Association between diet quality and ovarian cancer risk and survival

Abstract

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 utilized data from women in the prospective NIH-AARP Diet and Health Study enrolled from 1995-1996 and were 50-71 years old at baseline with follow-up through 12/31/2017. Participants completed a 124-item Food Frequency Questionnaire at baseline and diet quality was assessed via the Healthy Eating Index-2015 (HEI-2015), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension score (DASH). 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 multi-state model with Cox proportional hazards regression to account for semi-competing events.

Results: Among 150,643 participants with a median follow-up time of 20.5 years, 1,107 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 pre-diagnosis diet quality, according to the HEI-2015 (Quintile 5 vs Quintile 1 HR = 0.75 [0.60-0.93]) and aMED (Quintile 5 vs Quintile 1: HR = 0.68, [0.53-0.87]) was associated with lower all-cause mortality. There was no evidence of an association between DASH and all-cause mortality.

Conclusions: Better pre-diagnosis diet quality was associated with lower all-cause mortality after ovarian cancer diagnosis, but was not associated with ovarian cancer risk.