Post Diagnosis Diet Quality and Colorectal Cancer Survival in Women

Background: Dietary factors are known to influence colorectal cancer (CRC) risk, however, their association with CRC survival is unclear. Therefore, we prospectively examined the association between diet quality scores, dietary patterns and colorectal cancer (CRC) survival. Methods: 1201 women diagnosed with stage I–III CRC between 1986 and 2008, were followed through 2010. Diet was assessed via a food frequency questionnaire administered at least 6 months after diagnosis. We computed the Alternate Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet score (aMED) and Dietary Approaches to Stop Hypertension score (DASH) and derived two dietary patterns, Western (unhealthy) and prudent (healthy), by principal component analysis for each woman. Results: During follow-up, we documented 435 deaths, including 162 from CRC. After adjusting for potential confounders, only a higher AHEI-2010 score was significantly associated with lower overall mortality (HR comparing extreme quintiles = 0.71, 95% CI 0.52–0.98, p trend = 0.01) as well as borderline significantly with lower risk of CRC mortality by the trend test (HR Q5 vs Q1 = 0.72, 95% CI = 0.43–1.21, p trend = 0.07). When AHEI-2010 components were examined separately, inverse associations for overall mortality were primarily accounted for by moderate alcohol intake (HR comparing abstainers vs 5–15 g/d = 1.30, 95%CI = 1.05–1.61) and lower intake of sugar sweetened beverages and fruit juices combined (HR for each additional serving = 1.11, 95% CI = 1.01–1.23). No other diet quality score or dietary pattern was associated with overall or CRC-specific mortality. Conclusion: Higher AHEI-2010 score may be associated with lower overall mortality, moderate alcohol consumption and lower consumption of sugar sweetened beverages and juices combined appeared to account for most of the observed associations

Association between quintiles of post-diagnosis diet score (Hazard ratio and 95% CI) and colorectal cancer mortality.

<p>*Adjusted for age, physical activity, BMI, weight change, cancer grade, chemotherapy, smoking status, energy intake, colon or rectal cancer, stage of disease, and date of colorectal cancer diagnosis.</p><p>Association between quintiles of post-diagnosis diet score (Hazard ratio and 95% CI) and colorectal cancer mortality.</p

Multivariable^* hazard ratio (95% CI) of AHEI-2010 components (per serving per day unless otherwise specified) for mortality in NHS (1986–2010).

<p>*Adjusted for age, physical activity, BMI, weight change, cancer grade, chemotherapy, smoking status, energy intake, colon or rectal cancer, stage of disease, date of colorectal cancer diagnosis.</p><p>**After additional adjustment for an AHEI-2010 score without the specific component, RR of overall mortality for alcohol, sweetened beverages + juices remained unchanged and significant, but for nuts and CRC mortality was slightly attenuated and no longer significant (RR = 0.71, 95% CI = 0.50 = 1.01).</p><p>Multivariable^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0115377#nt104" target="_blank">*</a>} hazard ratio (95% CI) of AHEI-2010 components (per serving per day unless otherwise specified) for mortality in NHS (1986–2010).</p