Table 2.
Associations of pre-diagnostic energy-adjusted intake of total dairy, low-fat dairy, high-fat dairy, and dairy products with recurrence (n = 1315) and all-cause mortality (n = 1731) in sex-specific quartiles of people with stage I-III colorectal cancer
| Dietary variable | Recurrencea | All-cause mortality | ||||||
|---|---|---|---|---|---|---|---|---|
| Median energy-adjusted intake [IQR]b | n | No. of recurrences/person-years | Multivariable HR (95% CI)c | Median energy-adjusted intake [IQR]b | n | No. of deaths/person-years | Multivariable HR (95% CI)c | |
| Total dairy | ||||||||
| Q1 | 109.8 [69.7, 142.4] | 331 | 55/1033 | 1.00 | 114.3 [73.0, 147.3] | 432 | 74/2534 | 1.00 |
| Q2 | 220.3 [184.3, 253.9] | 330 | 46/1063 | 0.80 (0.54–1.19) | 224.5 [190.0, 247.3] | 432 | 78/2504 | 0.98 (0.71–1.35) |
| Q3 | 323.2 [278.1, 351.3] | 326 | 42/1049 | 0.72 (0.48–1.08) | 322.5 [279.1, 348.9] | 430 | 64/2485 | 0.77 (0.55–1.09) |
| Q4 | 489.6 [426.1, 591.02] | 328 | 30/1106 | 0.51 (0.33–0.80) | 481.0 [423.7, 581.2] | 437 | 66/2582 | 0.72 (0.52–1.01) |
| Ptrend | NA | NA | NA | 0.003 | NA | NA | NA | 0.029 |
| Continuous (per 100 g/day) | 267.9 [172.1, 385.4] | 1315 | 173/4251 | 0.89 (0.81–0.99) | 269.6 [177.6, 384.6] | 1731 | 282/10105 | 0.96 (0.89–1.03) |
| Low-fat dairyd | ||||||||
| Q1 | 20.5 [− 4.8, 42.3] | 333 | 56/1076 | 1.00 | 20.5 [− 3.5, 44.6] | 434 | 87/2511 | 1.00 |
| Q2 | 120.1 [94.8, 142.0] | 329 | 46/1034 | 0.83 (0.56–1.23) | 119.7 [94.9, 143.7] | 438 | 74/2503 | 0.84 (0.62–1.15) |
| Q3 | 223.0 [184.0, 254.9] | 325 | 47/1035 | 0.84 (0.57–1.24) | 219.6 [185.9, 253.4] | 425 | 63/2474 | 0.69 (0.50–0.96) |
| Q4 | 374.3 [317.8, 465.4] | 328 | 24/1108 | 0.42 (0.26–0.67) | 371.9 [315.4, 452.4] | 434 | 58/2618 | 0.58 (0.41–0.81) |
| Ptrend | NA | NA | NA | < .001 | NA | NA | NA | < 0.001 |
| Continuous (per 100 g/day) | 163.3 [68.2, 281.4] | 1315 | 173/4251 | 0.86 (0.77–0.96) | 164.8 [69.7, 281.2] | 1731 | 282/10105 | * |
| High-fat dairye | ||||||||
| Q1 | 25.4 [6.3, 36.9] | 328 | 45/1044 | 1.00 | 24.5 [5.5, 36.9] | 428 | 49/2553 | 1.00 |
| Q2 | 60.7 [50.9, 68.7] | 329 | 38/1065 | 0.80 (0.51–1.24) | 61.3 [51.5, 69.0] | 430 | 67/2525 | 1.13 (0.78–1.66) |
| Q3 | 96.7 [85.9, 109.2] | 325 | 43/1068 | 0.93 (0.60–1.44) | 96.8 [86.2, 109.2] | 431 | 80/2483 | 1.33 (0.92–1.93) |
| Q4 | 180.3 [149.6, 229.8] | 333 | 47/1075 | 0.97 (0.64–1.47) | 182.9 [149.8, 244.3] | 442 | 86/2545 | 1.41 (0.98–2.01) |
| Ptrend | NA | NA | NA | 0.83 | NA | NA | NA | 0.06 |
| Continuous (per 100 g/day) | 76.0 [45.6, 128.5] | 1315 | 173/4251 | 1.07 (0.91–1.26) | 77.7 [46.5, 127.9] | 1731 | 282/10105 | 1.15 (1.03–1.28) |
| Total milk | ||||||||
| Q1 | − 4.2 [-19.1, 7.1] | 331 | 43/1055 | 1.00 | − 4.9 [-19.4, 6.7] | 424 | 60/2508 | 1.00 |
| Q2 | 31.8 [21.2, 41.4] | 328 | 51/984 | 1.06 (0.69–1.64) | 30.9 [21.1, 40.5] | 432 | 75/2399 | 1.07 (0.75–1.55) |
| Q3 | 93.8 [69.6, 120.4] | 330 | 40/1100 | 0.89 (0.57–1.40) | 89.6 [67.4, 116.5] | 439 | 74/2558 | 1.09 (0.76–1.55) |
| Q4 | 231.5 [175.1, 304.3] | 326 | 39/1112 | 0.81 (0.52–1.27) | 227.0 [171.1, 297.5] | 436 | 73/2641 | 0.91 (0.64–1.29) |
