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1.
Reumatismo ; 76(1)2024 Mar 22.
Article En | MEDLINE | ID: mdl-38523582

OBJECTIVE: To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. METHODS: Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects' characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher's exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup. RESULTS: Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample. CONCLUSIONS: Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.


Breast Neoplasms , Hypertriglyceridemia , Vitamin D Deficiency , Vitamin D , Female , Humans , Breast Neoplasms/epidemiology , Breast Neoplasms/complications , Hypertriglyceridemia/complications , Italy/epidemiology , Life Style , Risk Factors , Vitamin D/analogs & derivatives , Vitamin D Deficiency/epidemiology
2.
J Cell Physiol ; 232(5): 1144-1150, 2017 05.
Article En | MEDLINE | ID: mdl-27579809

Hyperglycemia and hyperinsulinemia may play a role in breast carcinogenesis and prediabetes and diabetes have been associated with increased breast cancer (BC) risk. However, whether BC molecular subtypes may modify these associations is less clear. We therefore investigated these associations in all cases and by BC molecular subtypes among women living in Southern Italy. Cases were 557 patients with non-metastatic incident BC and controls were 592 outpatients enrolled during the same period as cases and in the same hospital for skin-related non-malignant conditions. Adjusted multivariate logistic regression models were built to assess the risks of developing BC in the presence of prediabetes or diabetes. The analyses were repeated by strata of BC molecular subtypes: Luminal A, Luminal B, HER2+, and Triple Negative (TN). Prediabetes and diabetes were significantly associated with higher BC incidence after controlling for known risk factors (OR = 1.94, 95% CI 1.32-2.87 and OR = 2.46, 95% CI 1.38-4.37, respectively). Similar results were seen in Luminal A and B while in the TN subtype only prediabetes was associated with BC (OR = 2.43, 95% CI 1.11-5.32). Among HER2+ patients, only diabetes was significantly associated with BC risk (OR = 3.04, 95% CI 1.24-7.47). Furthermore, when postmenopausal HER2+ was split into hormone receptor positive versus negative, the association with diabetes remained significant only in the former (OR = 5.13, 95% CI 1.53-17.22). These results suggest that prediabetes and diabetes are strongly associated with BC incidence and that these metabolic conditions may be more relevant in the presence of breast cancer molecular subtypes with positive hormone receptors. J. Cell. Physiol. 232: 1144-1150, 2017. © 2016 Wiley Periodicals, Inc.


Breast Neoplasms/classification , Breast Neoplasms/epidemiology , Diabetes Mellitus/epidemiology , Prediabetic State/epidemiology , Adult , Aged , Breast Neoplasms/complications , Case-Control Studies , Demography , Female , Humans , Italy/epidemiology , Menopause , Middle Aged , Odds Ratio , Prediabetic State/complications , Risk Factors
3.
Curr Res Transl Med ; 64(1): 15-20, 2016.
Article En | MEDLINE | ID: mdl-27140595

Breast cancer (BC) is the most common malignant tumor in women, obesity is associated with increased BC incidence and mortality and high levels of circulating insulin may negatively impact on cancer incidence. In the present study, we investigated whether the strength of several anthropometric and metabolic parameters varies between BC molecular subtypes. Eligible cases were 991 non-metastatic BC patients recruited between January 2009 and December 2013. Anthropometric, clinical and immunohistochemical features were measured. Multivariate logistic regression models were built to assess HER2 positive BC risk, comparing (a) triple positive (TP) with luminal A, luminal B and triple negative (TN) and (b) HER2-enriched group with luminal A, luminal B and TN. We stratified patients in pre- and post-menopause: significant differences emerged for luminal A in relation to age: they were more likely to be older compared to other groups. Among postmenopausal patients, the adjusted multivariate analysis showed that high BMI and high waist circumference were inversely correlated to TP subtype when compared to luminal B (OR=0.48 and OR=0.49, respectively). Conversely, HOMA-IR was a risk factor for TP when compared to luminal A and TN (OR=2.47 and OR=3.15, respectively). Our findings suggest a potential role of higher abdominal fat in the development of specific BC molecular subtypes in postmenopausal women. Moreover, they support a potential role of insulin resistance in the development of HER2 positive BC, although this role appears to be stronger when hormone receptors are co-expressed, suggesting a difference in the etiology of these two BC subtypes.


