Pre- and Post-Diagnosis Diet Quality and Ovarian Cancer Survival

Pre- and post-diagnosis dietary patterns and overall survival in patients with epithelial ovarian cancer: a prospective cohort study

BACKGROUND

Previous studies have examined the associations between individual foods or nutrients, but few studies have considered dietary patterns associated with ovarian cancer (OC) survival.

METHODS

In a prospective cohort study, we examined the association between pre-diagnosis and post-diagnosis overall diet, including changes from pre-diagnosis to post-diagnosis, and overall survival (OS) in 560 patients with OC. Dietary intake was collected using a valid 111-item food frequency questionnaire. Principal component analysis was performed to determine the dietary patterns. Cox proportional hazard regression models were used to assess the hazard ratio (HRs) and 95% confidence interval (CIs).

RESULTS

Two dietary patterns were identified: Balanced and nutritious pattern and Energy-dense pattern. The highest tertile of the post-diagnosis Balanced and nutritious pattern scores was related to better OS compared with the lowest tertile (HR = 0.40, 95% CI = 0.17-0.95, Ptrend < 0.05). However, no significant association between pre-diagnosis and post-diagnosis Energy-dense pattern scores and OS was observed. Compared to those who had persistently high Balanced and nutritious pattern scores, patients who changed from a high score of pre-diagnosis Balanced and nutritious pattern to low post-diagnosis, as well as those who shifted from a low to a high score, both had a decreased OS (HRhigh-low vs. high-high = 1.91, 95% CI = 1.18-3.08; HRlow-high vs. high-high = 2.19, 95% CI = 1.24-3.86). Additionally, patients who changed from a high pre-diagnosis score to a low post-diagnosis score had a decreased OS compared to those with consistently low Energy-dense pattern scores (HRhigh-low vs. low-low = 1.74, 95% CI = 1.06-2.84).

CONCLUSIONS

Greater adherence to the Balanced and nutritious pattern as well as less adherence to the Energy-dense pattern from pre-diagnosis to post-diagnosis were associated with better OC survival.

Impact of Lifestyle Modifications on Cancer Mortality: A Systematic Review and Meta-Analysis

Background and Objectives: Cancer survival poses significant challenges in oncology, with lifestyle modifications increasingly recognized as crucial in modifying patient outcomes post-diagnosis. This meta-analysis aims to systematically evaluate the impact of various lifestyle interventions on cancer survival across different types of cancer. Methods: A comprehensive literature search of electronic databases including PubMed, Scopus and Cochrane was performed to identify relevant studies up to 30 November 2024. Relevant studies were chosen and data were extracted and analyzed using SPSS Version 29.0 software. Results: Our systematic review included data from 98 studies involving a total of 1,461,834 cancer patients to evaluate the impact of lifestyle factors on cancer survival. Out of these, 64 studies were included in the meta-analysis. Our meta-analysis demonstrates that adherence to specific dietary patterns significantly improves cancer-specific outcomes. The Healthy Eating Index (HEI) diet was associated with a reduction in cancer-specific mortality (pooled log HR: -0.22; 95% CI: [-0.32, -0.12]; p < 0.001). Similar benefits were observed with the Mediterranean diet (aMED), which also reduced cancer mortality and recurrence (pooled log HR: -0.24; 95% CI: [-0.40, -0.07]; p < 0.001), and the Dietary Approaches to Stop Hypertension (DASH) diet (pooled log HR: -0.22; 95% CI: [-0.33, -0.12]; p < 0.001). Additionally, general dietary improvements were beneficial for breast cancer-specific mortality across 17 cohort studies (pooled log HR: -0.15; 95% CI: [-0.25, -0.06]; p < 0.001). Engaging in any form of physical activity post-diagnosis was associated with significant improvements in cancer-specific mortality or recurrence (pooled log HR: -0.31; 95% CI: [-0.38, -0.25]; p < 0.001). Participants who ceased smoking after diagnosis exhibited more favorable cancer outcomes (pooled log HR: -0.33; 95% CI: [-0.42, -0.24]; p < 0.001), with smoking cessation notably reducing cancer-specific mortality among lung cancer survivors (pooled log HR: -0.34; 95% CI: [-0.48, -0.20]; p < 0.001). Additionally, reducing alcohol intake post-diagnosis significantly improved cancer outcomes (pooled log HR: -0.26; 95% CI: [-0.33, -0.19]; p < 0.001). Alcohol moderation in gastrointestinal tract cancer survivors specifically decreased both cancer-specific mortality and recurrence (pooled log HR: -0.22; 95% CI: [-0.29, -0.15]; p < 0.001). Conclusions: Lifestyle modifications after cancer diagnosis significantly improve cancer-specific outcomes. Specific dietary patterns, increased physical activity, smoking cessation, and reduced alcohol intake are all associated with lower cancer-specific mortality. Integrating these lifestyle changes into oncology care may enhance patient survival and quality of life.

