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. 2020 Nov 2;113(5):543–552. doi: 10.1093/jnci/djaa164

Table 3.

Diet quality and risk of early-onset (aged younger than 50 years) adenoma according to malignant potential, NHSII, 1991-2011a

Quintile
 P trend d
Diet quality 1 (lowest) 2 3 4 5 (highest)
Dietary pattern
 Western dietary pattern
  High-risk adenoma
   No. of cases 52 72 78 72 101
   Unadjusted OR (95% CI) 1 (Referent) 1.36 (0.95 to 1.94) 1.38 (0.97 to 1.96) 1.26 (0.88 to 1.80) 1.67 (1.19 to 2.34) .01
   Age-adjusted OR (95% CI)b 1 (Referent) 1.35 (0.95 to 1.94) 1.38 (0.97 to 1.97) 1.26 (0.88 to 1.80) 1.66 (1.19 to 2.33) .01
   Multivariable OR (95% CI)c 1 (Referent) 1.33 (0.93 to 1.91) 1.37 (0.96 to 1.97) 1.26 (0.88 to 1.82) 1.67 (1.18 to 2.37) .01
  Low-risk adenoma
   No. of cases 125 131 138 150 189
   Unadjusted OR (95% CI) 1 (Referent) 1.03 (0.80 to 1.32) 1.01 (0.79 to 1.30) 1.09 (0.86 to 1.38) 1.30 (1.03 to 1.63) .04
   Age-adjusted OR (95% CI)b 1 (Referent) 1.01 (0.78 to 1.29) 1.00 (0.78 to 1.28) 1.08 (0.85 to 1.38) 1.31 (1.04 to 1.65) .02
   Multivariable OR (95% CI)c 1 (Referent) 0.99 (0.77 to 1.28) 0.98 (0.76 to 1.26) 1.05 (0.81 to 1.35) 1.25 (0.97 to 1.59) .08
 Prudent dietary pattern
  High-risk adenoma
   No. of cases 103 81 73 61 57
   Unadjusted OR (95% CI) 1 (Referent) 0.88 (0.65 to 1.18) 0.85 (0.63 to 1.14) 0.74 (0.54 to 1.02) 0.73 (0.53 to 1.01) .045
   Age-adjusted OR (95% CI)b 1 (Referent) 0.86 (0.64 to 1.16) 0.82 (0.61 to 1.11) 0.72 (0.52 to 0.99) 0.70 (0.50 to 0.98) .03
   Multivariable OR (95% CI)c 1 (Referent) 0.84 (0.62 to 1.13) 0.80 (0.58 to 1.09) 0.70 (0.50 to 0.98) 0.69 (0.48 to 0.98) .03
  Low-risk adenoma
   No. of cases 179 172 135 128 119
   Unadjusted OR (95% CI) 1 (Referent) 1.07 (0.87 to 1.32) 0.90 (0.72 to 1.13) 0.90 (0.71 to 1.13) 0.87 (0.69 to 1.11) .16
   Age-adjusted OR (95% CI)b 1 (Referent) 1.05 (0.85 to 1.30) 0.87 (0.69 to 1.10) 0.87 (0.69 to 1.10) 0.86 (0.68 to 1.09) .13
   Multivariable OR (95% CI)c 1 (Referent) 1.07 (0.86 to 1.32) 0.90 (0.71 to 1.14) 0.91 (0.72 to 1.16) 0.91 (0.71 to 1.17) .36
Recommendation-based dietary index
 Dietary Approaches to Stop Hypertension
  High-risk adenoma
   No. of cases 97 77 83 59 59
   Unadjusted OR (95% CI) 1 (Referent) 0.84 (0.62 to 1.13) 0.90 (0.67 to 1.21) 0.70 (0.51 to 0.97) 0.71 (0.52 to 0.99) .02
   Age-adjusted OR (95% CI)b 1 (Referent) 0.81 (0.60 to 1.10) 0.85 (0.62 to 1.15) 0.65 (0.47 to 0.91) 0.65 (0.46 to 0.91) .006
   Multivariable OR (95% CI)c 1 (Referent) 0.81 (0.59 to 1.10) 0.85 (0.62 to 1.16) 0.65 (0.46 to 0.91) 0.65 (0.45 to 0.93) .009
  Low-risk adenoma
   No. of cases 160 177 133 132 131
   Unadjusted OR (95% CI) 1 (Referent) 1.17 (0.94 to 1.45) 0.87 (0.69 to 1.10) 0.96 (0.76 to 1.21) 0.96 (0.76 to 1.22) .44
   Age-adjusted OR (95% CI)b 1 (Referent) 1.15 (0.93 to 1.43) 0.84 (0.66 to 1.06) 0.92 (0.73 to 1.18) 0.94 (0.73 to 1.20) .29
   Multivariable OR (95% CI)c 1 (Referent) 1.18 (0.95 to 1.47) 0.88 (0.69 to 1.11) 0.98 (0.77 to 1.26) 1.01 (0.78 to 1.31) .69
Alternative Mediterranean Diet