Body Weight , Breast Neoplasms/epidemiology , Carcinoma, Ductal, Breast/epidemiology , Estrogens , Genes, erbB-2 , Neoplasms, Hormone-Dependent/epidemiology , Progesterone , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor , Blood Glucose/analysis , Body Mass Index , Breast Neoplasms/chemistry , Breast Neoplasms/classification , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/genetics , Carcinoma, Ductal, Breast/pathology , Disease Susceptibility , Female , Humans , Insulin/blood , Insulin Resistance , Italy/epidemiology , Middle Aged , Neoplasms, Hormone-Dependent/genetics , Neoplasms, Hormone-Dependent/pathology , Postmenopause , Receptor, ErbB-2/analysis , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Retrospective Studies , Triple Negative Breast Neoplasms/epidemiology , Triple Negative Breast Neoplasms/genetics , Triple Negative Breast Neoplasms/pathology , Waist Circumference , Waist-Hip Ratio
4.
Nutr Metab Cardiovasc Dis ; 25(12): 1132-9, 2015 Dec.
Article En | MEDLINE | ID: mdl-26552742

BACKGROUND AND AIM: Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatments from the same study to assess the effect over time on systolic, diastolic and mean arterial pressure (MAP), and the relation to sodium (Na(+)), potassium (K(+)), and portfolio components. METHODS AND RESULTS: 241 participants with hyperlipidemia, from four academic centers across Canada were randomized and completed either a DASH-type diet (control n = 82) or a dietary portfolio that included, soy protein, viscous fibers and nuts (n = 159) for 24 weeks. Fasting measures and 7-day food records were obtained at weeks 0, 12 and 24, with 24-h urines at weeks 0 and 24. The dietary portfolio reduced systolic, diastolic and mean arterial blood pressure compared to the control by 2.1 mm Hg (95% CI, 4.2 to -0.1 mm Hg) (p = 0.056), 1.8 mm Hg (CI, 3.2 to 0.4 mm Hg) (p = 0.013) and 1.9 mm Hg (CI, 3.4 to 0.4 mm Hg) (p = 0.015), respectively. Blood pressure reductions were small at 12 weeks and only reached significance at 24 weeks. Nuts, soy and viscous fiber all related negatively to change in mean arterial pressure (ρ = -0.15 to -0.17, p ≤ 0.016) as did urinary potassium (ρ = -0.25, p = 0.001), while the Na(+)/K(+) ratio was positively associated (ρ = 0.20, p = 0.010). CONCLUSIONS: Consumption of a cholesterol-lowering dietary portfolio also decreased blood pressure by comparison with a healthy DASH-type diet. CLINICAL TRIAL REG. NO.: NCT00438425, clinicaltrials.gov.


Cardiovascular Diseases/diet therapy , Diet Records , Diet, Fat-Restricted/methods , Diet, Sodium-Restricted/methods , Hyperlipidemias/diet therapy , Hypertension/diet therapy , Adult , Aged , Blood Pressure Determination/methods , Canada , Cardiovascular Diseases/prevention & control , Diet, Mediterranean , Energy Intake , Female , Follow-Up Studies , Humans , Hyperlipidemias/prevention & control , Hypertension/prevention & control , Male , Middle Aged , Risk Assessment , Treatment Outcome
5.
Nutr Metab Cardiovasc Dis ; 25(9): 795-815, 2015 Sep.
Article En | MEDLINE | ID: mdl-26160327

BACKGROUND AND AIMS: The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS: International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS: The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS: Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.


Cardiovascular Diseases/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Glycemic Index , Glycemic Load , Neoplasms/epidemiology , Blood Glucose/metabolism , Body Weight , Cardiovascular Diseases/diet therapy , Diabetes Mellitus, Type 2/diet therapy , Diet, Mediterranean , Dietary Carbohydrates/administration & dosage , Dietary Fiber/administration & dosage , Humans , Insulin Resistance , Italy/epidemiology , Neoplasms/diet therapy , Postprandial Period , Prevalence , Risk Factors , Whole Grains
6.
Nutr Metab Cardiovasc Dis ; 24(8): 845-52, 2014 Aug.
Article En | MEDLINE | ID: mdl-24925120

