Table 3.
Associations of post-diagnostic energy-adjusted intake of total dairy, low-fat dairy, high-fat dairy, and dairy products with recurrence (n = 1215) and all-cause mortality (n = 1605) 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 | Adjusted model, HR (95% CI)c | Median energy-adjusted intake [IQR]b | n | No. of deaths/ person-years |
Adjusted model, HR (95% CI)c | |
| Total dairy | ||||||||
| Q1 | 125.3 [92.7, 157.9] | 305 | 31/889 | 1.00 | 125.7 [90.8, 157.9] | 396 | 51/2211 | 1.00 |
| Q2 | 227.7 [206.4, 257.8] | 304 | 41/899 | 1.38 (0.86–2.21) | 228.1 [206.6, 254.1] | 403 | 59/2186 | 1.06 (0.73–1.55) |
| Q3 | 341.6 [318.2, 365.7] | 303 | 39/842 | 1.31 (0.81–2.10) | 335.1 [303.5, 362.6] | 400 | 60/2161 | 1.07 (0.73–1.55) |
| Q4 | 485.9 [440.2, 606.7] | 303 | 39/853 | 1.27 (0.79–2.04) | 481.4 [434.8, 593.7] | 406 | 65/2272 | 1.00 (0.69–1.45) |
| Ptrend | NA | NA | NA | 0.47 | NA | NA | NA | 0.94 |
| Continuous (per 100 g/day) | 285.1 [184.7, 396.6] | 1215 | 150/3484 | 1.06 (0.97–1.16) | 282.7 [185.9, 393.7] | 1605 | 235/8829 | 1.03 (0.95–1.10) |
| Low-fat dairyd | ||||||||
| Q1 | 23.0 [0.3, 46.7] | 302 | 37/871 | 1.00 | 20.1 [− 1.7, 46.2] | 396 | 66/2151 | 1.00 |
| Q2 | 120.1 [94.4, 140.1] | 305 | 36/897 | 0.95 (0.60–1.50) | 119.3 [94.9, 139.8] | 402 | 58/2220 | 0.83 (0.58–1.18) |
| Q3 | 221.7 [187.0, 259.4] | 304 | 36/852 | 1.03 (0.65–1.63) | 216.9 [180.6, 255.5] | 402 | 52/2211 | 0.70 (0.49–1.01) |
| Q4 | 382.6 [322.3, 470.0] | 304 | 41/864 | 1.14 (0.73–1.78) | 380.3 [322.6, 469.4] | 405 | 59/2247 | 0.76 (0.53–1.08) |
| Ptrend | NA | NA | NA | 0.48 | NA | NA | NA | 0.12 |
| Continuous (per 100 g/day) | 161.0 [71.3, 288.0] | 1215 | 150/3484 | 1.03 (0.94–1.13) | 161.2 [72.0, 286.6] | 1605 | 235/8829 | * |
| High-fat dairye | ||||||||
| Q1 | 29.2 [13.2, 40.9] | 307 | 40/853 | 1.00 | 29.2 [13.5, 40.0] | 400 | 43/2213 | 1.00 |
| Q2 | 64.7 [54.8, 73.0] | 304 | 33/902 | 0.80 (0.50–1.30) | 64.9 [54.0, 73.0] | 403 | 61/2232 | 1.27 (0.85–1.89) |
| Q3 | 102.9 [90.7, 115.9] | 305 | 32/895 | 0.77 (0.48–1.24) | 102.2 [90.4, 116.2] | 405 | 49/2249 | 0.94 (0.62–1.44) |
| Q4 | 209.7 [168.5, 291.9] | 299 | 45/834 | 1.02 (0.66–1.57) | 202.7 [166.1, 273.6] | 397 | 82/2135 | 1.60 (1.10–2.33) |
| Ptrend | NA | NA | NA | 0.62 | NA | NA | NA | 0.010 |
| Continuous (per 100 g/day) | 81.2 [48.4, 136.6] | 1215 | 150/3484 | 1.08 (0.93–1.24) | 81.2 [48.5, 135.9] | 1605 | 235/8829 | 1.18 (1.06–1.32) |
| Total milk | ||||||||
| Q1 | − 0.4 [− 14.4, 8.4] | 307 | 32/863 | 1.00 | − 1.1 [− 15.3, 7.0] | 394 | 57/2106 | 1.00 |
| Q2 | 32.9 [25.6, 42.8] | 301 | 42/873 | 1.31 (0.82–2.10) | 31.9 [24.1, 40.5] | 401 | 54/2252 | 0.79 (0.53–1.17) |