Dietary protein intake and PM2.5 on ovarian cancer survival: A prospective cohort study

BACKGROUND

Evolving evidence suggests both protein consumption and particulate matter less than 2.5 micrometers (PM2.5) might be related to ovarian cancer (OC) mortality. However, no epidemiological studies have explored their potential interaction.

OBJECTIVE

The objective of this study was to explore the association of dietary protein, PM2.5, and their interaction with the survival of OC patients.

METHODS

A prospective cohort study was carried out, which encompassed 658 newly diagnosed OC patients (18-79 years) residing in China. Dietary protein intakes were collected through a food frequency questionnaire examination, including total protein and protein from diverse sources. Average residential PM2.5 concentrations were evaluated using satellite-derived models. We calculated the hazard ratio (HR) and its 95 % confidence interval (CI) by adjusting for multiple variables using Cox proportional risk models. By assessing the relative excess risk due to interaction (RERI) arising from the interplay between PM2.5 exposure and dietary protein intake, we explored the additive interaction between the two. Multiplicative interaction was assessed through a cross-product interaction term.

RESULTS

During a median follow-up of 37.60 months, 123 deaths were documented. As for all-cause mortality, the multivariate-adjusted HRs (95 % CIs) in the highest vs. the lowest tertile were 0.57 (0.35-0.93), 0.60 (0.36-0.99), and 0.58 (0.37-0.90) for intakes of fish, egg, as well as fruit/vegetable protein, respectively (all P for trend < 0.05). A positive association between PM2.5 exposure and all-cause mortality was observed (HR=1.52; 95 % CI: 1.13-2.05, per interquartile range increment). Notably, dietary fish, egg, and fruit/vegetable protein modified these associations, as patients with lower intakes had significantly higher PM2.5-related mortality in the cohort (all P for interaction < 0.05).

CONCLUSIONS

This study provides evidence linking the potential interactions between dietary fish, egg, and fruit/vegetable protein intake and PM2.5 exposure on all-cause mortality of OC patients. Our study demonstrates the importance of adherence to a certain protein diet in reducing PM2.5-related mortality risk for OC patients.

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Importance

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown.

Objective

To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC).

Design, Setting, and Participants

This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024.

Exposures

Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality.

Main outcomes and measures

Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC).

Results

Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1.

Conclusions and relevance

In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

Association between pre- and post-diagnosis healthy eating index 2020 and ovarian cancer survival: evidence from a prospective cohort study