BACKGROUND AND AIMS: Nut consumption has been associated with decreased risk of coronary heart disease (CHD) and type 2 diabetes which has been largely attributed to their healthy fatty acid profile, yet this has not been ascertained. Therefore, we investigated the effect of nut consumption on serum fatty acid concentrations and how these relate to changes in markers of glycemic control and calculated CHD risk score in type 2 diabetes. METHODS AND RESULTS: 117 subjects with type 2 diabetes consumed one of three iso-energetic (mean 475 kcal/d) supplements for 12 weeks: 1. full-dose nuts (50-100 g/d); 2. half-dose nuts with half-dose muffins; and 3. full-dose muffins. In this secondary analysis, fatty acid concentrations in the phospholipid, triacylglycerol, free fatty acid, and cholesteryl ester fractions from fasting blood samples obtained at baseline and week 12 were analyzed using thin layer and gas chromatography. Full-dose nut supplementation significantly increased serum oleic acid (OA) and MUFAs compared to the control in the phospholipid fraction (OA: P = 0.036; MUFAs: P = 0.024). Inverse associations were found with changes in CHD risk versus changes in OA and MUFAs in the triacylglycerol (r = -0.256, P = 0.011; r = -0.228, P = 0.024, respectively) and phospholipid (r = -0.278, P = 0.006; r = -0.260, P = 0.010, respectively) fractions. In the cholesteryl ester fraction, change in MUFAs was inversely associated with markers of glycemic control (HbA1c: r = -0.250, P = 0.013; fasting blood glucose: r = -0.395, P < 0.0001). CONCLUSION: Nut consumption increased OA and MUFA content of the serum phospholipid fraction, which was inversely associated with CHD risk factors and 10-year CHD risk. CLINICAL TRIAL REG NO: NCT00410722, clinicaltrials.gov.


Coronary Disease/blood , Diabetes Mellitus, Type 2/blood , Fatty Acids, Monounsaturated/blood , Fatty Acids, Nonesterified/blood , Nuts , Adult , Blood Glucose/metabolism , Cholesterol/blood , Coronary Disease/prevention & control , Diabetes Mellitus, Type 2/prevention & control , Diet , Energy Intake , Female , Humans , Male , Middle Aged , Phospholipids/blood , Triglycerides/blood
7.
Eur J Clin Nutr ; 68(3): 370-5, 2014 Mar.
Article En | MEDLINE | ID: mdl-24424074

BACKGROUND/OBJECTIVE: Nut consumption has been found to decrease risk of coronary heart disease and diabetes and to promote healthy body weights possibly related to their favorable macronutrient profile. We therefore assessed the effect of pistachios on postprandial glucose and insulin levels, gut hormones related to satiety and endothelial function. SUBJECTS/METHODS: In this randomized crossover study, 20 subjects with metabolic syndrome consumed five study meals over 5-10 weeks. The meals differed in fat type and quantity, but were matched according to available carbohydrates (CHOs). Three meals had 50 g available CHO: white bread (WB50g), white bread, butter and cheese (WB+B+Ch) and white bread and pistachios (WB+P). Two meals had 12 g available CHO: white bread (WB12g) and pistachios (P). RESULTS: Within each group of available CHO meals, postprandial glucose levels were the highest following the white bread-only meals, and glucose response was significantly attenuated when butter and cheese or pistachios were consumed (P<0.05). Postprandial insulin levels were highest after the WB+B+Ch meal (P<0.05), but did not differ between the white bread-only and pistachio meals. Both endothelial function (reactive hyperemia index) and arterial stiffness (augmentation index) significantly increased after the white bread-only meals compared with the WB+B+Ch meal (all P<0.05). Insulin secretagogue levels were higher when butter and cheese or pistachios were consumed than when white bread only was consumed (P<0.05). CONCLUSIONS: Compared with white bread, pistachio consumption reduced postprandial glycemia, increased glucagon-like-peptide levels and may have insulin-sparing properties. These effects could be beneficial for individuals with diabetes and metabolic syndrome.


Blood Glucose/metabolism , Endothelium/metabolism , Insulin/blood , Metabolic Syndrome/metabolism , Pistacia/chemistry , Adult , Aged , Bread/analysis , Cross-Over Studies , Female , Humans , Male , Meals , Middle Aged , Nuts/chemistry , Postprandial Period/physiology , Satiation/physiology , Triticum/chemistry
8.
Ann Oncol ; 24(12): 3094-9, 2013 Dec.
Article En | MEDLINE | ID: mdl-24155133

