
Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance)
Author(s) -
Temidayo Fadelu,
Sui Zhang,
Doniedzwiecki,
Xing Ye,
Leonard Saltz,
Robert J. Mayer,
Rex B. Mowat,
Renaud Whittom,
Alexander Hantel,
Al B. Benson,
Daniel Atienza,
Michael J. Messino,
Hedy L. Kindler,
Alan P. Venook,
Shuji Ogino,
Kimmie Ng,
Kana Wu,
Walter C. Willett,
Edward Giovannucci,
Jeffrey A. Meyerhardt,
Ying Bao,
Charles S. Fuchs
Publication year - 2018
Publication title -
journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 10.482
H-Index - 548
eISSN - 1527-7755
pISSN - 0732-183X
DOI - 10.1200/jco.2017.75.5413
Subject(s) - medicine , hazard ratio , glycemic load , colorectal cancer , proportional hazards model , cancer , observational study , type 2 diabetes , prospective cohort study , diabetes mellitus , surgery , glycemic index , gastroenterology , glycemic , confidence interval , insulin , endocrinology
Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known.Patients and Methods We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality.Results After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; P trend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; P trend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; P trend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; P trend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality.Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.