Background: Previous studies on the association between diet quality and ovarian cancer (OC) survival are limited and inconsistent. We evaluated the relationship between pre- and post-diagnosis diet quality based on the Healthy Eating Index-2020 (HEI-2020), as well as their changes and OC survival. Methods: This prospective cohort study involved 1082 patients with OC aged 18-79 years, enrolled between 2015 and 2022. Detailed dietary intake before and after diagnosis was recorded using a validated food frequency questionnaire. Deaths were ascertained until February 16th, 2023 via medical records and active follow-up. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Results: We included 549 OC cases with a median follow-up of 44.9 months, representing 206 total deaths. Higher HEI scores were associated with better OS (pre-diagnosis: HRT3 vs. T1 0.66, 95%CI: 0.46-0.93, HR1-SD 0.84, 95%CI: 0.73-0.96; post-diagnosis: HRT3 vs. T1 0.68, 95%CI: 0.49-0.96, HR1-SD 0.80, 95%CI: 0.69-0.92). Compared to the stable group, the group with decreased HEI scores (>3%) from pre- to post-diagnosis had worse OS (HR 1.93, 95%CI: 1.26-2.97). Conclusion: High pre- and post-diagnosis diet quality was associated with improved OC survival, whereas deterioration in diet quality after diagnosis was associated with decreased OC survival.

Association between diet quality and ovarian cancer risk and survival

BACKGROUND

Research on diet quality and ovarian cancer is limited. We examined the association between diet quality and ovarian cancer risk and survival in a large prospective cohort.

METHODS

We used data from women in the prospective National Institutes of Health-AARP Diet and Health Study enrolled from 1995 to 1996 who were aged 50-71 years at baseline with follow-up through December 31, 2017. Participants completed a 124-item food frequency questionnaire at baseline, and diet quality was assessed via the Healthy Eating Index-2015, the alternate Mediterranean diet score, and the Dietary Approaches to Stop Hypertension score. Primary outcomes were first primary epithelial ovarian cancer diagnosis from cancer registry data and among those diagnosed with ovarian cancer all-cause mortality. We used a semi-Markov multistate model with Cox proportional hazards regression to account for semicompeting events.

RESULTS

Among 150 643 participants with a median follow-up time of 20.5 years, 1107 individuals were diagnosed with a first primary epithelial ovarian cancer. There was no evidence of an association between diet quality and ovarian cancer risk. Among those diagnosed with epithelial ovarian cancer, 893 deaths occurred with a median survival of 2.5 years. Better prediagnosis diet quality, according to the Healthy Eating Index-2015 (quintile 5 vs quintile 1: hazard ratio [HR] = 0.75, 95% confidence interval [CI] = 0.60 to 0.93) and alternate Mediterranean diet score (quintile 5 vs quintile 1: HR = 0.68, 95% CI = 0.53 to 0.87), was associated with lower all-cause mortality. There was no evidence of an association between Dietary Approaches to Stop Hypertension score and all-cause mortality.

CONCLUSIONS

Better prediagnosis diet quality was associated with lower all-cause mortality after ovarian cancer diagnosis but was not associated with ovarian cancer risk.

Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study

BACKGROUND

Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet.

METHODS

Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations.

RESULTS

The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model.

CONCLUSIONS

Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.

Post-Diagnosis Dietary Patterns among Cancer Survivors in Relation to All-Cause Mortality and Cancer-Specific Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

The role of overall diet on longevity among cancer survivors (CS) needs further elucidation. We performed a systematic review of the literature and a meta-analysis of related cohort studies published up to October 2022 investigating post-diagnosis a priori (diet quality indices) and a posteriori (data-driven) dietary patterns (DPs) in relation to all-cause and cancer-specific mortality. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using random-effects meta-analyses comparing highest versus lowest categories of adherence to DPs. We assessed heterogeneity and risk of bias in the selected studies. A total of 19 cohort studies with 38,846 adult CS, some assessing various DPs, were included in the meta-analyses. Higher adherence to a priori DPs was associated with lower all-cause mortality by 22% (HR = 0.78, 95% CI: 0.73-0.83, I2 = 22.6%) among all CS, by 22% (HR = 0.78, 95% CI: 0.73-0.84, I2 = 0%) among breast CS and by 27% (HR = 0.73, 95% CI: 0.62-0.86, I2 = 41.4%) among colorectal CS. Higher adherence to a "prudent/healthy" DP was associated with lower all-cause mortality (HR = 0.79, 95% CI: 0.64-0.97 I2 = 49.3%), whereas higher adherence to a "western/unhealthy" DP was associated with increased all-cause mortality (HR = 1.48, 95% CI: 1.26-1.74, I2 = 0%) among all CS. Results for cancer-specific mortality were less clear. In conclusion, higher adherence to a "healthy" DP, either a priori or a posteriori, was inversely associated with all-cause mortality among CS. A "healthy" overall diet after cancer diagnosis could protect and promote longevity and well-being.