BACKGROUND: Carbohydrate foods with high glycemic and insulinemic potential may influence cancer risk possibly through the insulin/growth-factor axis. Two staple carbohydrate foods of the Mediterranean diet, bread and pasta, have different glycemic and insulinemic responses and hence may affect cancer risk differently. MATERIALS AND METHODS: We studied the association of bread and pasta with breast and colorectal cancer risk using data from two Italian case-control studies. These studies included 2569 women with histologically confirmed breast cancer and 1953 men and women with colorectal cancer. Controls were 2588 and 4154, respectively, admitted to the same hospitals as cases for acute, non-neoplastic conditions. Multivariate odds ratios (ORs) were obtained after allowance for relevant confounding factors. RESULTS: The ORs of breast cancer for the highest versus the lowest quintile were 1.28 (95% confidence interval, CI: 1.03-1.58, P-trend = 0.0342) for bread and 1.07 (95% CI: 0.88-1.31, P-trend = 0.7072) for pasta. The association with bread remained virtually unchanged with postmenopause and overweight. The ORs of colorectal cancer in women for the highest versus the lowest quintile were 2.02 (95% CI: 1.46-2.80, P-trend = 0.0002) for bread and 1.37 (95% CI: 1.00-1.88, P-trend = 0.0164) for pasta. The associations remained significant only for bread in strata of menopausal status and in women with overweight. No significant associations were seen in men for either bread or pasta. CONCLUSIONS: Overall, these two cancer case-control studies showed stronger positive associations with bread than pasta in women, particularly if overweight, suggesting possible hormonal-related mechanisms.


Bread/adverse effects , Breast Neoplasms/etiology , Colorectal Neoplasms/etiology , Dietary Carbohydrates/adverse effects , Aged , Body Mass Index , Case-Control Studies , Diet, Mediterranean , Female , Humans , Male , Middle Aged , Odds Ratio , Risk Factors
9.
Diabetologia ; 56(11): 2405-13, 2013 Nov.
Article En | MEDLINE | ID: mdl-23975324

AIMS/HYPOTHESIS: The role of diet in the prevention of diabetes remains uncertain. The aim of this study was to investigate two different dietary aspects, i.e. adherence to the Mediterranean diet and glycaemic load (GL), in relation to diabetes occurrence. METHODS: We analysed data from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). From a total of 22,295 participants, actively followed for a median of 11.34 years, 2,330 cases of incident type 2 diabetes were recorded. All participants completed a validated, interviewer-administered semi-quantitative food frequency questionnaire at enrolment. From this information, we calculated a ten point Mediterranean diet score (MDS), reflecting adherence to the traditional Mediterranean diet, as well as the dietary GL. We estimated HRs and the corresponding 95% CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders. RESULTS: A higher MDS was inversely associated with diabetes risk (HR 0.88 [95% CI 0.78, 0.99] for MDS ≥ 6 vs MDS ≤ 3). GL was positively associated with diabetes (HR 1.21 [95% CI 1.05, 1.40] for the highest vs the lowest GL quartile). A significant protection of about 20% was found for a diet with a high MDS and a low GL. CONCLUSIONS/INTERPRETATION: A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.


Diabetes Mellitus, Type 2/epidemiology , Diet, Mediterranean , Adult , Aged , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/blood , Female , Humans , Incidence , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Surveys and Questionnaires
10.
Ann Oncol ; 24(1): 245-51, 2013 Jan.
Article En | MEDLINE | ID: mdl-22831983

BACKGROUND: Dietary glycemic index (GI) and glycemic load (GL) have been related to the risk of selected cancers, but the issue remains open. PATIENTS AND METHODS: Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces for incident, histologically confirmed cases of the stomach (n=1182), colon (n=1727), rectum (n=1447), liver (n=309), pancreas (n=628), lung (n=3341), breast (n=2362), ovary (n=442), prostate (n=1799), testis (n=686), kidney (n=1345), bladder (n=1029), brain (n=1009), non-Hodgkin's lymphomas (NHL, n=1666), leukemias (n=1069), multiple myelomas (n=343), and 5039 population controls. Dietary information on eating habits 2 years before participants' enrollment in the study was obtained using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) and 95% confidence intervals (CI) were derived by unconditional logistic regression including recognized confounding factors. RESULTS: Dietary GI was positively associated with the risk of prostate cancer (OR, 1.26 for the highest versus the lowest quartile). A higher dietary GL significantly increased the risk of colorectal (OR, 1.28), rectal (OR, 1.44) and pancreatic (OR, 1.41) cancers. No other significant associations were found. CONCLUSIONS: Our findings suggest that a diet high in GI and GL is associated with increased risk of selected cancers.