| Q3 | 104.6 [78.9, 133.8] | 305 | 30/897 | 1.01 (0.61–1.67) | 101.2 [75.7, 128.6] | 403 | 50/2209 | 0.78 (0.53–1.15) |
| Q4 | 256.2 [191.9, 306.5] | 302 | 46/851 | 1.39 (0.88–2.19) | 237.1 [183.6, 299.5] | 407 | 74/2261 | 0.99 (0.70–1.42) |
| Ptrend | NA | NA | NA | 0.28 | NA | NA | NA | 0.54 |
| Continuous (per 100 g/day) | 58.8 [16.9, 159.8] | 1215 | 150/3484 | 1.05 (0.93–1.18) | 56.9 [16.4, 155.6] | 1605 | 235/8829 | 1.02 (0.92–1.12) |
| Total yoghurt | ||||||||
| Q1 | 4.5 [− 4.3, 11.7] | 301 | 30/888 | 1.00 | 4.2 [-4.4, 12.1] | 397 | 62/2229 | 1.00 |
| Q2 | 45.7 [29.4, 58.9] | 303 | 44/862 | 1.38 (0.86–2.20) | 47.4 [29.1, 61.2] | 402 | 62/2171 | 0.99 (0.70–1.41) |
| Q3 | 104.1 [84.9, 121.7] | 305 | 33/897 | 1.03 (0.63–1.69) | 103.8 [82.9, 121.1] | 402 | 56/2215 | 0.84 (0.58–1.20) |
| Q4 | 187.3 [144.2, 266.7] | 306 | 43/836 | 1.51 (0.96–2.39) | 187.8 [143.8, 269.6] | 404 | 55/2214 | 0.89 (0.62–1.28) |
| Ptrend | NA | NA | NA | 0.39 | NA | NA | NA | 0.17 |
| Continuous (per 100 g/day) | 76.3 [20.5, 136.8] | 1215 | 150/3484 | 1.07 (0.91–1.27) | 75.5 [21.7, 137.2] | 1605 | 235/8829 | 0.96 (0.83–1.11) |
| Total cheese | ||||||||
| Q1 | 8.9 [3.3, 12.9] | 303 | 37/848 | 1.00 | 8.1 [2.1, 12.6] | 397 | 55/2133 | 1.00 |
| Q2 | 21.2 [18.9, 23.8] | 301 | 47/825 | 1.37 (0.88–2.12) | 21.1 [18.6, 23.4] | 403 | 66/2193 | 1.02 (0.71–1.48) |
| Q3 | 32.9 [29.6, 36.9] | 305 | 34/889 | 0.92 (0.57–1.46) | 32.7 [29.3, 36.5] | 403 | 55/2247 | 0.86 (0.59–1.25) |
| Q4 | 53.1 [46.8, 67.5] | 306 | 32/921 | 0.83 (0.51–1.33) | 52.4 [46.5, 66.4] | 402 | 59/2257 | 0.89 (0.61–1.29) |
| Ptrend | NA | NA | NA | 0.18 | NA | NA | NA | 0.40 |
| Continuous (per 30 g/day) | 26.3 [16.3, 40.9] | 1215 | 150/3484 | 0.85 (0.68–1.07) | 26.1 [15.9, 40.4] | 1605 | 235/8829 | 0.93 (0.78–1.11) |
CI confidence interval, HR hazard ratio; IQR inter-quartile range. Cut-off points for female quartiles were as follows: 208.8, 317.5 and 418.1 g/day for total dairy; 91.2, 181.8 and 303.1 g/day for low-fat dairy; 61.0, 89.8 and 145.5 g/day for high-fat dairy; 21.7, 52.0 and 153.5 g/day for milk; 45.1, 102.9 and 152.5 g/day for yoghurt; 18.5, 28.2 and 42.4 g/day for cheese. Cut-off points for male quartiles were as follows: 166.9, 263.2 and 375.3 g/day for total dairy; 61.6, 147.3 and 270.6 g/day for low-fat dairy; 42.5, 74.0 and 129.1 g/day for high-fat dairy; 12.7, 59.4 and 155.5 g/day for milk; 14.0, 58.7 and 121.9 g/day for yoghurt; 14.1, 24.4 and 39.4 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 = 419), when they had no surgery (n = 8) or when they had a recurrence before filling out the post-diagnostic FFQ (n = 9)
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 post-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