Association between Dietary Indices and Dietary Patterns and Mortality and Cancer Recurrence among Cancer Survivors: An Updated Systematic Review and Meta-Analysis of Cohort Studies

The number of cancer survivors is growing rapidly; however, specific lifestyle recommendations for these patients are still sparse, including dietary approaches. Thus, the aim of the present systematic review and meta-analysis was to examine the associations between adherence to diet-quality indices and dietary patterns on overall mortality, cancer-specific mortality, and cancer recurrence among cancer survivors. The literature search was conducted in PubMed and Web of Science between 18 May 2016 and 22 May 2022 with no language restrictions. Thirty-nine studies were included for quantitative analysis, providing data from 77,412 participants. Adherence to both diet-quality indices and a healthy/prudent dietary pattern was inversely associated with overall mortality (RR, 0.81; 95% CI, 0.77-0.86; RR, 0.80; 95% CI, 0.70-0.92, respectively) and with cancer-specific mortality (RR, 0.86; 95% CI, 0.79-0.94; RR, 0.79; 95% CI, 0.64-0.97, respectively). These associations could be observed following assessment of dietary patterns either pre- and/or postdiagnosis. For unhealthy/western dietary patterns, high adherence was associated with overall mortality (RR, 1.26; 95% CI, 1.08-1.47). Although the certainty of evidence was rated as low, we conclude that there are no reservations against high adherence to healthy dietary patterns or indices in cancer survivors.

Association of protein intake with recurrence and survival following primary treatment of ovarian cancer

BACKGROUND

Malnutrition is common during treatment for ovarian cancer and one in three report multiple symptoms affecting food intake after primary treatment. Little is known about diet post-treatment in relation to ovarian cancer survival, however, general recommendations for cancer survivors are to maintain a higher level of protein intake to support recovery and minimize nutritional deficits.

OBJECTIVE

To investigate whether intake of protein and protein food sources following primary treatment for ovarian cancer is associated with recurrence and survival.

DESIGN

Intake levels of protein and protein food groups were calculated from dietary data collected about 12 months post-diagnosis using a validated food frequency questionnaire in an Australian cohort of females with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 years follow-up). Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for protein intake and progression-free and overall survival.

RESULTS

Among 591 females who were progression-free at 12-months follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1-1.5 vs. ≤1 grams per kilogram body weight (g/kg): HR_adjusted=0.69, 95% CI 0.48, 1.00; >1.5 vs. ≤1g/kg: HR_adjusted=0.61, 95% CI 0.41, 0.90; >20% vs. ≤20% total energy intake from protein: HR_adjusted=0.77, 95% CI 0.61, 0.96). There was no evidence for better progression-free survival with any particular protein food sources. There was a suggestion of better overall survival among those with higher total intakes of animal-based protein foods, particularly dairy products (HR=0.71, 95% CI 0.51, 0.99 for highest vs. lowest tertiles of total dairy intake).

CONCLUSIONS

After primary treatment for ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.

Lifestyle intervention in ovarian cancer enhanced survival (LIVES) study (NRG/GOG0225): Recruitment, retention and baseline characteristics of a randomized trial of diet and physical activity in ovarian cancer survivors

OBJECTIVE

The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants.