Dietary Carbohydrates/administration & dosage , Glucose/administration & dosage , Glycemic Index , Neoplasms/etiology , Body Mass Index , Case-Control Studies , Dietary Carbohydrates/adverse effects , Female , Glucose/adverse effects , Humans , Male
11.
Nutr Metab Cardiovasc Dis ; 21 Suppl 1: S34-9, 2011 Jun.
Article En | MEDLINE | ID: mdl-21561748

BACKGROUND AND AIMS: The intake of nuts has been linked to a reduced risk of cardiovascular disease (CVD) and diabetes in large cohort studies. One potential contributing mechanism may be the ability of nuts to improve post-meal glycemic response. We, therefore, examined the effect of nuts alone and in combination with white bread on postprandial glycemia. METHODS AND RESULTS: 30, 60 and 90 g (approximately 1, 2 and 3 ounces) of mixed nuts were consumed with and without 50 g available carbohydrate from white bread by 10-14 normoglycemic and 5-10 type 2 diabetic subjects. Glycemic response (GR) was assessed by calculating the incremental area under the 2 h blood glucose curve. All three doses of mixed nuts, when fed alone, significantly reduced the glycemic response in both normoglycemic and diabetic patients. Furthermore, in the normoglycemic subjects, adding nuts to white bread progressively reduced the GR of the meal by 11.2 ± 11.6%, 29.7 ± 12.2% and 53.5 ± 8.5% for the 30, 60, and 90 g doses (P = 0.354, P = 0.031 and P < 0.001, respectively), while in subjects with type 2 diabetes, the effect was half of that seen in the non-diabetic subjects (P = 0.474, P = 0.113 and P = 0.015, respectively). CONCLUSION: Nuts alone have little effect on post-meal blood glucose response. Furthermore, when taken with bread, nuts progressively reduce the glycemic response in a dose-dependent manner. While these findings support a short-term benefit for nuts in postprandial glucose response, more studies are required to determine whether these acute benefits result in long-term improvements in glycemic control.


Blood Glucose/analysis , Bread , Diabetes Mellitus, Type 2/blood , Diet , Glycemic Index , Nuts , Adult , Aged , Case-Control Studies , Dietary Carbohydrates/administration & dosage , Female , Humans , Male , Postprandial Period
12.
Eur J Clin Nutr ; 61(2): 221-5, 2007 Feb.
Article En | MEDLINE | ID: mdl-16969380

OBJECTIVE: To explore the relation between a wide range of alcohol consumptions and levels of the components of insulin-like growth factor system (IGFs) and adiponectin in humans. DESIGN: A cross-sectional study using controls from a case-control study on ovarian and endometrial cancer. SETTINGS: The study included women hospitalized between 1999 and 2002 in Pordenone, Italy. SUBJECTS: One hundred and eight cancer-free (controls) with a median age of 61 years (range 29-79 years), admitted for acute conditions unrelated to gynecologic, hormonal or metabolic disorders or diseases leading to dietary modifications. INTERVENTIONS: Levels of IGF-I (total and free), total IGF-II, IGF-binding protein 1 (IGFBP-1), IGFBP-3 and adiponectin were individually measured, and their distributions across strata of alcohol consumption were tested by the Kruskal-Wallis statistic. RESULTS: Median concentrations of total IGF-I were higher (P<0.01) in women reporting low (151 ng/ml) or no alcohol consumption (134 ng/ml) compared to drinkers of 12-23 g/day (103 ng/ml) or >or=24 g/day (118 ng/ml). Median concentrations were higher (P=0.05) for IGFBP-3 in non-drinkers (2333 ng/ml) and in light drinkers (2647 ng/ml) compared to drinkers of >or=24 g/day (2090 ng/ml). No statistically significant difference emerged for other IGFs across levels of alcohol intakes. Adiponectin was slightly lower for non-drinkers, compared to all drinkers categories. CONCLUSIONS: Our study suggests that alcohol consumption is related to circulating levels of components of the IGF system and adiponectin. These results may have a potential impact on the prevention of several chronic diseases. SPONSORSHIP: Italian Association for Research on Cancer, Milan, Italy, and Italian League against Tumours, Milan, Italy.


