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Epidemiology

Dietary patterns with combined and site-specific cancer incidence in Alberta’s Tomorrow Project cohort

European Journal of Clinical Nutrition volume 76, pages 360–372 (2022)Cite this article

Subjects

Abstract

Background/Objectives

Poor diet quality has been associated with an increased risk of cancer. Here, we examine the association between dietary patterns derived with two methods, and combined and site-specific cancer incidence in Canada.

Subjects/Methods

Dietary data were obtained from participants enrolled in Alberta’s Tomorrow Project, a prospective cohort study, between 2000 and 2008. Principle component analysis (PCA) and reduced rank regression (RRR) were used to derive dietary patterns, and data linkage with the Alberta Cancer Registry was used for incident cancer cases. Cox proportional hazard regressions were used to estimate multivariable-adjusted models for the association between each dietary pattern score with combined and site-specific cancer incidence.

Results

PCA revealed three dietary patterns (“western”, “prudent”, and “sugar, fruits, and dairy”) and RRR resulted in four patterns (“dietary fiber“, “vitamin D”, “fructose”, and “discretionary fat”). Five cancer sites were included in our site-specific analysis: lung, colon, breast, prostate, and endometrial cancers. The most protective dietary patterns for combined cancer sites were the “Prudent” pattern (HR = 0.82, CI = 0.73–0.92) and the “Dietary fiber” pattern (HR = 0.82, CI = 0.69–0.97). The “Fructose” pattern was associated with increased risk of combined cancers (HR = 1.14, CI = 1.02–1.27). Three dietary patterns were protective against colon cancer (“Prudent”, “Dietary fiber”, and “Discretionary fats”), and other risk reductions were seen for the “sugar, fruit, and dairy” pattern (lung cancer), and the “Dietary fiber” pattern (prostate cancer).

Conclusions

These results support cancer prevention strategies for a diet high in vegetables, fruits, fish, and whole grains. Further studies should explore the possible association between discretionary fats and colon cancer.

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Acknowledgements

Dr. Jessica McNeil is a recipient of Postdoctoral Fellowship Awards from the Canadian Institutes of Health Research and Alberta Innovates. Dr. Christine Friedenreich was supported by a Health Senior Scholar Award from Alberta Innovates-Health Solutions and the Alberta Cancer Foundation Weekend to End Women’s Cancers Breast Cancer Chair. Dr. Darren Brenner was supported by a Capacity Development Award in Cancer Prevention from the Canadian Cancer Society (#703917). Alberta’s Tomorrow Project is only possible due to the commitment of its research participants, its staff, and its funders: Alberta Health and the Alberta Cancer Prevention Legacy Fund, Alberta Cancer Foundation, Canadian Partnership Against Cancer and substantial in kind funding from Alberta Health Services. The views expressed herein represent the views of the authors and not of Alberta’s Tomorrow Project or any of its funders.

Funding

Alberta’s Tomorrow Project received funding from Alberta Health and the Alberta Cancer Prevention Legacy Fund, the Alberta Cancer Foundation, the Canadian Partnership Against Cancer and substantial in kind funding from Alberta Health Services. Funding was not received for the analysis and writing of this manuscript.

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Authors and Affiliations

  1. Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands

    Romy F. Willemsen

  2. Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada

    Romy F. Willemsen, Jessica McNeil, Emily Heer, Christine M. Friedenreich & Darren R. Brenner

  3. Department of Kinesiology, Faculty of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, North Carolina, USA

    Jessica McNeil

  4. Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada

    Steven T. Johnson

  5. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Christine M. Friedenreich & Darren R. Brenner

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Contributions

R.F.W., J.M., S.T.J., C.M.F., and D.R.B. were involved in the conception of the research question and analyses. R.F.W. conducted statistical analyses. R.F.W., J.M., and E.H. drafted the manuscript. All authors critically revised the manuscript for intellectual content, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work at appropriately investigated and resolved.

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Correspondence to Darren R. Brenner.

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Willemsen, R.F., McNeil, J., Heer, E. et al. Dietary patterns with combined and site-specific cancer incidence in Alberta’s Tomorrow Project cohort. Eur J Clin Nutr 76, 360–372 (2022). https://doi.org/10.1038/s41430-021-00958-7

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