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 |
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.
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).
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).
Calculated using the median of each quartile as a continuous variable.