Adiponectin/blood , Alcohol Drinking , Somatomedins/metabolism , Adult , Aged , Chronic Disease/prevention & control , Cross-Sectional Studies , Dose-Response Relationship, Drug , Female , Humans , Insulin-Like Growth Factor Binding Protein 1/blood , Insulin-Like Growth Factor Binding Protein 3/blood , Insulin-Like Growth Factor I/metabolism , Insulin-Like Growth Factor II/metabolism , Middle Aged , Statistics, Nonparametric
13.
Ann Oncol ; 15(4): 581-4, 2004 Apr.
Article En | MEDLINE | ID: mdl-15033662

BACKGROUND: Dietary carbohydrates have been directly associated with gastric cancer risk and have been considered general indicators of a poor diet. However, elevated levels of glucose and insulin elicited by consumption of high amounts of refined carbohydrates may stimulate mitogenic and cancer-promoting insulin-like growth factors (IGF). Glycemic index (GI) and glycemic load (GL), which represent indirect measures of dietary insulin demand, were analysed to understand further the association between carbohydrates and gastric cancer. PATIENTS AND METHODS: Data were derived from a hospital-based case-control study on gastric cancer, conducted in Italy between 1985 and 1997, including 769 cases with incident, histologically confirmed gastric cancer and 2081 controls admitted to the same hospital network as cases for acute, non-neoplastic diseases. All subjects were interviewed using a reproducible food frequency questionnaire. RESULTS: The multivariate odds ratios (OR) for subsequent quartiles of dietary GL were 1.44 [95% confidence interval (CI) 1.11-1.87], 1.62 (95% CI 1.24-2.12) and 1.94 (95% CI 1.47-2.55). No consistent pattern of risk was seen with GI. The associations were consistent in different strata of age, education and body mass index, and were stronger in women. CONCLUSIONS: This study supports the hypothesis of a direct association between GL and gastric cancer risk, thus providing an innovative interpretation, linked to excess circulating insulin and related IGFs, for the association between carbohydrates and risk of gastric cancer.


Glycemic Index , Stomach Neoplasms/etiology , Adult , Aged , Confidence Intervals , Female , Humans , Italy , Male , Middle Aged , Odds Ratio , Risk Factors , Surveys and Questionnaires
15.
Heart ; 89(7): 722-6, 2003 Jul.
Article En | MEDLINE | ID: mdl-12807839

OBJECTIVES: To assess the relation between selected carbohydrate foods, dietary glycaemic load and glycaemic index, and the risk of non-fatal acute myocardial infarction in a population with a high intake of refined carbohydrates. DESIGN AND SETTING: Hospital based case-control study conducted in Milan, Italy, between 1995 and 1999. PATIENTS: 433 non-diabetic subjects with a first episode of non-fatal acute myocardial infarction, and 448 controls admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential risk factors for acute myocardial infarction. METHODS: Information was collected by interviewer administered questionnaires. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple logistic regression models. RESULTS: Compared with patients in the lowest tertile of intake, the multivariate OR for those in the highest tertile was 1.00 for bread, 1.27 for pasta and rice, 1.38 for soups, 0.78 for potatoes, 0.97 for desserts, and 1.00 for sugar. The OR for the highest tertile of score was 1.08 for glycaemic load and 1.38 for glycaemic index. None of the estimates was significant. A significant association with acute myocardial infarction risk was found for glycaemic index in patients aged > or = 60 years (OR 1.81, 95% CI 1.07 to 3.07 for the highest tertile of score compared with the lowest) and in those with a body mass index > or = 25 kg/m2 (OR 2.02, 95% CI 1.21 to 3.34). CONCLUSIONS: In this Italian population high glycaemic load and glycaemic index were not strongly associated with acute myocardial infarction risk, but slightly increased odds ratios were observed for glycaemic index in elderly people and in association with overweight.


Blood Glucose , Dietary Carbohydrates/adverse effects , Myocardial Infarction/etiology , Adult , Age of Onset , Aged , Case-Control Studies , Female , Glycemic Index , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/blood , Odds Ratio , Risk Factors
16.
Eur J Clin Nutr ; 57(2): 376-82, 2003 Feb.
Article En | MEDLINE | ID: mdl-12571674

