Post-diagnosis dietary insulinemic potential and survival outcomes among colorectal cancer patients

Abstract

Background: The empirical dietary index for hyperinsulinemia (EDIH) score is a validated food-based dietary score that assesses the ability of whole-food diets to predict plasma c-peptide concentrations. Although the EDIH has been extensively applied and found to be predictive of risk of developing major chronic diseases, its influence on cancer survival has not been evaluated. We applied the EDIH score in a large cohort of colorectal cancer patients to assess the insulinemic potential of their dietary patterns after diagnosis and determine its influence on survival outcomes. Methods: We calculated EDIH scores to assess the insulinemic potential of post-diagnosis dietary patterns and examined survival outcomes in a sample of 1718 stage I-III colorectal cancer patients in the Nurses' Health Study and Health Professionals Follow-up Study cohorts. Multivariable-adjusted Cox regression was applied to compute hazard ratios (HR) and 95% confidence intervals (CI) for colorectal cancer-specific mortality and all-cause mortality. We also examined the influence of change in diet from pre-to post-diagnosis period, on mortality. Results: During a median follow-up of 9.9 years, there were 1008 deaths, which included 272 colorectal cancerspecific deaths (27%). In the multivariable-adjusted analyses, colorectal cancer patients in the highest compared to lowest EDIH quintile, had a 66% greater risk of dying from colorectal cancer: HR, 1.66; 95% CI, 1.03, 2.69; and a 24% greater risk of all-cause death: HR, 1.24; 95%CI, 0.97, 1.58. Compared to patients who consumed low insulinemic diets from pre-to post-diagnosis period, patients who persistently consumed hyperinsulinemic diets were at higher risk of colorectal cancer death (HR,1.51; 95%CI, 0.98, 2.32) and all-cause death (HR, 1.31; 95%CI, 1.04, 2.64). Conclusion: Our findings suggest that a hyperinsulinemic dietary pattern after diagnosis of colorectal cancer is associated with poorer survival. Interventions with dietary patterns to reduce insulinemic activity and impact survivorship are warranted.

The association of insulinemic potential of diet and lifestyle with the risk of insulin-related disorders: a prospective cohort study among participants of Tehran Lipid and Glucose Study

“…Since hyperinsulinemia has been identified as an early metabolic dysfunction indicator previously [ 3 ], several studies explored the association of these two indices with the risk of chronic diseases, in which impaired insulin balance plays an important role in their pathogenesis [ 16 – 21 ]. In this regard, a significant association has been observed between these indices and the risk of some insulin-related malignancies, including colorectal cancer [ 18 ], digestive system cancer [ 19 ], and multiple myeloma [ 20 , 21 ], previously. Two prospective studies with long-term follow-up have also demonstrated that a higher EDIH score is associated with an increased risk of diabetes [ 19 ] and substantial weight gain [ 20 ].…”

“…Lee et al, in a recent study, demonstrated that a higher EDIH score is associated with an increased risk of type 2 diabetes mellitus (T2DM) [ 16 ] and long-term weight gain [ 17 ]. Also, some other studies explored the relationship between EDIH and ELIH with some diseases related to insulin disorders such as colorectal cancer [ 18 ], gastrointestinal cancer [ 19 ], and multiple myeloma [ 20 , 21 ]. However, no study has been conducted to investigate the relationship between indices of the insulinemic potential of diet and lifestyle with insulin-related disorders.…”

The Role of Diet in Prognosis among Cancer Survivors: A Systematic Review and Meta-Analysis of Dietary Patterns and Diet Interventions

“…Another study conducted within the NHS and Health Professionals Follow-up Study (HPFS) cohorts revealed that higher adherence to the empirical dietary index for hyperinsulinaemia (EDIH) had a 66% increased risk of dying from CRC and a 24% increased risk of death from all causes [46].…”

Higher dietary insulinaemic potential is associated with increased risk of liver steatosis and fibrosis

“…its development is data-driven) to assess the insulinaemic potential of habitual diet and have been suggested to be associated with multiple health outcomes including several sitespecific cancers, [16][17][18] type 2 diabetes, 19 weight gain 20 and survival among patients with colorectal cancer. 21,22 To date, however, there has been no epidemiological studies investigating the association of EDIH or EDIR with the risk of hepatic steatosis and fibrosis. In addition, the EDIH and EDIR indices by Tabung et al 15 were derived based on populations from matched case-control studies within 3…”