Of interest, dysregulation of endogenous growth factors such as insulin-like growth factor-1 and insulin also contributes to MM pathogenesis (12,15,16,55), lending plausibility to our observation of suggestive positive associations with MM risk for EDIR and EDIH, which were derived to characterize the insulinemic potential of diet, particularly related to insulin resistance and hyperinsulinemia, respectively (39). Here, INS is linked to hyperinsulinism.