OBJECTIVE: To determine the effect of high-protein diets, which have recently been promoted for their health benefits, on urinary calcium losses and bone turnover in older subjects. DESIGN: Randomized controlled cross-over study. SETTING: Teaching hospital and university. SUBJECTS: Twenty hyperlipidemic men and postmenopausal women (age 56+/-2 y) completed the study. INTERVENTION: One-month test and control phases during which subjects consumed equi-energy metabolic diets high in calcium (1578 and 1593 mg/day, respectively). On the test diet 11% of total dietary energy from starch in the control bread was replaced by protein (wheat gluten), resulting in 27% of energy from protein on the test diet vs 16% on the control diet. MAIN OUTCOME MEASURE: Urinary calcium excretion. RESULTS: Compared with the control diet, at week 4, the test diet increased mean (+/-s.e.m.) 24 h urinary output of calcium (139+/-15 vs 227+/-21 mg, P=0.004). The treatment difference in urinary calcium loss correlated with the serum anion gap as a marker of metabolic acid production (r=0.57, P=0.011). Serum calcium levels were marginally lower 2.41+/-0.02 vs 2.38+/-0.02 mmol/l (P=0.075), but there was no significant treatment difference in calcium balance, possibly related to the high background calcium intake on both diets. CONCLUSION: In the presence of high dietary calcium intakes the vegetable protein gluten does not appear to have a negative effect on calcium balance despite increased urinary calcium loss.


Calcium/urine , Dietary Proteins/pharmacology , Vegetables , Adult , Aged , Cross-Over Studies , Diet , Dietary Proteins/blood , Dietary Proteins/urine , Feces , Female , Humans , Hyperlipidemias/blood , Hyperlipidemias/urine , Male , Middle Aged , Postmenopause/urine
17.
Ann Oncol ; 14(1): 78-84, 2003 Jan.
Article En | MEDLINE | ID: mdl-12488297

BACKGROUND: Dietary carbohydrates vary in their ability to raise blood glucose and insulin levels, which, in turn, influence levels of sex hormones and insulin-like growth factors. We analyzed the effect of type and amount of carbohydrates on ovarian cancer risk, using the glycemic index (GI) and the glycemic load (GL) measurement in a large case-control study conducted in Italy. MATERIALS AND METHODS: Cases included 1031 women with incident, histologically confirmed epithelial ovarian cancer, from four Italian regions. Controls included 2411 women admitted to the same hospital networks for acute, non-neoplastic conditions. Average daily GI and GL were calculated from a validated food frequency questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were computed using multiple logistic regression. RESULTS: Ovarian cancer was directly associated with dietary GI (OR for highest versus lowest quartile = 1.7, 95% CI 1.3-2.1) and GL (OR = 1.7, 95% CI 1.3-2.1). The associations were observed in pre- and postmenopausal women, and they remained consistent across strata of major covariates identified. CONCLUSIONS: This study supports the hypothesis of a direct association between GI and GL and ovarian cancer risk and, consequently, of a possible role of hyperinsulinemia/insulin resistance in ovarian cancer development.


Blood Glucose/metabolism , Dietary Carbohydrates/adverse effects , Glycemic Index , Ovarian Neoplasms/etiology , Adult , Aged , Case-Control Studies , Female , Humans , Hyperinsulinism/complications , Insulin/blood , Insulin Resistance , Italy/epidemiology , Menopause , Middle Aged , Odds Ratio , Ovarian Neoplasms/blood , Risk Factors
18.
Eur J Clin Nutr ; 56(11): 1049-71, 2002 Nov.
Article En | MEDLINE | ID: mdl-12428171

AIM: The intent of this review is to critically analyze the scientific evidence on the role of the glycemic index in chronic Western disease and to discuss the utility of the glycemic index in the prevention and management of these disease states. BACKGROUND: The glycemic index ranks foods based on their postprandial blood glucose response. Hyperinsulinemia and insulin resistance, as well as their determinants (eg high energy intake, obesity, lack of physical activity) have been implicated in the etiology of diabetes, coronary heart disease and cancer. Recently, among dietary factors, carbohydrates have attracted much attention as a significant culprit, however, different types of carbohydrate produce varying glycemic and insulinemic responses. Low glycemic index foods, characterized by slowly absorbed carbohydrates, have been shown in some studies to produce beneficial effects on glucose control, hyperinsulinemia, insulin resistance, blood lipids and satiety. METHOD: Studies on the short and long-term metabolic effects of diets with different glycemic indices will be presented and discussed. The review will focus primarily on clinical and epidemiological data, and will briefly discuss in vitro and animal studies related to possible mechanisms by which the glycemic index may influence chronic disease.


