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Carbohydrates and Colorectal Cancer Risk among Chinese in North America

Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, V5Z 4E6 Canada [M. J. B., R. P. G.]; Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, V6T 1Z3 Canada [M. J. B., S. B. S., R. P. G.]; Department of Health Research and Policy, Stanford University, Stanford, California 94305-5092 [A. S. W.]; Department of Preventative Medicine, University of Southern California, California 90033 [A. H. W.]; and Cancer Prevention Research, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Washington 98109-1024 [J. D. P.]

Previous studies have analyzed total carbohydrate as a dietary risk factor for colorectal cancer (CRC) but obtained conflicting results, perhaps attributable in part to the embedded potential confounder, fiber. The aim of this study was to analyze the nonfiber ("effective") carbohydrate component (eCarb) separately and to test the hypothesis that effective carbohydrate consumption is directly related to CRC risk. The data (473 cases and 1192 controls) were from a large, multicenter, case-control study of Chinese residing in North America. Multivariate logistic regression was used to perform a secondary analysis controlling for age; sex; consumption of fat, fiber, calcium, and total kilocalories; body mass (Quetelet’s) index; family history; education; and years in North America. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate risk among subgroups by sex and cancer site. A statistically significant positive association was observed between eCarb consumption and risk of CRC in both men (OR, 1.7 comparing highest with lowest tertile of eCarb consumption; 95% CI, 1.1–2.7) and women (OR, 2.7; 95% CI, 1.5–4.8). As expected, the ORs for total carbohydrate were somewhat lower than those for effective carbohydrate, but the differences were not large. A sex difference in risk by colorectal subsite was observed, with risk concentrated in the right colon for women (OR, 6.5; 95% CI, 2.4–18.4) and in the rectum for men (OR, 2.4; 95% CI, 1.2–4.8). These data indicate that increased eCarb and total carbohydrate consumption are both associated with increased risk of CRC in both sexes, and that among women, relative risk appears greatest for the right colon, whereas among men, relative risk appears greatest for the rectum.

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