| Ptrend | NA | NA | NA | 0.23 | NA | NA | NA | 0.39 |
| Continuous (per 100 g/day) | 52.2 [15.3, 145.8] | 1315 | 173/4251 | 0.90 (0.78–1.04) | 51.2 [15.5, 142.5] | 1731 | 282/10105 | 1.02 (0.92–1.12) |
| Total yoghurt | ||||||||
| Q1 | 2.4 [− 7.1, 9.9] | 325 | 43/1088 | 1.00 | 2.4 [− 6.1, 11.3] | 427 | 78/2531 | 1.00 |
| Q2 | 45.8 [22.2, 62.0] | 328 | 48/1040 | 1.14 (0.75–1.72) | 45.3 [22.5, 68.0] | 429 | 80/2449 | 0.91 (0.66–1.25) |
| Q3 | 102.3 [76.1, 122.0] | 333 | 49/1074 | 1.09 (0.72–1.64) | 102.3 [76.4, 124.7] | 438 | 68/2588 | 0.74 (0.53–1.02) |
| Q4 | 205.0 [147.1, 277.2] | 329 | 33/1049 | 0.78 (0.50–1.24) | 204.6 [147.5, 273.6] | 437 | 56/2537 | 0.70 (0.50–0.99) |
| Ptrend | NA | NA | NA | 0.21 | NA | NA | NA | 0.029 |
| Continuous (per 100 g/day) | 70.8 [18.5, 138.4] | 1315 | 173/4251 | 0.96 (0.83–1.13) | 72.8 [19.9, 140.1] | 1731 | 282/10105 | 0.86 (0.75–0.99) |
| Total cheese | ||||||||
| Q1 | 9.0 [2.5, 12.6] | 329 | 47/1065 | 1.00 | 8.6 [2.4, 12.4] | 429 | 63/2518 | 1.00 |
| Q2 | 21.6 [19.4, 25.1] | 325 | 35/1048 | 0.76 (0.49–1.18) | 21.5 [19.0, 24.8] | 429 | 64/2523 | 0.92 (0.65–1.32) |
| Q3 | 34.8 [31.1, 38.1] | 331 | 47/1007 | 0.97 (0.64–1.46) | 34.5 [31.1, 37.4] | 436 | 78/2449 | 1.08 (0.77–1.51) |
| Q4 | 57.2 [49.1, 73.3] | 330 | 44/1131 | 0.91 (0.60–1.38) | 57.6 [49.1, 74.0] | 437 | 77/2615 | 1.04 (0.75–1.46) |
| Ptrend | NA | NA | NA | 0.95 | NA | NA | NA | 0.61 |
| Continuous (per 30 g/day) | 28.0 [16.1, 43.7] | 1315 | 173/4251 | 1.03 (0.85–1.24) | 27.8 [15.9, 43.2] | 1731 | 282/10105 | 1.03 (0.89–1.19) |
CI confidence interval, HR hazard ratio, IQR inter-quartile range. Cut-off points for female quartiles were as follows: 220.8, 308.1 and 441.3 g/day for total dairy; 101.4, 201.4 and 313.5 g/day for low-fat dairy; 58.0, 84.0 and 129.1 g/day for high-fat dairy; 23.6, 60.0 and 149.6 g/day for milk; 40.7, 104.6 and 164.6 g/day for yoghurt; 17.9, 29.8 and 44.8 g/day for cheese. Cut-off points for male quartiles were as follows: 152.1, 244.1 and 358.0 g/day for total dairy; 56.6, 145.7 and 264.0 g/day for low-fat dairy; 38.0, 72.5 and 123.1 g/day for high-fat dairy; 9.4, 46.0 and 137.2 g/day for milk; 9.7, 54.7 and 120.5 g/day for yoghurt; 14.3, 26.2 and 41.9 g/day for cheese
*This association was observed to be non-linear in restricted cubic splines. See Fig. 2 for the continuous analysis
aRecurrence is defined as a locoregional recurrence or distant metastasis. Participants were excluded from data analysis when they had missing data on recurrence status (n = 463) or when they had no surgery (n = 8)
bDietary intake was adjusted for energy using the energy residual method. To improve interpretability, the predicted nutrient intake at the median total energy intake was added to individual residuals [15]
cThe adjusted model was adjusted for age, sex, stage of disease and pre-diagnostic energy intake
dLow-fat dairy included buttermilk and low-fat, reduced-fat or skimmed versions of milk, yoghurt, custard, and soft curd cheese
eHigh-fat dairy included whole and condensed milk, full-fat versions of yoghurt, custard and soft curd cheese, all other cheeses, ice cream, whipped cream, and butter