High-
carbohydrate diets have been linked to
pancreatic cancer risk in case-control studies, but prospective studies have shown mostly null results. The authors investigated the associations of glycemic load, glycemic index, and
carbohydrate intake with
pancreatic cancer risk in the Prostate, Lung, Colorectal, and
Ovarian Cancer Screening Trial. Dietary intake was assessed by using a self-administered questionnaire. Between 1998 and 2006 (median follow-up = 6.5 years), 266 incident, confirmed
pancreatic cancers were identified among 109,175 participants. Hazards ratios and 95% confidence intervals were adjusted for sex, smoking, body mass index, and total energy. Overall, elevated risks for
pancreatic cancer were observed in the 90th versus 10th percentile of glycemic load (hazards ratio (HR) = 1.45, 95% confidence interval (CI): 1.05, 2.00), available
carbohydrate (HR = 1.47, 95% CI: 1.05, 2.06), and
sucrose (HR = 1.37, 95% CI: 0.99, 1.89) intake. The positive association for available
carbohydrate intake was observed during the first 4 years of follow-up (HR(<2 years) = 2.60, 95% CI: 1.34, 5.06; HR(2-<4 years) = 1.94, 95% CI: 1.06, 3.55) but not subsequently (HR = 0.86, 95% CI: 0.52, 1.44); the opposite pattern was observed for total fat and saturated fat intake. Rather than being causal, the short-term increase in
pancreatic cancer risk associated with high available
carbohydrate and low fat intake may be capturing dietary changes associated with subclinical disease.