No Link Between Gluten Intake, Digestive System Cancers in People Without Celiac Disease

Among patients with celiac disease, gluten may play a role in the development of certain digestive system malignancies, including cancer of the esophagus and small intestine, according to several cohort studies.

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However, the association does not appear to extend to the general population without celiac disease, according to new research from Yiqing Wang, PhD, a research fellow in the Department of Medicine at Massachusetts General Hospital, Andrew T. Chan, MD, MPH, director of cancer epidemiology in the Mass General Cancer Center, chief of the Clinical and Translational Epidemiology Unit in the Department of Medicine and vice chair of Research in the Division of Gastroenterology, and colleagues.

In their analysis of three large prospective U.S. cohorts, long-term gluten consumption was not associated with an increased risk of digestive system cancers in people without celiac disease. The data are presented in Clinical Gastroenterology and Hepatology.

Methods

The researchers analyzed data on 206,206 individuals:

• 73,166 female registered nurses from the Nurses' Health Study (launched in 1976, median follow-up, 31 years)
• 42,617 male clinicians from the Health Professionals Follow-up Study (1986; 26 years)
• 90,423 female registered nurses from the Nurses' Health Study II (1989; 24 years)

All participants were free of cancer, heart disease and inflammatory bowel disease before and at baseline, and did not report a history of celiac disease diagnosis during follow-up.

Participants were asked to complete detailed questionnaires on lifestyle and diseases every two years and a food frequency questionnaire every four years. The researchers confirmed participant-reported cancer diagnoses by reviewing medical records and government databases.

Results

The full multivariable analysis was adjusted for cohort, age, race, body mass index, family history of cancer, personal history of diabetes, physical examination, smoking status, physical activity, multivitamin use, aspirin use, non-steroid anti-inflammatory drug use, menopausal status (in women), alcohol intake, total calorie intake, calcium intake, folic acid intake, coffee intake, and diet quality.

The results showed no significant association between quintile categories of gluten intake and the risk of digestive system cancer. This was true both overall and in analyses undertaken with the three separate cohorts.

Similarly, there was no association between gluten intake and individual cancers: oral cavity and oropharyngeal, esophageal, stomach, small intestine, colorectal, pancreatic, gallbladder and liver cancer.

Information for Patient Counseling

Avoidance of gluten not only is unlikely to reduce the risk of digestive system cancer in the general population, but it may also worsen the already low quality of the Western diet. Individuals who strictly adhere to a gluten-free diet have been shown to be deficient in certain minerals and vitamins, including calcium, zinc, folate, and vitamin B-12. In addition, gluten-free foods tend to have less protein and more saturated fat, sodium and cholesterol than foods with gluten.

What's more, recent studies demonstrated that people on a gluten-free diet may have higher levels of heavy metals and toxins such as lead, mercury, cadmium and arsenic, probably because of the high intake of rice, which tends to accumulate more of these toxins than other crops.

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