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Four a priori‐ defined Diet Quality Indexes and Survival among Men and Women with Colorectal Cancer: The Multiethnic Cohort
Author(s) -
Maskarinec Gertraud,
Jacobs Simone,
Harmon Brook E,
Wilkens Lynne R,
Le Marchand Loic,
Kolonel Laurence N,
Boushey Carol J
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.42.2
Subject(s) - medicine , hazard ratio , colorectal cancer , proportional hazards model , dash , mediterranean diet , cohort , confounding , demography , cancer , cohort study , confidence interval , refined grains , food group , gerontology , environmental health , whole grains , sociology , chemistry , food science , computer science , operating system
Background Given the increasing number of colorectal cancer (CRC) survivors, the possible effect of modifiable health behaviors, in particular optimal nutrition, on prognosis is critical. In recent years, the idea has emerged that dietary patterns may be better suited to capture the complexity of dietary intake than the analysis of single foods or nutrients. We investigated the association between four a priori dietary quality indexes assessed 6.0±4.7 years before diagnosis and CRC‐specific survival in the Multiethnic Cohort (MEC). Methods At baseline, more than 215,000 African American, Native Hawaiian, Japanese American, Latino, and white adults completed a validated quantitative food frequency questionnaire designed to capture dietary intake in the five relevant ethnic groups. Colorectal cancer cases and deaths from all causes were identified through linkages to SEER cancer registries and the National Death Index. Cox proportional hazards regression was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the Healthy Eating Index‐2010 (HEI‐2010), the Alternative HEI‐2010 (AHEI‐2010), the Alternate Mediterranean Diet Score (aMED), and the Dietary Approaches to Stop Hypertension (DASH) while adjusting for relevant confounders. Results Among 4,204 MEC participants diagnosed with invasive CRC cases during follow‐up, 1,976 all‐cause and 1,095 CRC‐specific deaths were identified. CRC‐specific survival was significantly associated with higher scores on the HEI‐2010 (p trend =0.04); for one standard deviation increase in the HEI‐2010, the HR was 0.93 (95%CI: 0.88–0.99). Individuals in the highest vs. lowest diet quality quartile experienced 20% lower mortality (HR=0.80; 95%CI: 0.67–0.97). A higher aMED score was associated with borderline lower CRC mortality (HR=0.94; 95%CI: 0.88–1.01; p trend =0.09). No significant associations of CRC‐specific survival with the DASH and AHEI‐2010 indexes were detected. Conclusions The current findings may be related to the HEI‐2010 inclusion of dairy intake as a positive dietary component and added sugars from all sources as a negative one. Also, scores for the HEI‐2010 and aMED are positively influenced by fish intake and a higher ratio of unsaturated to saturated fatty acids, which are considered possible preventive factors. These results emphasize the merit of an overall healthful diet for optimal survival outcomes. Support or Funding Information The Multiethnic Cohort Study has been supported by grants R37CA54281 and UM1CA164973 from the National Cancer Institute. Dr. Harmon was supported by postdoctoral fellowships on grant R25CA90956. The tumor registries are supported by NCI contracts N01 PC 35137 and N01 PC 35139.