

AU - Hantel, Alexander

AU - Benson III, Al B

AU - Atienza, Daniel

AU - Messino, Michael

AU - Kindler, Hedy

AU - Venook, Alan

AU - Ogino, Shuji

AU - Wu, Kana

AU - Willett, Walter C.

AU - Giovannucci, Edward L.

AU - Wolpin, Brian M.

AU - Meyerhardt, Jeffrey A.

AU - Fuchs, Charles S.

AU - Ng, Kimmie

PY - 2019/2/1

Y1 - 2019/2/1

N2 - BACKGROUND: Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS: We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS: High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS: Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.

AB - BACKGROUND: Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients. METHODS: We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided. RESULTS: High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability. CONCLUSIONS: Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.

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U2 - 10.1093/jnci/djy098

DO - 10.1093/jnci/djy098

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