Table 3.
Relative risks (RR) and 95% confidence intervals (CI) for the association between cumulative average energy-adjusted dietary fat and cholesterol intake and ovarian cancer risk by cohort and menopausal status (NHS/NHSII)
| Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | p-trend | p-het* | |
|---|---|---|---|---|---|---|
| Total fat | ||||||
| Range (g/day) | <53 | 53-<59 | 59-<66 | ≥66 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 13/60,805 | 27/82,098 | 18/88,407 | 24/80,465 | ||
| RR (95%CI) | 1 (Ref) | 1.53(0.78,2.99) | 0.97(0.47,2.00) | 1.41(0.69,2.87) | 0.6 | 0.24 |
| RR (95%CI) + fiber | 1 (Ref) | 1.68(0.84,3.35) | 1.11(0.52,2.38) | 1.76(0.81,3.80) | 0.30 | 0.28 |
| NHS2 | ||||||
| Cases/PY | 31/223,766 | 34/255,139 | 38/307,647 | 43/415,310 | ||
| RR (95%CI) | 1 (Ref) | 0.95(0.58,1.56) | 0.88(0.54,1.44) | 0.72(0.44,1.18) | 0.17 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.97(0.59,1.60) | 0.91(0.54,1.52) | 0.75(0.44,1.30) | 0.27 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 219/406,986 | 176/338,912 | 145/259,337 | 78/153,217 | ||
| RR (95%CI) | 1 (Ref) | 1.02(0.83,1.25) | 1.15(0.92,1.44) | 1.11(0.84,1.47) | 0.27 | 0.11 |
| RR (95%CI) + fiber | 1 (Ref) | 1.05(0.85,1.30) | 1.22(0.96,1.54) | 1.19(0.88,1.61) | 0.13 | 0.12 |
| NHS2 | ||||||
| Cases/PY | 7/36,389 | 16/48,214 | 15/61,242 | 12/81,006 | ||
| RR (95%CI) | 1 (Ref) | 1.44(0.58,3.57) | 1.00(0.39,2.55) | 0.57(0.21,1.55) | 0.09 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.67(0.66,4.20) | 1.30(0.49,3.48) | 0.81(0.28,2.39) | 0.40 | |
| Animal fat | ||||||
| Range (g/day) | <27 | 27-<32 | 32-<37 | ≥37 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 13/51,780 | 19/75,405 | 22/90,331 | 28/94,258 | ||
| RR (95%CI) | 1 (Ref) | 0.94(0.45,1.94) | 1.04(0.51,2.11) | 1.21(0.60,2.45) | 0.48 | 0.25 |
| RR (95%CI) + fiber | 1 (Ref) | 1.06(0.50,2.22) | 1.25(0.59,2.64) | 1.56(0.72,3.42) | 0.20 | 0.29 |
| NHS2 | ||||||
| Cases/PY | 36/229,030 | 29/261,550 | 40/316,030 | 41/395,253 | ||
| RR (95%CI) | 1 (Ref) | 0.72(0.44,1.19) | 0.86(0.54,1.36) | 0.71(0.44,1.15) | 0.26 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.74(0.44,1.24) | 0.89(0.54,1.46) | 0.75(0.44,1.30) | 0.44 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 201/382,689 | 174/327,001 | 138/261,279 | 105/187,484 | ||
| RR (95%CI) | 1 (Ref) | 1.10(0.89,1.35) | 1.16(0.92,1.46) | 1.38(1.07,1.79) | 0.02 | 0.12 |
| RR (95%CI) + fiber | 1 (Ref) | 1.16(0.94,1.45) | 1.27(0.99,1.62) | 1.57(1.17,2.09) | <0.01 | 0.14 |
| NHS2 | ||||||
| Cases/PY | 17/57,559 | 12/58,194 | 12/57,219 | 9/53,878 | ||
| RR (95%CI) | 1 (Ref) | 0.55(0.26,1.20) | 0.63(0.29,1.37) | 0.51(0.21,1.21) | 0.15 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.68(0.30,1.54) | 0.84(0.36,1.97) | 0.76(0.28,2.05) | 0.68 | |
| Vegetable fat | ||||||
