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Epidemiology

Pre-diagnosis and post-diagnosis dietary patterns and survival in women with ovarian cancer

Abstract

Background

Evidence is limited on inflammation-related dietary patterns and mortality in ovarian cancer survivors.

Methods

We examined the associations between pre- and post-diagnosis dietary patterns, including change in diet from before to after diagnosis, and mortality among 1003 ovarian cancer survivors in two prospective cohort studies. Dietary pattern scores for empirical dietary inflammatory pattern (EDIP) and Alternative Healthy Eating Index (AHEI) were calculated based on food frequency questionnaires. We used Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer-specific and all-cause mortality.

Results

Pre-diagnosis EDIP score and AHEI were not associated with mortality. Among non-high grade serous cases, a higher post-diagnosis EDIP score was associated with increased risk of all-cause mortality (HR5th vs 1st quintile = 1.95, 95% CI = 1.04–3.67, p-trend = 0.06). Compared to survivors consuming a low EDIP score diet before and after diagnosis, high post-diagnosis EDIP was associated with increased risk of ovarian cancer specific mortality (pre-to-post diagnosis low/high, HR = 1.38, 95% CI = 0.99–1.92; high/high HR = 1.58, 95% CI = 1.09–2.30) and all-cause mortality (low/high HR = 1.44, 95% CI = 1.06–1.95; high/high HR = 1.55, 95% CI = 1.10–2.19).

Conclusion

Consuming a more inflammatory dietary pattern post-diagnosis was associated with increased mortality in ovarian cancer survivors, suggesting limiting the inflammatory potential of diet post-diagnosis could lead to enhanced survivorship.

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Fig. 1: Flow diagram describing the exclusions in the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII).

Data availability

The data generated in this study are not publicly available but are available upon request. Further information including the procedures to obtain and access data from the Nurses’ Health Studies is described at https://www.nurseshealthstudy.org/researchers (contact email: nhsaccess@channing.harvard.edu).

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Acknowledgements

We would like to thank the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data.

Funding

This work was supported in part by the National Institutes of Health (UM1 CA186107, P01 CA87969, U01 CA176726). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. NS was supported by the Rivkin Scientific Scholars Award and Department of Defense W81XWH2110320.

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Contributions

NS, KLT, SST, HRH contributed to the study concept and design. NS conducted the statistical analysis and drafted the initial manuscript. All authors contributed to the data interpretation and provided critical revisions of the final manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Naoko Sasamoto.

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Competing interests

SST received a grant from BMS that is unrelated to this work. The authors declare no competing interest.

Ethics approval and consent to participate

The study protocol was approved by the institutional review boards of the Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, and those of participating registries as required. Completion of the questionnaire implied informed consent.

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Sasamoto, N., Wang, T., Townsend, M.K. et al. Pre-diagnosis and post-diagnosis dietary patterns and survival in women with ovarian cancer. Br J Cancer (2022). https://doi.org/10.1038/s41416-022-01901-8

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