METHODS

The LIVES study (NRG Oncology/GOG 0225) is a Phase III diet plus physical activity intervention trial testing the hypothesis that ovarian cancer survivors in the lifestyle intervention will demonstrate better progression-free survival than those in the control condition. Study interventions were delivered via centralized telephone-based health coaching. Baseline descriptive statistics were computed for demographic, clinical, and lifestyle behavior characteristics.

RESULTS

The LIVES study exceeded its recruitment goals, enrolling 1205 ovarian cancer survivors from 195 NRG/NCORP-affiliated oncology practices across 49 states from 2012 to 2018. The mean age of enrollees was 59.6 years; the majority (69.4%) with stage III disease; 89% White, 5.5% Hispanic; 64% overweight/obese. Baseline self-reported diet showed a mean daily intake of 6.6 servings of fruit and vegetables, 62.7 fat grams, and 21.7 g of fiber. Physical activity averaged 13.0 MET-hours/week of moderate to vigorous physical activity; 50.9 h/week of sedentary time. Retention rates exceeded 88%.

CONCLUSION

The LIVES study demonstrates efficiency in recruiting and retaining ovarian cancer survivors in a 24-month study of diet and physical activity intervention with a primary endpoint of progression free survival that will be reported.

TRIAL REGISTRATION

ClinicalTrials.govNCT00719303.

Association between dietary inflammatory potential and mortality after cancer diagnosis in the Women's Health Initiative

BACKGROUND

Chronic inflammation is implicated in cancer prognosis and can be modulated by diet. We examined associations between post-diagnosis dietary inflammatory potential and mortality outcomes among post-menopausal women diagnosed with cancer in the Women's Health Initiative (WHI).

METHODS

Energy-adjusted dietary inflammatory index scores (E-DII) were calculated from dietary and supplemental intake data collected on the first food frequency questionnaire following the diagnosis of primary invasive cancer for 3434 women in the WHI. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for risk of death from any cause, cancer, cardiovascular disease (CVD) and other causes by post-diagnosis quartiles of E-DII. Subgroup analyses by cancer stage and grade were performed.

RESULTS

There were 1156 deaths after a median 13 years of follow-up from the date of a cancer diagnosis. In the multivariable-adjusted analyses, a more anti-inflammatory diet plus supplements after cancer diagnosis was associated with lower all-cause mortality, cancer mortality, CVD mortality and mortality from other causes with HRsQ1vs.Q4 ranging from 0.47 to 0.68 (all P-trends < 0.05). Associations were stronger for cancers diagnosed at more distant stages or moderately differentiated grades.

CONCLUSION

A more anti-inflammatory diet plus supplements after a cancer diagnosis may improve survival for post-menopausal cancer survivors.

Association between pre-diagnostic dietary copper, zinc, and copper-to-zinc ratio and severity of ovarian cancer

BACKGROUND

The impact of dietary trace elements intake on ovarian cancer (OC) severity is unknown.

OBJECTIVE

We firstly explore the relationship between dietary copper (Cu), zinc (Zn), and copper-to-zinc (Cu/Zn) ratio and severity of OC.

METHODS

This cross-sectional study included 701 women from the OC follow-up study between 2015 and 2020. Dietary information was collected by a validated food frequency questionnaire (FFQ). The severity information of OC including age at diagnosis, histological type, International Federation of Gynecology and Obstetrics (FIGO) stage, and histopathologic grade was ascertained from medical records. Logistic regression model was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of aforementioned associations.

RESULTS

Among 701 participants, the number of patients age at diagnosis older than 50 were 443 (63.2%). The number of patients diagnosed as serous, III-IV stage, and poorly differentiation OC were 477 (68.05%), 336 (47.93%), and 597 (85.16%), respectively. In addition, compared with the lowest tertile intake, higher possibility of non-serous OC was associated with the pre-diagnosis dietary Cu (OR = 2.39, 95% CI = 1.28-4.47, p trend < 0.05) and Cu/Zn ratio (OR = 2.06, 95% CI = 1.26-3.39, P trend < 0.05) in the highest tertile intake. The risk of poorly differentiation OC at diagnosis was significant inversely related to dietary Cu intake (OR = 0.40, 95% CI = 0.18-0.88, P trend < 0.05). Besides, the results of subgroup analyses were consistent with the main findings but not all of them showed statistical significance.