| Range (g/day) | <22 | 22-<27 | 27-<31 | ≥31 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 26/93,485 | 23/79,476 | 13/74,614 | 20/64,199 | ||
| RR (95%CI) | 1 (Ref) | 1.08(0.61,1.94) | 0.66(0.33,1.31) | 1.24(0.66,2.33) | 0.81 | 0.89 |
| RR (95%CI) + fiber | 1 (Ref) | 1.11(0.62,1.99) | 0.7(0.35,1.40) | 1.36(0.72,2.61) | 0.58 | 0.91 |
| NHS2 | ||||||
| Cases/PY | 22/263,597 | 41/286,486 | 42/308,069 | 41/343,711 | ||
| RR (95%CI) | 1 (Ref) | 1.67(0.99,2.82) | 1.51(0.89,2.57) | 1.25(0.72,2.17) | 0.82 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.67(0.99,2.83) | 1.51(0.89,2.58) | 1.25(0.72,2.18) | 0.81 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 175/349,834 | 179/318,780 | 147/277,945 | 117/211,893 | ||
| RR (95%CI) | 1 (Ref) | 1.09(0.88,1.35) | 1.01(0.80,1.27) | 1.09(0.85,1.41) | 0.61 | 0.14 |
| RR (95%CI) + fiber | 1 (Ref) | 1.11(0.89,1.37) | 1.04(0.83,1.32) | 1.15(0.89,1.49) | 0.38 | 0.12 |
| NHS2 | ||||||
| Cases/PY | 7/26,087 | 6/43,274 | 20/62,163 | 17/95,327 | ||
| RR (95%CI) | 1 (Ref) | 0.41(0.13,1.23) | 0.84(0.34,2.07) | 0.38(0.15,0.98) | 0.09 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.44(0.14,1.35) | 0.94(0.38,2.34) | 0.45(0.17,1.17) | 0.17 | |
| Saturated fat | ||||||
| Range (g/day) | <18 | 18-<20 | 20-<23 | ≥23 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 9/49,879 | 21/75,745 | 27/92,705 | 25/93,445 | ||
| RR (95%CI) | 1 (Ref) | 1.71(0.73,3.98) | 2.21(0.89,5.49) | 2.14(0.73,6.31) | 0.22 | 0.38 |
| RR (95%CI) + fiber | 1 (Ref) | 1.84(0.78,4.34) | 2.45(0.97,6.18) | 2.43(0.82,7.23) | 0.16 | 0.41 |
| NHS2 | ||||||
| Cases/PY | 40/220,588 | 17/259,343 | 43/317,581 | 46/404,351 | ||
| RR (95%CI) | 1 (Ref) | 0.38(0.21,0.70) | 0.90(0.53,1.53) | 0.81(0.42,1.55) | 0.91 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.39(0.21,0.71) | 0.91(0.53,1.57) | 0.83(0.42,1.61) | 0.85 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 221/405,019 | 177/332,568 | 137/254,004 | 83/166,861 | ||
| RR (95%CI) | 1 (Ref) | 1.10(0.88,1.38) | 1.21(0.92,1.58) | 1.24(0.88,1.76) | 0.17 | 0.17 |
| RR (95%CI) + fiber | 1 (Ref) | 1.13(0.90,1.42) | 1.25(0.95,1.64) | 1.30(0.91,1.85) | 0.11 | 0.19 |
| NHS2 | ||||||
| Cases/PY | 12/49,524 | 17/55,558 | 10/59,531 | 11/62,239 | ||
| RR (95%CI) | 1 (Ref) | 1.13(0.49,2.63) | 0.67(0.24,1.85) | 0.70(0.22,2.30) | 0.39 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.37(0.58,3.21) | 0.82(0.30,2.29) | 0.97(0.29,3.18) | 0.71 | |
| Monounsaturated fat | ||||||
| Range (g/day) | <19.7 | 19.7-<22.5 | 22.5-<25.4 | ≥25.4 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 19/73,443 | 18/88,611 | 27/88,122 | 18/61,597 | ||
| RR (95%CI) | 1 (Ref) | 0.73(0.35,1.53) | 1.23(0.54,2.81) | 1.09(0.36,3.28) | 0.67 | 0.14 |
| RR (95%CI) + fiber | 1 (Ref) | 0.76(0.36,1.59) | 1.29(0.57,2.95) | 1.14(0.38,3.38) | 0.62 | 0.15 |
| NHS2 | ||||||
| Cases/PY | 26/216,921 | 39/247,670 | 39/311,742 | 42/425,530 | ||
