A Comparative Study of Healthy Dietary Patterns for Incident and Fatal Digestive System Cancer

Abstract

Background and Aims: We examined multiple dietary patterns in relation to total digestive system cancer (DSC) incidence and death. Method: A total of 213,038 health professionals from the Health Professionals Follow-up Study (1986-2016) and the Nurses’ Health Study (NHS) (1986-2018) and the NHS II (1991-2017) with no cancer diagnosis at baseline were analyzed. DSC incidence and death were estimated using time varying Cox proportional hazards regression models. Results: During up to 32 years of follow-up, 5724 DSC cases accrued. Adherence to eight healthy diet patterns were associated with a 7-13% lower risk of DSC, particularly for digestive tract cancers. An inverse association with gastrointestinal tract cancer was also shown for all pattern scores except alternative Mediterranean diet (AMED) and healthy Plant Dietary Index, with hazard ratios (HRs) between 0.84 and 0.89. Inverse associations were shown for the rEDIH (HR for 90th versus 10th percentile 0.64, 95% confidence interval (CI) 0.47 to 0.87) and the empirical dietary index associated with lower inflammation (rEDIP) (0.53, 95% CI 0.39 to 0.72) for stomach cancer, and for the rEDIP (0.58, 95% CI 0.37 to 0.92) for small intestine cancer. Among accessory cancers, the Alternate Healthy Eating Index-2010 (AHEI-2010), AMED, and diabetes risk reduction diet were associated with a 43-51% lower risk of liver cancer. The rEDIH, rEDIP, and the AHEI-2010 were inversely associated with risk of digestive system fatal cancer. Conclusions: Adherence to healthy diets was associated with a lower risk of incident and fatal DSC, although the magnitude of the association varied slightly among the patterns.