  High-risk adenoma
   No. of cases 103 72 74 72 54
   Unadjusted OR (95% CI) 1 (Referent) 0.77 (0.57 to 1.04) 0.79 (0.58 to 1.06) 0.85 (0.63 to 1.16) 0.63 (0.45 to 0.88) .03
   Age-adjusted OR (95% CI)b 1 (Referent) 0.74 (0.54 to 1.00) 0.74 (0.54 to 1.00) 0.77 (0.56 to 1.06) 0.55 (0.38 to 0.78) .005
   Multivariable OR (95% CI)c 1 (Referent) 0.74 (0.54 to 1.01) 0.73 (0.53 to 1.00) 0.76 (0.55 to 1.06) 0.55 (0.38 to 0.79) .007
  Low-risk adenoma
   No. of cases 175 158 136 129 135
   Unadjusted OR (95% CI) 1 (Referent) 0.99 (0.80 to 1.23) 0.85 (0.68 to 1.07) 0.90 (0.72 to 1.13) 0.93 (0.74 to 1.16) .76
   Age-adjusted OR (95% CI)b 1 (Referent) 0.97 (0.78 to 1.20) 0.83 (0.66 to 1.04) 0.87 (0.68 to 1.10) 0.91 (0.71 to 1.16) .39
   Multivariable OR (95% CI)c 1 (Referent) 1.00 (0.81 to 1.25) 0.87 (0.69 to 1.10) 0.93 (0.73 to 1.19) 1.00 (0.77 to 1.29) .91
Alternative Healthy Eating Index-2010
  High-risk adenoma
   No. of cases 103 86 73 54 59
   Unadjusted OR (95% CI) 1 (Referent) 0.90 (0.67 to 1.20) 0.82 (0.61 to 1.12) 0.64 (0.46 to 0.90) 0.76 (0.55 to 1.04) .02
   Age-adjusted OR (95% CI)b 1 (Referent) 0.89 (0.66 to 1.18) 0.81 (0.60 to 1.10) 0.63 (0.45 to 0.88) 0.74 (0.53 to 1.03) .01
   Multivariable OR (95% CI)c 1 (Referent) 0.87 (0.65 to 1.16) 0.79 (0.58 to 1.07) 0.61 (0.43 to 0.87) 0.71 (0.51 to 1.01) .01
  Low-risk adenoma
   No. of cases 172 147 163 135 116
   Unadjusted OR (95% CI) 1 (Referent) 0.92 (0.73 to 1.15) 1.10 (0.89 to 1.37) 0.96 (0.77 to 1.21) 0.89 (0.70 to 1.13) .52
   Age-adjusted OR (95% CI)b 1 (Referent) 0.90 (0.72 to 1.12) 1.09 (0.87 to 1.35) 0.94 (0.75 to 1.19) 0.88 (0.69 to 1.12) .51
   Multivariable OR (95% CI)c 1 (Referent) 0.92 (0.73 to 1.15) 1.13 (0.90 to 1.41) 1.01 (0.79 to 1.28) 0.95 (0.74 to 1.23) .90
a

High-risk adenoma includes adenoma at or greater than 1 cm, or with tubulovillous or villous histology or high-grade dysplasia, or 3 or more adenomas.CI = confidence interval; NHSII = Nurses’ Health Study II; OR = odds ratio.

b

Adjusted for age (continuous), total caloric intake (in quintiles), time period of endoscopy (in 2-year intervals), number of reported endoscopies (continuous), time in years since the most recent endoscopy (continuous), and reason for the current endoscopy (screening, symptoms, missing).

c

Additionally adjusted for height (continuous), body mass index (in quintiles), family history of colorectal cancer (yes, no), menopausal status (premenopausal, postmenopausal), menopausal hormone use (never, past, current use of menopausal hormones), personal history of type 2 diabetes (yes, no), pack-years of smoking (never, 1-4.9, 5-19.9, 20-39.9, ≥40 pack-years), physical activity (in metabolic equivalent of task-hours per week, quintiles), current use of multivitamin (yes, no), regular use of aspirin (yes, no), and regular use of nonsteroidal anti-inflammatory drugs (yes, no). For Dietary Approaches to Stop Hypertension, we additionally adjusted for alcohol intake (0, 0.1-14.9, ≥15 g/d).

d

Calculated using the median of each quintile as a continuous variable.