TABLE 4.
Associations between quintiles of AMED scores and risk of CRC outcomes in the NHS and HPFS1
| Q1 | Q2 | Q3 | Q4 | Q5 | P-trend2 | P-nonlinearity3 | P-heterogeneity4 | |
|---|---|---|---|---|---|---|---|---|
| Total CRC | ||||||||
| Men | ||||||||
| Cases, n | 225 | 215 | 260 | 252 | 210 | |||
| Age-adjusted | 1.00 (ref) | 0.91 (0.76, 1.10) | 0.93 (0.78, 1.12) | 0.83 (0.69, 1.00) | 0.73 (0.60, 0.89) | 0.0002 | ||
| MV-adjusted5 | 1.00 (ref) | 0.94 (0.78, 1.14) | 0.98 (0.81, 1.17) | 0.89 (0.74, 1.08) | 0.80 (0.65, 0.98) | 0.02 | ||
| Women | ||||||||
| Cases, n | 294 | 313 | 301 | 303 | 317 | |||
| Age-adjusted | 1.00 (ref) | 0.86 (0.74, 1.01) | 0.78 (0.66, 0.91) | 0.79 (0.67, 0.93) | 0.84 (0.71, 0.99) | 0.03 | ||
| MV-adjusted6 | 1.00 (ref) | 0.91 (0.77, 1.07) | 0.85 (0.71, 1.00) | 0.89 (0.75, 1.05) | 0.99 (0.83, 1.18) | 0.98 | 0.05 | |
| Pooled | ||||||||
| Cases, n | 519 | 528 | 561 | 555 | 527 | |||
| MV-adjusted7 | 1.00 (ref) | 0.92 (0.82, 1.04) | 0.90 (0.78, 1.04) | 0.89 (0.78, 1.01) | 0.89 (0.73, 1.10) | 0.31 | 0.10 | |
| Total colon cancer | ||||||||
| Men | ||||||||
| Cases, n | 175 | 160 | 209 | 203 | 174 | |||
| Age-adjusted | 1.00 (ref) | 0.86 (0.69, 1.07) | 0.96 (0.78, 1.18) | 0.85 (0.69, 1.05) | 0.78 (0.63, 0.96) | 0.01 | ||
| MV-adjusted5 | 1.00 (ref) | 0.88 (0.71, 1.10) | 1.00 (0.81, 1.23) | 0.92 (0.74, 1.14) | 0.85 (0.67, 1.06) | 0.21 | ||
| Women | ||||||||
| Cases, n | 224 | 247 | 234 | 249 | 250 | |||
| Age-adjusted | 1.00 (ref) | 0.89 (0.74, 1.06) | 0.78 (0.65, 0.94) | 0.84 (0.70, 1.01) | 0.86 (0.71, 1.03) | 0.13 | ||
| MV-adjusted6 | 1.00 (ref) | 0.94 (0.78, 1.13) | 0.85 (0.70, 1.03) | 0.96 (0.79, 1.16) | 1.02 (0.83, 1.25) | 0.60 | 0.12 | |
| Pooled | ||||||||
| Cases, n | 399 | 407 | 443 | 452 | 424 | |||
| MV-adjusted7 | 1.00 (ref) | 0.92 (0.80, 1.05) | 0.92 (0.78, 1.08) | 0.94 (0.81, 1.08) | 0.94 (0.78, 1.12) | 0.59 | 0.21 | |
| Proximal colon cancer | ||||||||
| Men | ||||||||
| Cases, n | 71 | 68 | 88 | 91 | 78 | |||
| Age-adjusted | 1.00 (ref) | 0.89 (0.64, 1.25) | 1.00 (0.73, 1.37) | 0.94 (0.68, 1.29) | 0.85 (0.61, 1.17) | 0.46 | ||
| MV-adjusted5 | 1.00 (ref) | 0.89 (0.63, 1.24) | 0.98 (0.71, 1.35) | 0.94 (0.68, 1.30) | 0.85 (0.60, 1.20) | 0.56 | ||
| Women | ||||||||
| Cases, n | 140 | 170 | 145 | 157 | 143 | |||
| Age-adjusted | 1.00 (ref) | 0.97 (0.77, 1.21) | 0.76 (0.60, 0.97) | 0.83 (0.66, 1.04) | 0.77 (0.61, 0.98) | 0.04 | ||
| MV-adjusted6 | 1.00 (ref) | 1.00 (0.80, 1.25) | 0.80 (0.63, 1.02) | 0.88 (0.69, 1.13) | 0.85 (0.65, 1.10) | 0.36 | ||
| Pooled | ||||||||
| Cases, n | 211 | 238 | 233 | 248 | 221 | |||
| MV-adjusted7 | 1.00 (ref) | 0.96 (0.80, 1.16) | 0.86 (0.71, 1.04) | 0.94 (0.78, 1.15) | 0.85 (0.69, 1.05) | 0.28 | 0.89 | |
| Distal colon cancer | ||||||||
| Men | ||||||||
| Cases, n | 66 | 63 | 74 | 75 | 57 | |||
| Age-adjusted | 1.00 (ref) | 0.92 (0.65, 1.31) | 0.90 (0.65, 1.27) | 0.81 (0.58, 1.13) | 0.67 (0.47, 0.96) | 0.01 | ||
| MV-adjusted5 | 1.00 (ref) | 0.95 (0.67, 1.35) | 0.98 (0.69, 1.38) | 0.90 (0.63, 1.27) | 0.76 (0.52, 1.12) | 0.15 | ||