CONCLUSION

Pre-diagnostic dietary Cu and Cu/Zn ratio were contributed to reducing the severity of OC at diagnosis, especially for the risk of serous OC and poorly differentiation OC.

Alternative Healthy Eating Index-2010 and Incident Non-Communicable Diseases: Findings from a 15-Year follow up of Women from the 1973–78 Cohort of the Australian Longitudinal Study on Women’s Health

Non-communicable diseases (NCDs) and multimorbidity (≥two chronic conditions), are increasing globally. Diet is a risk factor for some NCDs. We aimed to investigate the association between diet quality (DQ) and incident NCDs. Participants were from the Australian Longitudinal Study on Women’s Health 1973–78 cohort with no NCD and completed dietary data at survey 3 (2003, aged 25–30 years) who responded to at least one survey between survey 4 (2006) and survey 8 (2018). DQ was measured by the Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included coronary heart disease (CHD), hypertension (HT), asthma, cancer (excluding skin cancer), diabetes mellitus (DM), depression and/or anxiety, multimorbidity, and all-cause mortality. Repeated cross-sectional multivariate logistic regressions were performed to investigate the association between baseline DQ and NCDs over 15 years. The AHEI-2010 mean (±sd) for participants (n = 8017) was 51.6 ± 11.0 (range: 19–91). There was an inverse association between AHEI-2010 and incident asthma at survey 4 (OR_Q5–Q1: 0.75, 95% CI: 0.57, 0.99). Baseline DQ did not predict the occurrence of any NCDs or multimorbidity between the ages of 25–45 years. Further well-planned, large prospective studies conducted in young women are needed to explore dietary risk factors before the establishment of NCDs.

Pre-diagnosis fiber : carbohydrate intake ratio and mortality of ovarian cancer: results from a prospective cohort study

Background: The association between the ratio of fiber to carbohydrate (F : C-R) and cancer mortality is not currently well-known. We prospectively evaluated for the first time the aforementioned topic among ovarian cancer (OC) patients. Methods: A total of 703 newly diagnosed OC patients aged 18-79 years were included. Pre-diagnosis diet intake details were collected with a validated food frequency questionnaire. Deaths were ascertained until March 31, 2021, based on medical records and the cancer registry. Cox proportional hazard models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) between pre-diagnostic fiber, carbohydrate, and F : C-R intake and OC mortality. Restricted cubic splines were used to analyze the potential nonlinear relationship between F : C-R and OC mortality. Results: During the follow-up period (median: 37.2 months; interquartile: 24.7-50.2 months), we observed 130 (18.49%) OC patients died. The pre-diagnosis higher fiber intake (comparing the highest with the lowest tertile of intake: HR = 0.56, 95% CI = 0.35-0.92; HR per 1 SD increment: 0.78, 95% CI = 0.64-0.96; P trend < 0.05) and higher F : C-R intake (comparing the highest with the lowest tertile of intake: HR = 0.51, 95% CI = 0.31-0.85; HR per 1-SD increment: 0.73; 95% CI = 0.59-0.91; P trend < 0.05) were significantly associated with lower mortality for OC patients, but no evidence of the association between pre-diagnosis carbohydrate intake and OC mortality was observed. We found no evidence of a nonlinear relationship between F : C-R and OC mortality. Significant inverse associations were also observed for subgroup analyses stratified by age at diagnosis, menopausal status, residual lesions, histological type, FIGO stage, and body mass index, although not all associations showed statistical significance. Conclusion: Pre-diagnosis high fiber intake and high F : C-R diet intake were associated with a decreased risk of OC mortality.