Blood Glucose/metabolism , Diabetes Mellitus/etiology , Food/classification , Glycemic Index , Heart Diseases/etiology , Neoplasms/etiology , Area Under Curve , Chronic Disease , Diabetes Mellitus/prevention & control , Dietary Carbohydrates/administration & dosage , Dietary Carbohydrates/classification , Dietary Carbohydrates/metabolism , Exercise/physiology , Heart Diseases/prevention & control , Humans , Hyperinsulinism/etiology , Hyperinsulinism/prevention & control , Insulin/metabolism , Insulin Resistance , Neoplasms/prevention & control , Obesity/metabolism , Postprandial Period
19.
Am J Clin Nutr ; 74(1): 57-63, 2001 Jul.
Article En | MEDLINE | ID: mdl-11451718

BACKGROUND: The metabolic effects of diets high in vegetable protein have not been assessed despite much recent interest in the effect of soy proteins in reducing serum cholesterol. OBJECTIVE: We assessed the metabolic effects of diets high in vegetable protein (specifically, wheat gluten) on serum lipids, uric acid concentrations, and renal function. DESIGN: Twenty hyperlipidemic men and women consumed isoenergetic test (high-protein) and control metabolic diets for 1 mo in a randomized crossover design. In the high-protein diet, 11% of the total dietary energy from starch in the control bread was replaced by vegetable protein (wheat gluten), resulting in 27% of total energy from protein compared with 16% in the control diet. In other respects, the 2 diets were identical. RESULTS: Compared with the control, the high-protein diet resulted in lower serum concentrations of triacylglycerol (by 19.2 +/- 5.6%; P = 0.003), uric acid (by 12.7 +/- 2.0%; P < 0.001), and creatinine (by 2.5 +/- 1.1%; P = 0.035) and higher serum concentrations of urea (by 42.2 +/- 5.8%; P < 0.001) and a higher 24-h urinary urea output (by 99.2 +/- 17.2%; P < 0.001). No significant differences were detected in total or HDL cholesterol or in the renal clearance of creatinine. LDL oxidation, assessed as the ratio of conjugated dienes to LDL cholesterol in the LDL fraction, was lower with the high-protein diet (by 10.6 +/- 3.6%; P = 0.009). CONCLUSIONS: High intakes of vegetable protein from gluten may have beneficial effects on cardiovascular disease risk by reducing oxidized LDL, serum triacylglycerol, and uric acid. Further studies are required to assess the longer-term effects on renal function.


Dietary Proteins/administration & dosage , Glutens/pharmacology , Hyperlipidemias/diet therapy , Kidney/physiology , Lipids/blood , Uric Acid/blood , Adult , Aged , Creatinine/blood , Cross-Over Studies , Female , Glomerular Filtration Rate , Humans , Hyperlipidemias/blood , Kidney/drug effects , Male , Middle Aged , Oxidation-Reduction , Triticum , Urea/urine
20.
Ann Oncol ; 12(11): 1533-8, 2001 Nov.
Article En | MEDLINE | ID: mdl-11822751

BACKGROUND: Certain types of carbohydrates increase glucose and insulin levels to a greater extent than others. In turn, insulin may raise levels of insulin-like growth factors, which may influence breast cancer risk. We analyzed the effect of type and amount of carbohydrates on breast cancer risk, using the glycemic index and the glycemic load measures in a large case-control study conducted in Italy. PATIENTS AND METHODS: Cases were 2,569 women with incident, histologically-confirmed breast cancer interviewed between 1991 and 1994. Controls were 2588 women admitted to the same hospital network for a variety of acute, non-neoplastic conditions. Average daily glycemic index and glycemic load were calculated from a validated 78-item food frequency questionnaire. RESULTS: Direct associations with breast cancer risk emerged for glycemic index (odds ratio, OR for highest vs. lowest quintile = 1.4; P for trend <0.01) and glycemic load (OR = 1.3; P < 0.01). High glycemic index foods, such as white bread, increased the risk of breast cancer (OR = 1.3) while the intake of pasta, a medium glycemic index food, seemed to have no influence (OR = 1.0). Findings were consistent across different strata of menopausal status, alcohol intake, and physical activity level. CONCLUSIONS: This study supports the hypothesis of moderate, direct associations between glycemic index or glycemic load and breast cancer risk and, consequently, a possible role of hyperinsulinemia/insulin resistance in breast cancer development.


Blood Glucose/metabolism , Breast Neoplasms/etiology , Dietary Carbohydrates/adverse effects , Hyperinsulinism/etiology , Adult , Aged , Alcohol Drinking , Breast Neoplasms/blood , Case-Control Studies , Education , Exercise , Feeding Behavior , Female , Humans , Insulin/blood , Italy/epidemiology , Menopause , Middle Aged , Odds Ratio , Parity , Risk Factors
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