Dietary patterns of insulinemia, inflammation and glycemia, and pancreatic cancer risk: Findings from the women's health initiative

Qi Jin, Phil A. Hart, Ni Shi, Joshua J. Joseph, Macarius Donneyong, Darwin L. Conwell, Steven K. Clinton, Zobeida Cruz-Monserrate, Theodore M. Brasky, Lesley F. Tinker, Simin Liu, Aladdin H. Shadyab, Cynthia A. Thomson, Lihong Qi, Thomas Rohan, Fred K. Tabung

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Pancreatic cancer risk is increasing in countries with high consumption of Western dietary patterns and rising obesity rates. We examined the hypothesis that specific dietary patterns reflecting hyperinsulinemia (empirical dietary index for hyperinsulinemia; EDIH), systemic inflammation (empirical dietary inflammatory pattern; EDIP), and postprandial glycemia [glycemic index (GI); glycemic load (GL)] are associated with pancreatic cancer risk, including the potential modifying role of type 2 diabetes (T2D) and body mass index (BMI). Methods: We calculated dietary scores from baseline (1993-1998) food frequency questionnaires among 129,241 women, 50-79 years-old in the Women's Health Initiative. We used multivariable-adjusted Cox regression to estimate HRs and 95% confidence intervals (95% CI) for pancreatic cancer risk. Results: During a median 19.9 years of follow-up, 850 pancreatic cancer cases were diagnosed. We observed no association between dietary scores and pancreatic cancer risk overall. However, risk was elevated among participants with longstanding T2D (present >3 years before pancreatic cancer diagnosis) for EDIH. For each 1 SD increment in dietary score, the HRs (95% CIs) were: EDIH, 1.33 (1.06-1.66); EDIP, 1.26 (0.98-1.63); GI, 1.26 (0.96-1.67); and GL, 1.23 (0.96-1.57); although interactions were not significant (all Pinteraction >0.05). Separately, we observed inverse associations between GI [0.86 (0.76-0.96), Pinteraction ¼ 0.0068] and GL [0.83 (0.73-0.93), Pinteraction ¼ 0.0075], with pancreatic cancer risk among normal-weight women. Conclusions: We observed no overall association between the dietary patterns evaluated and pancreatic cancer risk, although women with T2D appeared to have greater cancer risk. Impact: The elevated risk for hyperinsulinemic diets among women with longstanding T2D and the inverse association among normal-weight women warrant further examination.

Original languageEnglish
Pages (from-to)1229-1240
Number of pages12
JournalCancer Epidemiology Biomarkers and Prevention
Issue number6
StatePublished - Jun 2021

Bibliographical note

Funding Information:
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

Publisher Copyright:
© 2021 American Association for Cancer Research.

ASJC Scopus subject areas

  • Medicine (all)


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