***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Recent studies of pancreatic cancer suggest a role for hyperinsulinemia in carcinogenesis . Because insulin is secreted in response to elevated blood glucose concentrations , dietary factors that increase these concentrations may be important in pancreatic carcinogenesis . OBJECTIVE The objective was to examine prospect ively the relation between pancreatic cancer risk and dietary glycemic load ( GL ) , overall glycemic index ( GI ) , and intake of total carbohydrates and mono- and disaccharides . DESIGN The Netherl and s Cohort Study consisted of 120,852 men and women who completed a baseline question naire in 1986 . After 13.3 y of follow-up , 408 pancreatic cancer cases were detected , 66 % of which were microscopically confirmed . A vali date d 150-item food-frequency question naire , completed at baseline , was used to calculate carbohydrate and mono- and disaccharide intakes and the GL and GI of the diet . RESULTS Dietary GL , GI , or intake of carbohydrates and mono- and disaccharides were not associated with pancreatic cancer risk in this cohort . Also , the associations were not modified by sex . Our results did not change after the analysis was restricted to microscopically confirmed pancreatic cancer cases or after individuals who reported a history of diabetes at baseline were excluded from the analyses . CONCLUSIONS Overall , our findings do not support the hypothesis that GL , GI , or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk . This is in agreement with previous prospect i ve studies that investigated the relation between GL and GI and pancreatic cancer risk Hyperinsulinemia may explain excess colorectal cancer among individuals who are overweight or inactive . Recent studies have observed elevated colorectal cancer risk among individuals with elevated insulin levels 2 hours after oral glucose challenge or with elevated plasma C-peptide levels . The effect of consuming a high glycemic diet on colorectal risk , however , remains uncertain . Two prospect i ve cohort studies , the Nurses ' Health Study and the Health Professionals Follow-up Study , contributed up to 20 years of follow-up . After exclusions , 1,809 incident colorectal cancers were available for analyses .  Dietary glycemic load ( GL ) was calculated as a function of glycemic index ( postpr and ial blood glucose response as compared with a reference food ) , carbohydrate content , and frequency of intake of individual foods reported on food frequency question naires . Multivariable Cox proportional hazards models were used to adjust for potential confounders . Intakes of dietary carbohydrate , GL , overall glycemic index , sucrose , and fructose were not associated with  colorectal cancer risk in women . A small increase in risk was observed in men with high dietary GL ( multivariate relative risk , 1.32 ; 95 % confidence interval , 0.98 - 1.79 ; highest versus lowest quintile ) , sucrose or fructose ( multivariate relative risk , 1.37 ; 95 % confidence interval , 1.05 - 1.78 ; highest versus lowest quintile of fructose , P = 0.008 ) . Associations were slightly stronger among men with elevated body mass index ( > or = 25 kg/m(2 ) ) . Results among women were similar after stratifying by body mass index or physical activity . High intakes of GL , fructose , and sucrose were related to an elevated  colorectal cancer risk among men . For women , however , these factors did not seem to increase the risk of colorectal cancer CONTEXT Diabetes is a serious and costly disease that is becoming increasingly common in many countries . The role of diabetes as a cancer risk factor remains unclear . OBJECTIVE To examine the relationship between fasting serum glucose and diabetes and risk of all cancers and specific cancers in men and women in Korea . DESIGN , SETTING , AND PARTICIPANTS Ten-year prospect i ve cohort study of 1,298,385 Koreans ( 829,770 men and 468,615 women ) aged 30 to 95 years who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation in 1992 - 1995 ( with follow-up for up to 10 years ) . MAIN OUTCOME MEASURES Death from cancer and registry-documented incident cancer or hospital admission for cancer . RESULTS During the 10 years of follow-up , there were 20,566 cancer deaths in men and 5907 cancer deaths in women . Using Cox proportional hazards models and controlling for smoking and alcohol use , the stratum with the highest fasting serum glucose ( > or = 140 mg/dL [ > or = 7.8 mmol/L ] ) had higher death rates from all cancers combined ( hazard ratio [ HR ] , 1.29 ; 95 % confidence interval [ CI ] , 1.22 - 1.37 in men and HR , 1.23 ; 95 % CI , 1.09 - 1.39 in women ) compared with the stratum with the lowest level ( < 90 mg/dL [ < 5.0 mmol/L ] ) . By cancer site , the association was strongest for pancreatic cancer , comparing the highest and lowest strata in men ( HR , 1.91 ; 95 % CI , 1.52 - 2.41 ) and in women ( HR , 2.05 ; 95 % CI , 1.43 - 2.93 ) . Significant associations were also found for cancers of the esophagus , liver , and colon/rectum in men and of the liver and cervix in women , and there were significant trends with glucose level for cancers of the esophagus , colon/rectum , liver , pancreas , and bile duct in men and of the liver and pancreas in women . Of the 26,473 total cancer deaths in men and women , 848 were estimated as attributable to having a fasting serum glucose level of less than 90 mg/dL. For cancer incidence , the general patterns reflected those found for mortality . For persons with a diagnosis of diabetes or a fasting serum glucose level greater than 125 mg/dL ( 6.9 mmol/L ) , risks for cancer incidence and mortality were generally elevated compared with those without diabetes . CONCLUSION In Korea , elevated fasting serum glucose