Relationship between different forms of dietary choline and ovarian cancer survival: findings from the ovarian cancer follow-up study, a prospective cohort study

Higher levels of pre-diagnosis fat-soluble choline intake was associated with better overall survival of ovarian cancer, and this association was more attributed to phosphatidylcholine.

Association between pre-diagnostic dietary pattern and survival of ovarian cancer: Evidence from a prospective cohort study

BACKGROUND

Evidence for a role of single nutrition or foods on ovarian cancer (OC) survival has been limited and inconclusive. Due to the potentially complex interactions in dietary, we applied dietary patterns to this study to firstly explore the relationship between the pre-diagnosis overall diet and OC survival.

METHODS

The prospective cohort study was conducted among 853 OC patients aged 18-79 years during 2015-2020. Dietary intake was collected using a validated 111-item food frequency questionnaire. Deaths were obtained by medical records and cancer registry up to March 31, 2021. Cox proportional hazards regression models was used to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of pre-diagnosis dietary patterns with overall survival (OS).

RESULTS

Overall, during the follow-up period (median: 37.57 months, interquartile: 25.00-50.17 months), 130 (18.49%) OC patients died. Four dietary patterns were identified: healthy pattern, ethnic pattern, animal foods pattern, and sweet pattern. The highest tertile of the healthy pattern scores was related to better OS compared with the lowest tertile scores (HR = 0.54, 95% CI = 0.30-0.98, p trend <0.05), whereas OC patients with highest adherence to the animal foods pattern was associated with worse OS than those with the lowest adherence (HR = 1.90, 95% CI = 1.14-3.17, p trend <0.05). We found no significant associations between adherence to ethnic pattern and sweet pattern and OS of OC patients.

CONCLUSION

Pre-diagnosis healthy patterns was associated with better OC survival, whereas animal pattern was associated with worse survival among OC survivals.

Association Between Diet Quality and Risk of Ovarian and Endometrial Cancers: A Systematic Review of Epidemiological Studies

Objectives

The relationship between diet quality indices and risk of ovarian and endometrial cancers were unclear. We aimed at conducting a systematic review to evaluate the epidemiological evidence.

Methods

Embase, PubMed, Web of Science and Scopus databases were searched for eligible studies up to December 2020. Epidemiological studies reported the association of the diet quality with risk of ovarian and endometrial cancers were evaluated.

Results

Eleven eligible studies were identified, of which six studies were case-control studies, four were cohort studies, and one was case-cohort study. All studies were considered as high-quality with low risk of bias. Seven studies evaluated the association of diet quality with risk of ovarian cancer. Four studies reported null association for diet quality indices such as Healthy Eating Index (HEI)-2005, HEI-2010, Mediterranean Diet Score (MDS) and Recommended Foods Score (RFS). Two studies reported significantly inverse association for Alternate Healthy Eating Index (AHEI)-2010 and Healthy Diet Score (HDS) indices. One study reported significantly increased risk of ovarian cancer associated with higher level of Dietary Guidelines for Americans Index. Dose-response analysis showed pooled relative risks of 0.98 (95%Cl: 0.95, 1.01) and 0.94 (95%Cl: 0.77, 1.13) for each 10 points increase in the HEI-2005 and AHEI-2010 indices. Seven studies evaluated the association of diet quality with risk of endometrial cancer. Three studies reported significantly inverse association of diet quality as assessed by the MDS and Diet Score Quintiles with risk of endometrial cancer. Four studies reported null association for other diet quality indices including HEI-2005, HEI-2010, RFS and HDS. Dose-response analysis showed a pooled relative risk of 0.87 (95%CI: 0.81, 0.93) for one unit increment of the MDS.

Conclusion

This study suggests little evidence on the association between diet quality and risk of ovarian cancer. Adherence to high quality diet, as assessed by MDS, might be associated with lower the risk of endometrial cancer.