| RR (95%CI) | 1 (Ref) | 1.29(0.75,2.23) | 1.05(0.56,1.95) | 0.77(0.35,1.68) | 0.32 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.29(0.75,2.23) | 1.05(0.56,1.96) | 0.78(0.36,1.69) | 0.32 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 220/403,683 | 170/343,316 | 152/262,826 | 76/148,627 | ||
| RR (95%CI) | 1 (Ref) | 0.92(0.73,1.16) | 1.10(0.82,1.46) | 0.97(0.66,1.42) | 0.88 | 0.06 |
| RR (95%CI) + fiber | 1 (Ref) | 0.92(0.73,1.17) | 1.10(0.83,1.47) | 0.97(0.66,1.43) | 0.86 | 0.07 |
| NHS2 | ||||||
| Cases/PY | 9/33,130 | 13/45,113 | 14/60,660 | 14/87,948 | ||
| RR (95%CI) | 1 (Ref) | 0.91(0.36,2.30) | 0.63(0.22,1.78) | 0.42(0.12,1.52) | 0.14 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.12(0.43,2.91) | 0.81(0.28,2.36) | 0.58(0.16,2.10) | 0.29 | |
| Polyunsaturated fat | ||||||
| Range (g/day) | <9.4 | 9.4-<10.7 | 10.7-<12.3 | ≥12.3 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 17/69,607 | 16/68,916 | 19/75,794 | 30/97,457 | ||
| RR (95%CI) | 1 (Ref) | 0.92(0.45,1.91) | 1.14(0.56,2.33) | 1.42(0.68,2.98) | 0.25 | 0.23 |
| RR (95%CI) + fiber | 1 (Ref) | 0.89(0.43,1.84) | 1.08(0.53,2.21) | 1.31(0.62,2.76) | 0.36 | 0.23 |
| NHS2 | ||||||
| Cases/PY | 31/296,975 | 42/304,560 | 43/298,161 | 30/302,167 | ||
| RR (95%CI) | 1 (Ref) | 1.30(0.80,2.11) | 1.34(0.80,2.23) | 0.91(0.50,1.66) | 0.63 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.29(0.79,2.11) | 1.33(0.79,2.23) | 0.90(0.49,1.66) | 0.61 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 157/331,358 | 178/301,563 | 147/279,239 | 136/246,291 | ||
| RR (95%CI) | 1 (Ref) | 1.25(0.99,1.56) | 1.12(0.87,1.44) | 1.25(0.94,1.66) | 0.23 | 0.04 |
| RR (95%CI) + fiber | 1 (Ref) | 1.24(0.98,1.55) | 1.11(0.86,1.43) | 1.23(0.92,1.63) | 0.29 | 0.04 |
| NHS2 | ||||||
| Cases/PY | 7/34,041 | 11/51,398 | 23/65,796 | 9/75,617 | ||
| RR (95%CI) | 1 (Ref) | 1.06(0.40,2.86) | 1.56(0.60,4.03) | 0.55(0.17,1.74) | 0.23 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.98(0.37,2.64) | 1.31(0.50,3.42) | 0.39(0.12,1.27) | 0.07 | |
| Trans fat | ||||||
| Range (g/day) | <2.1 | 2.1-<2.6 | 2.6-<3.3 | ≥3.3 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 12/46,221 | 18/65,131 | 25/87,844 | 27/112,578 | ||
| RR (95%CI) | 1 (Ref) | 1.05(0.49,2.25) | 1.04(0.48,2.22) | 0.79(0.34,1.82) | 0.44 | 0.49 |
| RR (95%CI) + fiber | 1 (Ref) | 1.12(0.52,2.42) | 1.14(0.52,2.47) | 0.89(0.38,2.09) | 0.62 | 0.51 |
| NHS2 | ||||||
| Cases/PY | 43/241,641 | 33/270,738 | 33/305,277 | 37/384,207 | ||
| RR (95%CI) | 1 (Ref) | 0.74(0.46,1.19) | 0.64(0.38,1.07) | 0.64(0.36,1.13) | 0.14 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.74(0.45,1.20) | 0.64(0.38,1.08) | 0.63(0.35,1.14) | 0.15 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 209/359,941 | 186/319,710 | 136/279,756 | 87/199,043 | ||
