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Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort.

Abstract

BACKGROUND

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial.

OBJECTIVE

We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC).

METHODS

The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993-1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes.

RESULTS

Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer.

CONCLUSIONS

The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing.

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  • Authors+Show Affiliations

    ,

    University of Hawaii Cancer Center, Honolulu, HI;

    ,

    School of Public Health, University of Memphis, Memphis, TN;

    ,

    Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and.

    ,

    University of Hawaii Cancer Center, Honolulu, HI;

    ,

    University of Southern California, Health Sciences Campus, Los Angeles, CA.

    ,

    University of Hawaii Cancer Center, Honolulu, HI;

    ,

    University of Hawaii Cancer Center, Honolulu, HI;

    ,

    University of Hawaii Cancer Center, Honolulu, HI;

    University of Hawaii Cancer Center, Honolulu, HI; gertraud@cc.hawaii.edu.

    Source

    The Journal of nutrition 146:9 2016 09 pg 1746-55

    MeSH

    African Americans
    Aged
    Asian Americans
    Body Mass Index
    California
    Colorectal Neoplasms
    Diet
    Diet, Mediterranean
    European Continental Ancestry Group
    Exercise
    Female
    Follow-Up Studies
    Hawaii
    Hispanic Americans
    Humans
    Male
    Middle Aged
    Mortality
    Nutrition Assessment
    Proportional Hazards Models
    Prospective Studies
    Reproducibility of Results
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    27511927

    Citation

    Jacobs, Simone, et al. "Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated With Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort." The Journal of Nutrition, vol. 146, no. 9, 2016, pp. 1746-55.
    Jacobs S, Harmon BE, Ollberding NJ, et al. Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort. J Nutr. 2016;146(9):1746-55.
    Jacobs, S., Harmon, B. E., Ollberding, N. J., Wilkens, L. R., Monroe, K. R., Kolonel, L. N., ... Maskarinec, G. (2016). Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort. The Journal of Nutrition, 146(9), pp. 1746-55. doi:10.3945/jn.116.234237.
    Jacobs S, et al. Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated With Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort. J Nutr. 2016;146(9):1746-55. PubMed PMID: 27511927.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort. AU - Jacobs,Simone, AU - Harmon,Brook E, AU - Ollberding,Nicholas J, AU - Wilkens,Lynne R, AU - Monroe,Kristine R, AU - Kolonel,Laurence N, AU - Le Marchand,Loic, AU - Boushey,Carol J, AU - Maskarinec,Gertraud, Y1 - 2016/08/10/ PY - 2016/04/12/received PY - 2016/07/05/accepted PY - 2016/8/12/entrez PY - 2016/8/12/pubmed PY - 2017/6/28/medline KW - Alternative Healthy Eating Index KW - Cox regression KW - Dietary Approaches to Stop Hypertension index KW - Healthy Eating Index KW - Multiethnic Cohort KW - alternate Mediterranean Diet score KW - colorectal cancer KW - dietary patterns KW - nutrition KW - survival SP - 1746 EP - 55 JF - The Journal of nutrition JO - J. Nutr. VL - 146 IS - 9 N2 - BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial. OBJECTIVE: We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC). METHODS: The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993-1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes. RESULTS: Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer. CONCLUSIONS: The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/27511927/Among_4_Diet_Quality_Indexes_Only_the_Alternate_Mediterranean_Diet_Score_Is_Associated_with_Better_Colorectal_Cancer_Survival_and_Only_in_African_American_Women_in_the_Multiethnic_Cohort_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.3945/jn.116.234237 DB - PRIME DP - Unbound Medicine ER -