| Women | ||||||||
| Cases, n | 76 | 69 | 86 | 87 | 99 | |||
| Age-adjusted | 1.00 (ref) | 0.74 (0.53, 1.02) | 0.85 (0.63, 1.17) | 0.91 (0.67, 1.24) | 1.01 (0.74, 1.36) | 0.85 | ||
| MV-adjusted6 | 1.00 (ref) | 0.80 (0.58, 1.12) | 1.00 (0.72, 1.38) | 1.13 (0.81, 1.57) | 1.35 (0.96, 1.90) | 0.06 | ||
| Pooled | ||||||||
| Cases, n | 142 | 132 | 160 | 162 | 156 | |||
| MV-adjusted7 | 1.00 (ref) | 0.87 (0.68, 1.11) | 0.99 (0.78, 1.25) | 1.01 (0.80, 1.29) | 1.02 (0.58, 1.79) | 0.89 | 0.02 | |
| Rectal cancer | ||||||||
| Men | ||||||||
| Cases, n | 50 | 55 | 51 | 49 | 36 | |||
| Age-adjusted | 1.00 (ref) | 1.11 (0.75, 1.64) | 0.84 (0.56, 1.24) | 0.75 (0.50, 1.11) | 0.58 (0.37, 0.89) | 0.0007 | ||
| MV-adjusted5 | 1.00 (ref) | 1.13 (0.76, 1.67) | 0.87 (0.58, 1.30) | 0.79 (0.52, 1.20) | 0.62 (0.39, 0.99) | 0.008 | ||
| Women | ||||||||
| Cases, n | 70 | 66 | 67 | 54 | 67 | |||
| Age-adjusted | 1.00 (ref) | 0.79 (0.56, 1.11) | 0.77 (0.55, 1.08) | 0.62 (0.43, 0.88) | 0.80 (0.57, 1.13) | 0.08 | ||
| MV-adjusted6 | 1.00 (ref) | 0.81 (0.58, 1.14) | 0.82 (0.58, 1.16) | 0.66 (0.45, 0.97) | 0.88 (0.60, 1.29) | 0.28 | ||
| Pooled | ||||||||
| Cases, n | 120 | 121 | 118 | 103 | 103 | |||
| MV-adjusted7 | 1.00 (ref) | 0.94 (0.68, 1.30) | 0.84 (0.64, 1.09) | 0.72 (0.54, 0.95) | 0.76 (0.54, 1.07) | 0.02 | 0.25 | |
1Values are HRs (95% CIs) unless otherwise indicated. AMED, Alternative Mediterranean Diet; CRC, colorectal cancer; HPFS, Health Professionals Follow-up Study; MET, metabolic equivalent of task; MV, multivariable; NHS, Nurses' Health Study; NSAID, nonsteroidal anti-inflammatory drug; Q, quintile.
2 P-value for the continuous AMED score determined using the Wald test.
3 P-value for the likelihood ratio test comparing the model with cubic splines to the model without splines. If missing, no spline variables were selected from the stepwise procedure, and the relation between the dietary index and the CRC endpoint is assumed to be linear.
4 P-value for between-studies heterogeneity for continuous AMED score determined using the Q statistic.
5Adjusted for total energy intake (kcal/d, quintiles), alcohol intake (g/d, quintiles), physical activity (MET-hours/wk, quintiles), NSAID use [≥2 NSAIDs/wk vs. <2 NSAIDs/wk (ref)], family history of CRC [yes vs. no (ref)], previous CRC screening via colonoscopy or sigmoidoscopy [yes vs. no (ref)], history of polyps [yes vs. no (ref)], smoking [never smoker (ref), 0–<10, 10–<20, 20–<30, 30–<40, 40–<50, ≥50 pack-years], multivitamin use [regular use vs. nonuse (ref)], supplemental calcium intake [none (ref), >0–200, >200–400, >400–600, >600 mg/d], and young adult BMI [in kg/m2; <25 (ref), 25–<27.5, 27.5–<30, ≥30].
6Adjusted for the same multivariable models as in men + menopausal status [postmenopausal vs. not (ref)] and postmenopausal hormone use [never use (ref), past use, current use].
7Pooled HRs and 95% CIs were estimated by pooling the cohort-specific HRs using a random effects model.