| RR (95%CI) | 1 (Ref) | 0.97(0.78,1.20) | 0.84(0.66,1.08) | 0.80(0.58,1.08) | 0.09 | 0.36 |
| RR (95%CI) + fiber | 1 (Ref) | 0.99(0.80,1.23) | 0.86(0.67,1.11) | 0.83(0.60,1.13) | 0.17 | 0.34 |
| NHS2 | ||||||
| Cases/PY | 14/68,940 | 19/62,463 | 6/56,643 | 11/38,805 | ||
| RR (95%CI) | 1 (Ref) | 1.69(0.78,3.68) | 0.69(0.23,2.07) | 2.07(0.73,5.86) | 0.35 | |
| RR (95%CI) + fiber | 1 (Ref) | 2.15(0.96,4.79) | 1(0.32,3.09) | 3.24(1.08,9.73) | 0.09 | |
| Cholesterol | ||||||
| Range (g/day) | <196 | 196-<230 | 230-<270 | ≥270 | ||
| Premenopausal | ||||||
| NHS | ||||||
| Cases/PY | 18/47,014 | 18/61,449 | 11/78,904 | 35/124,407 | ||
| RR (95%CI) | 1 (Ref) | 0.73(0.37,1.43) | 0.37(0.17,0.80) | 0.73(0.40,1.33) | 0.43 | 0.64 |
| RR (95%CI) + fiber | 1 (Ref) | 0.75(0.38,1.50) | 0.39(0.18,0.85) | 0.78(0.42,1.45) | 0.58 | 0.59 |
| NHS2 | ||||||
| Cases/PY | 40/297,569 | 34/307,521 | 37/306,972 | 35/289,801 | ||
| RR (95%CI) | 1 (Ref) | 0.83(0.52,1.32) | 0.85(0.54,1.34) | 0.82(0.51,1.32) | 0.46 | |
| RR (95%CI) + fiber | 1 (Ref) | 0.85(0.53,1.36) | 0.88(0.55,1.40) | 0.86(0.53,1.41) | 0.61 | |
| Postmenopausal | ||||||
| NHS | ||||||
| Cases/PY | 174/318,224 | 151/293,880 | 130/280,891 | 163/265,457 | ||
| RR (95%CI) | 1 (Ref) | 0.98(0.78,1.22) | 0.93(0.74,1.18) | 1.36(1.08,1.71) | 0.02 | 0.72 |
| RR (95%CI) + fiber | 1 (Ref) | 1.00(0.80,1.25) | 0.96(0.76,1.22) | 1.41(1.11,1.79) | 0.01 | 0.76 |
| NHS2 | ||||||
| Cases/PY | 14/59,368 | 12/60,808 | 13/58,161 | 11/48,515 | ||
| RR (95%CI) | 1 (Ref) | 0.84(0.38,1.83) | 0.98(0.45,2.15) | 1.04(0.46,2.39) | 0.85 | |
| RR (95%CI) + fiber | 1 (Ref) | 1.00(0.45,2.25) | 1.24(0.55,2.82) | 1.43(0.59,3.45) | 0.37 |
*
p-het=p-for-heterogeneity by cohort (NHS, NHSII)
PY=person-years
Models adjusted for age (continuous), calendar year (continuous), total caloric intake (continuous), family history of ovarian cancer (no, yes), age at menarche (continuous), tubal ligation (no, yes), hysterectomy (no, yes, unknown), unilateral oophorectomy (no, yes, unknown), BMI (kg/m2, continuous), nulliparity (no, yes), parity (continuous), oral contraceptive use (never, <1, 1–5, 5+yrs), smoking (pack-years, continuous), menopausal status (premenopausal, postmenopausal), estrogen only HT use (never, past <5 years, past 5+ years, current <5 years, current 5+ years), estrogen + progestin HT use (never, past <5 years, past 5+ years, current <5 years, current 5+ years), other HT use (never, past <5 years, past 5+ years, current <5 years, current 5+ years), lactose intake (g/day, continuous), caffeine intake (mg/day, continuous), fiber intake (g/day, continuous), and physical activity (METs/week: 0–3.8, >3.8–11.1, >11.1–26.4, >26.4, unknown). Vegetable fat and animal fat were mutually adjusted for each other. Saturated fat, polyunsaturated fat, monounsaturated fat, and trans-unsaturated fat were mutually adjusted for each other.