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

Table 4.

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

Quartile
P trend d
Diet quality 1 (lowest) 2 3 4 (highest)
Dietary pattern
 Western dietary pattern
  Proximal
   No. of cases 22 22 24 25
   Unadjusted OR (95% CI) 1 (Referent) 0.96 (0.53 to 1.73) 1.00 (0.56 to 1.78) 0.98 (0.55 to 1.75) .90
   Age-adjusted OR (95% CI)b 1 (Referent) 0.93 (0.51 to 1.69) 0.97 (0.55 to 1.73) 0.97 (0.55 to 1.73) .91
   Multivariable OR (95% CI)c 1 (Referent) 0.93 (0.50 to 1.71) 0.96 (0.53 to 1.75) 0.96 (0.52 to 1.78) .88
  Distal and rectal
   No. of cases 48 65 68 90
   Unadjusted OR (95% CI) 1 (Referent) 1.30 (0.89 to 1.88) 1.30 (0.89 to 1.88) 1.62 (1.14 to 2.31) .01
   Age-adjusted OR (95% CI)b 1 (Referent) 1.31 (0.90 to 1.90) 1.33 (0.91 to 1.93) 1.61 (1.13 to 2.30) .01
   Multivariable OR (95% CI)c 1 (Referent) 1.30 (0.89 to 1.91) 1.34 (0.91 to 1.97) 1.65 (1.14 to 2.38) .01
 Prudent dietary pattern
  Proximal
   No. of cases 25 25 21 22
   Unadjusted OR (95% CI) 1 (Referent) 1.14 (0.65 to 1.98) 1.02 (0.57 to 1.82) 1.13 (0.64 to 2.01) .70
   Age-adjusted OR (95% CI)b 1 (Referent) 1.09 (0.62 to 1.91) 0.97 (0.54 to 1.75) 1.10 (0.62 to 1.95) .79
   Multivariable OR (95% CI)c 1 (Referent) 1.10 (0.62 to 1.95) 1.00 (0.55 to 1.82) 1.14 (0.61 to 2.11) .71
  Distal and rectal
   No. of cases 91 73 56 51
   Unadjusted OR (95% CI) 1 (Referent) 0.91 (0.67 to 1.24) 0.75 (0.53 to 1.04) 0.72 (0.51 to 1.02) .049
   Age-adjusted OR (95% CI)b 1 (Referent) 0.91 (0.67 to 1.23) 0.73 (0.52 to 1.02) 0.70 (0.49 to 0.99) .03
   Multivariable OR (95% CI)c 1 (Referent) 0.89 (0.65 to 1.21) 0.71 (0.50 to 1.01) 0.68 (0.47 to 0.99) .04
Recommendation-based dietary index
 Dietary Approaches to Stop Hypertension
  Proximal
   No. of cases 33 16 18 26
   Unadjusted OR (95% CI) 1 (Referent) 0.52 (0.29 to 0.95) 0.58 (0.33 to 1.03) 0.92 (0.55 to 1.54) .83
   Age-adjusted OR (95% CI)b 1 (Referent) 0.51 (0.28 to 0.95) 0.58 (0.32 to 1.05) 0.92 (0.54 to 1.58) .81
   Multivariable OR (95% CI)c 1 (Referent) 0.52 (0.28 to 0.95) 0.59 (0.32 to 1.08) 0.93 (0.53 to 1.65) .85
  Distal and rectal
   No. of cases 78 84 61 48
   Unadjusted OR (95% CI) 1 (Referent) 1.16 (0.85 to 1.58) 0.83 (0.60 to 1.17) 0.72 (0.50 to 1.03) .04
   Age-adjusted OR (95% CI)b 1 (Referent) 1.10 (0.80 to 1.51) 0.77 (0.54 to 1.09) 0.63 (0.43 to 0.93) .007
   Multivariable OR (95% CI)c 1 (Referent) 1.10 (0.80 to 1.52) 0.77 (0.54 to 1.09) 0.63 (0.42 to 0.94) .01
 Alternative Mediterranean Diet
  Proximal
   No. of cases 30 18 20 25
   Unadjusted OR (95% CI) 1 (Referent) 0.61 (0.34 to 1.10) 0.73 (0.41 to 1.29) 0.94 (0.55 to 1.60) .84
   Age-adjusted OR (95% CI)b 1 (Referent) 0.62 (0.34 to 1.13) 0.74 (0.41 to 1.34) 0.94 (0.53 to 1.67) .94
   Multivariable OR (95% CI)c 1 (Referent) 0.64 (0.34 to 1.17) 0.76 (0.42 to 1.37) 0.97 (0.54 to 1.76) .86
  Distal and rectal
   No. of cases 80 66 70 55
   Unadjusted OR (95% CI) 1 (Referent) 0.84 (0.61 to 1.17) 0.96 (0.70 to 1.33) 0.78 (0.55 to 1.10) .34
   Age-adjusted OR (95% CI)b 1 (Referent) 0.80 (0.57 to 1.11) 0.87 (0.62 to 1.22) 0.67 (0.46 to 0.97) .11
   Multivariable OR (95% CI)c 1 (Referent) 0.80 (0.57 to 1.13) 0.86 (0.61 to 1.23) 0.67 (0.45 to 0.99) .14
 Alternative Healthy Eating Index-2010
  Proximal
   No. of cases 30 19 24 20
   Unadjusted OR (95% CI) 1 (Referent) 0.69 (0.39 to 1.23) 0.95 (0.55 to 1.62) 0.86 (0.49 to 1.52) .93
   Age-adjusted OR (95% CI)b 1 (Referent) 0.67 (0.38 to 1.19) 0.90 (0.52 to 1.58) 0.82 (0.46 to 1.45) .64
   Multivariable OR (95% CI)c 1 (Referent) 0.67 (0.37 to 1.20) 0.91 (0.52 to 1.61) 0.83 (0.47 to 1.49) .69
  Distal and rectal
   No. of cases 91 77 51 52
   Unadjusted OR (95% CI) 1 (Referent) 0.93 (0.68 to 1.26) 0.66 (0.47 to 0.94) 0.74 (0.52 to 1.04) .01
   Age-adjusted OR (95% CI)b 1 (Referent) 0.93 (0.69 to 1.26) 0.66 (0.47 to 0.94) 0.74 (0.52 to 1.05) .02
   Multivariable OR (95% CI)c 1 (Referent) 0.91 (0.67 to 1.24) 0.64 (0.44 to 0.92) 0.71 (0.49 to 1.03) .02
a

Advanced adenoma includes adenoma at or greater than 1 cm, or with tubulovillous or villous histology or high-grade dysplasia. 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), pack-years of smoking (never, 1-20, ≥20 pack-years), physical activity (in metabolic equivalent of task-hours/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 quartile as a continuous variable.