Dietary consumption of advanced glycation end products and pancreatic cancer in the prospective NIH-AARP Diet and Health Study

Background: Advanced glycation end products (AGEs) are a heterogeneous group of compounds present in uncooked foods as well as in foods cooked at high temperatures. AGEs have been associated with insulin resistance, oxidative stress, and chronic inflammation in patients with diabetes. Dietary AGEs are an important contributor to the AGE pool in the body. N-epsilon-(carboxymethyplysine (CML) AGE is one of the major biologically and chemically well-characterized AGE markers. The consumption of red meat, which is CIVIL-AGE rich, has been positively associated with pancreatic cancer in men. Objectives: With the use of a published food CML-AGE database, we estimated the consumption of CML AGE in the prospective NTH-AARP Diet and Health Study and evaluated the association between CIVIL-AGE consumption and pancreatic cancer and the mediating effect of CML AGE on the association between red meat consumption and pancreatic cancer. Design: Multivariate Cox proportional hazard regression models were used to estimate HRs and 95% CIs for pancreatic cancer. Results: During an average of 10.5 y of follow-up, we identified 2193 pancreatic cancer cases (1407 men and 786 women) from 528,251 subjects. With the comparison of subjects in the fifth and the first quintiles of CIVIL-AGE consumption, we observed increased pancreatic cancer risk in men (HR: 1.43; 95% CI: 1.06, 1.93, P-trend = 0.003) but not women (HR: 1.14; 95% CI: 0.76, 1.72, P-trend = 0.42). Men in the highest quintile of red meat consumption had higher risk of pancreatic cancer (IIR: 1.35; 95% CI: 1.07, 1.70), which attenuated after adjustment for CIVIL-AGE consumption (HR: 1.20; 95% CI: 0.95, 1.53). Conclusion: Dietary CML-AGE consumption was associated with modestly increased risk of pancreatic cancer in men and may partially explain the positive association between red meat and pancreatic cancer.