Low-carbohydrate diet and risk of cancer incidence: The Japan Public Health Center-based prospective study

Honglin Cai; Tomotaka Sobue; Tetsuhisa Kitamura; Junko Ishihara; Akiko Nanri; Tetsuya Mizoue; Motoki Iwasaki; Taiki Yamaji; Manami Inoue; Shoichiro Tsugane; Norie Sawada

doi:10.1111/cas.15215

Low-carbohydrate diet and risk of cancer incidence: The Japan Public Health Center-based prospective study

Cancer Sci. 2022 Feb;113(2):744-755. doi: 10.1111/cas.15215. Epub 2021 Dec 15.

Authors

Honglin Cai¹, Tomotaka Sobue¹, Tetsuhisa Kitamura¹, Junko Ishihara², Akiko Nanri^{3

4}, Tetsuya Mizoue⁴, Motoki Iwasaki⁵, Taiki Yamaji⁵, Manami Inoue⁵, Shoichiro Tsugane^{5

6}, Norie Sawada⁵

Affiliations

¹ Department of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Suita, Japan.
² Department of Food and Life Science, Azabu University, Sagamihara, Japan.
³ Department of Food and Health Sciences, International College of Arts and Sciences, Fukuoka Women's University, Fukuoka, Japan.
⁴ Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
⁶ National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.

Abstract

Epidemiological evidence on the effects of a long-term low-carbohydrate diet (LCD) on cancer incidence remains sparse. We investigate the association between LCD and the risk of overall and specific cancer site incidence in a Japanese population-based prospective cohort study among 90 171 participants aged 45-74. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median 17.0 y of follow-up, we identified 15 203 cancer cases. A higher overall LCD score was associated with increased overall cancer risk (HR = 1.08 [CI: 1.02-1.14], P-trend = .012), while it was associated with decreased gastric cancer (GC) risk (0.81 [0.71-0.93], P-trend = .006). A higher animal-based LCD score was associated with higher risk of overall cancer (1.08 [1.02-1.14], P-trend = .003), colorectal cancer (CRC) (1.11 [0.98-1.25], P-trend = .018), rectal cancer (RC) (1.24 [1.00-1.54], P-trend = .025), lung cancer (LC) (1.16 [1.00-1.34], P-trend = .042), and lower risk of GC (0.90 [0.79-1.01], P-trend = .033). Furthermore, we found that plant-based LCD score was related to lower GC incidence (0.87 [0.77-0.99], P-trend = .031). Additionally, adjusted for plant fat intake amplified the adverse associations (overall cancer: 1.08 [1.02-1.14] vs. 1.11 [1.05-1.18]; CRC: 1.08 [0.95-1.22] vs. 1.13 [0.99-1.30]; LC: 1.14 [0.98-1.33] vs. 1.19 [1.01-1.41]). We conclude that LCD enriching with animal products was associated with increased overall cancer, CRC, and LC incidence. These adverse associations could be attenuated by plant fat consumption. LCD reduces the risk of developing GC. Long-term adherence to LCD without paying attention to the balance between animal and plant food source consumption might cause adverse overall cancer incidence consequences.

Keywords: Asian population; cancer incidence; low-carbohydrate diet; prospective cohort study; specific cancer site incidence.

MeSH terms

Aged
Diet, Carbohydrate-Restricted* / adverse effects
Diet, Carbohydrate-Restricted* / statistics & numerical data
Dietary Fats / analysis
Dietary Proteins / analysis
Female
Follow-Up Studies
Humans
Incidence
Japan / epidemiology
Male
Middle Aged
Neoplasms / classification
Neoplasms / epidemiology*
Neoplasms / etiology
Proportional Hazards Models
Prospective Studies
Public Health / statistics & numerical data
Risk Factors

Substances

Dietary Fats
Dietary Proteins

Abstract

MeSH terms

Substances

Grants and funding