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Yue Y, Hur J, Cao Y, Tabung FK, Wang M, Wu K, Song M, Zhang X, Liu Y, Meyerhardt JA, Ng K, Smith-Warner SA, Willett WC, Giovannucci E. Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women. Ann Oncol 2021; 32:778-786. [PMID: 33812017 DOI: 10.1016/j.annonc.2021.03.200] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although colorectal cancer (CRC) incidence in the USA is declining overall, its incidence is increasing among those younger than 50 years of age. The reasons underlying the increasing trend are largely unknown, although behavioral changes, such as unhealthy diet and lifestyle factors, may be partially responsible. DESIGN A prospective cohort study included 94 217 women aged 26-45 years at baseline. Validated anthropometric measures and lifestyle information were self-reported biennially. Exposures were four recommendation-based dietary indices-the prime diet quality score and three plant-based dietary indices; and two mechanism-based indices-the empirical dietary and lifestyle index for hyperinsulinemia (EDIH and ELIH). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall CRC and for early-onset (before age 50) and after age 50 CRC separately. RESULTS We documented 332 cases of CRC during 24 years of follow-up (2 113 655 person-years), with an average age of 52 ± 7 years at diagnosis. Hyperinsulinemic dietary and lifestyle patterns were associated with a higher risk of CRC. Multivariable-adjusted HRs (95% CIs) comparing participants in the highest versus lowest quartile were: 1.67 for EDIH (95% CI: 1.15-2.44, P-trend = 0.01) and 1.51 for ELIH (95% CI: 1.10-2.08, P-trend = 0.01). Moreover, per 75% increment in rank, ELIH appeared to be a stronger risk factor for early-onset CRC (HR = 1.86, 95% CI: 1.12-3.07) than after age 50 CRC (HR = 1.20, 95% CI: 0.83-1.73, P-heterogeneity = 0.16). The four recommendation-based indices were not significantly associated with overall, early-onset, or after age 50 CRC risk (per 75% increment in rank, HRs ranged from 0.75 to 1.28). CONCLUSION Dietary and lifestyle patterns contributing to hyperinsulinemia were associated with greater CRC risk in younger women. Moreover, the hyperinsulinemic lifestyle showed a suggestively stronger positive association with early-onset CRC risk, compared with after age 50 CRC. Our findings suggest that dietary and lifestyle interventions to reduce insulinemic potential may be effective for CRC prevention among younger women.
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Affiliation(s)
- Y Yue
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - J Hur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Y Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA; Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, USA
| | - F K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, USA; The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - M Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - K Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - M Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA; Harvard Medical School, Boston, USA
| | - X Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Y Liu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, USA
| | - J A Meyerhardt
- Evidence-Based Chinese Medicine, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - K Ng
- Evidence-Based Chinese Medicine, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - S A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - W C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - E Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
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Zheng JL, Tabung FK, Zhang JJ, Shivappa N, Ockene JK, Caan B, Kroenke C, Hebert JR, Steck SE. Association Between Post-Cancer Diagnosis Dietary Inflammatory Potential and Survival in WHI Observational Study and Dietary Modification Trial. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1055-9965.epi-16-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Inflammation regulates key biologic processes in chronic disease and can be modulated by diet. Our objective was to use the dietary inflammatory index (DII), a novel tool to characterize the inflammatory potential of diet, to examine how post-cancer diagnosis dietary quality is associated with overall survival in the Women's Health Initiative (WHI) Observational Study (OS) and Dietary Modification Trial (DM). Methods: After excluding baseline cancers and energy outliers, the analytical cohort had 4,241 postmenopausal women (19% of total cancer cases), aged 50 to 79 years at baseline, in the WHI OS (n = 1,852) and DM (n = 2,389), who developed invasive cancer during follow-up and completed a food frequency questionnaire after diagnosis. These women were followed from dietary assessment until death from any cause. Energy-adjusted DII scores from food only and from food plus supplement (any reported dietary supplement related to DII parameters) after cancer diagnosis for each subject were calculated by multiplying the inflammatory effect scores determined based on extensive literature review and intake values for each food parameter, and then summing across all the food parameters. Death was ascertained by clinical center follow-up or by searching the National Death Index with central or local adjudication. Cox proportional hazards models were fit to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality comparing women in higher DII quartiles with those in the first quartile. Results: After a median 11.2 years of follow-up, 1,470 deaths occurred. After adjustment for key covariates, women who consumed a more pro-inflammatory diet (in higher quartiles of DII score from food only) after a cancer diagnosis had a significantly higher risk of death from any cause compared to women consuming a more anti- inflammatory diet (HR Q4:Q1 = 1.18; 95% CI, 1.01–1.38; P trend = 0.015). In analyses using DII score from both diet and supplements, a pro-inflammatory DII score was associated with even higher risk of all-cause mortality (HRQ4:Q1 = 1.63; 95% CI, 1.40–1.91; P trend < 0.0001). Conclusions: Consuming a more pro-inflammatory diet after cancer diagnosis was associated with increased risk of death from any cause.
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