levels and a diagnosis of diabetes are independent risk factors for several major cancers , and the risk tends to increase with an increased level of fasting serum glucose Factors linked to glucose metabolism are involved in the etiology of several cancers . High glycemic index ( GI ) or high glycemic load ( GL ) diets , which chronically raise postpr and ial blood glucose , may increase cancer risk by affecting insulin-like growth factor . We prospect ively investigated cancer risk and dietary GI/GL in the EPIC-Italy cohort . After a median 14.9 years , 5112 incident cancers and 2460 deaths were identified among 45,148 recruited adults . High GI was associated with increased risk of colon and bladder cancer . High GL was associated with : increased risk of colon cancer ; increased risk of diabetes-related cancers ; and decreased risk of rectal cancer . High intake of carbohydrate from high GI foods was significantly associated with increased risk of colon and diabetes-related cancers , but decreased risk of stomach cancer ; whereas high intake of carbohydrates from low GI foods was associated with reduced colon cancer risk . In a Mediterranean population with high and varied carbohydrate intake , carbohydrates that strongly raise postpr and ial blood glucose may increase colon and bladder cancer risk , while the quantity of carbohydrate consumed may be involved in diabetes-related cancers . Further studies are needed to confirm the opposing effects of high dietary GL on risks of colon and rectal cancers The objective of this study was to evaluate the prospect i ve associations between dietary glycemic index ( GI ) and glycemic load ( GL ) and the risk for invasive breast cancer incidence  in postmenopausal women at high cardiovascular disease ( CVD ) risk . This study was conducted within the framework of the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a nutritional intervention trial for primary cardiovascular prevention . We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease .  Dietary information was collected using a vali date d 137-item food frequency question naire . We assigned GI values using the International Tables of GI and GL values . Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index . Only cases confirmed by results from cytology tests or histological evaluation were included . We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models . We repeated our analyses using yearly repeated measures of GI/GL intakes . No associations were found between baseline dietary GI/GL and invasive breast cancer incidence . The multivariable hazard ratio and 95 % confidence interval ( CI ) for the top tertile of dietary GI was 1.02 ( 95 % CI : 0.42–2.46 ) and for dietary GL was 1.00 ( 95 % CI : 0.44–2.30 ) when compared with the bottom tertile . Repeated- measures analyses yielded similar results . In sensitivity analyses , no significant associations were observed for women with obesity or diabetes . Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content Epidemiological evidence regarding the association between carbohydrate intake , glycaemic load ( GL ) and glycaemic index ( GI ) and risk of ovarian cancer  has been mixed . Little is known about their impact on ovarian cancer risk in African-American women . Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study ( AACES ) . AACES is an ongoing population -based case-control study of ovarian cancer in African-Americans in the USA . Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by r and om-digit dialling . Dietary information over the year preceding diagnosis or the reference date was obtained using a FFQ . Multivariable logistic regression models were used to estimate odds ratios and 95 % CI adjusted for covariates . The OR comparing the highest quartile of total carbohydrate intake and total sugar intake v. the lowest quartile were 1·57 ( 95 % CI 1·08 , 2·28 ; P trend=0·03 ) and 1·61 ( 95 % CI 1·12 , 2·30 ; P trend<0·01 ) , respectively . A suggestion of an inverse association was found for fibre intake . Higher GL was positively associated with the risk of ovarian cancer ( OR 1·18 for each 10 units/4184 kJ ( 1000 kcal ) ; 95 % CI 1·04 , 1·33 ) . No associations were observed for starch or GI . Our findings suggest that high intake of total sugars and GL are associated with greater risk of ovarian cancer in African-American women BACKGROUND The glycemic potential of a diet is associated with chronically elevated insulin concentrations , which may augment breast cancer ( BC ) risk by stimulating insulin receptor or by affecting insulin-like growth factor I (IGF-I)-mediated mitogenesis . It is unclear whether this effect differs by BC phenotype . OBJECTIVE The objective was to investigate the relation between glycemic index ( GI ) , glycemic load ( GL ) , and total carbohydrate intake with BC by using data from the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . DESIGN We identified 11,576 women with invasive BC among 334,849 EPIC women aged 34 - 66 y ( 5th to 95th percentiles ) at baseline over a median follow-up of 11.5 y.  Dietary GI and GL were calculated from country-specific dietary question naires . We used multivariable Cox proportional hazards models to quantify the association between GI , GL , and carbohydrate intake and BC risk . BC tumors were classified by receptor status 
    Output:
    
GL was not significantly related to those cancer sites .
Stomach , prostate and lung cancers were not associated with GI and GL .
The present analysis , based on an up date d comprehensive evaluation of the epidemiological literature , indicates moderate unfavorable effects of high versus low GI on colorectal , and possibly bladder and kidney cancers , and a possible moderate positive association between GL and endometrial cancer