Healthy Eating Index 2005 and Risk for Pancreatic Cancer in the NIH–AARP Study
JNCI: Journal of the National Cancer Institute ,
Sep 2013
Arem, Hannah , Reedy, Jill , Sampson, Josh , Jiao, Li , Hollenbeck, Albert R. , Risch, Harvey , Mayne, Susan T. , Stolzenberg-Solomon, Rachael Z.
Healthy Eating Index 2005 and Risk for Pancreatic Cancer in the NIH–AARP Study
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t he Healthy eating index 2005 and r isk for Pancreatic c ancer in the NiH-AAr P Study
Hannah Arem
Jill Reedy
Josh Sampson
Li Jiao
Albert R. Hollenbeck
Harvey Risch
Susan T. Mayne
Rachael Z. Stolzenberg-Solomon
Background Dietary pattern analyses characterizing combinations of food intakes offer conceptual and statistical advantages over food- and nutrient-based analyses of disease risk. However, few studies have examined dietary patterns and pancreatic cancer risk and none focused on the 2005 Dietary Guidelines for Americans. We used the Healthy Eating Index 2005 (HEI-2005) to estimate the association between meeting those dietary guidelines and pancreatic cancer risk. We calculated the HEI-2005 score for 537 218 men and women in the National Institutes of Health-American Association of Retired Persons Diet and Health Study using responses to food frequency questionnaires returned in 1995 and 1996. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of pancreatic cancer according to HEI-2005 quintiles and explored effect modification by known risk factors. Pinteraction values were calculated using the Wald test. All statistical tests were two-sided. We identified 2383 incident, exocrine pancreatic cancer cases (median = 10.5 years follow-up). Comparing participants who met the most dietary guidelines (Q5) with those who met the fewest guidelines (Q1), we observed a reduced risk of pancreatic cancer (HR = 0.85, 95% CI = 0.74 to 0.97). Among men there was an interaction by body mass index (Pinteraction = .03), with a hazard ratio of 0.72 (95% CI = 0.59 to 0.88) comparing Q5 vs Q1 in overweight/ obese men (body mass index ≥25 kg/m2) but no association among normal weight men.
Methods
Results
Conclusions
Our findings support the hypothesis that consuming a high-quality diet, as scored by the HEI-2005, may reduce
the risk of pancreatic cancer.
J Natl Cancer Inst;2013;105:1298–1305
Pancreatic cancer is one of the most rapidly fatal cancers and is
the fourth leading cause of cancer death in the United States (
1,2
).
Although most food- and nutrient-based analyses have shown
weak or no associations with pancreatic cancer (
3,4
), dietary
pattern analysis may better predict disease risk than individual food or
nutrient intakes for several reasons. First, high correlation between
nutrients may be difficult to unravel statistically (5). Second, there
may be biologic interaction or synergy between different nutrients
and/or dietary constituents/components that is not captured when
assessing single foods or nutrients (
6
). Third, diet-related
associations with disease may be easier to detect when comparing overall
diets of poor or high quality rather than intake of an isolated food
or nutrient (
6,7
).
The few studies on dietary patterns and pancreatic cancer risk
have shown inconsistent results (
8–13
) and used different statistical
methods that reflect distinct research questions. All but one of
the previous studies examined data-driven, study-specific dietary
patterns, preventing comparison between studies. A priori patterns,
on the other hand, may be compared between studies because they
are characterized based on disease-specific biologic rationale or
public health guidance. One such a priori pattern is the Dietary
Guidelines for Americans 2005 (14), which can be measured using
the Healthy Eating Index 2005 (HEI-2005). These guidelines were
the basis of federal nutrition policy and nutrition education activities
from 2005 to 2010. Thus, associations between this dietary pattern
and disease risk have nationally relevant public health implications.
To our knowledge, no previous studies have assessed the
HEI2005 and pancreatic cancer risk. Also, most previous dietary pattern
and pancreatic cancer studies lack sufficient case subjects to fully
explore effect modification. Given these identified gaps in the
literature, we tested the association between the HEI-2005 score and
pancreatic cancer risk in the large, prospective National Institutes
of Health (NIH)–AARP (formerly known as the American
Association of Retired Persons) Diet and Health Study cohort.
Methods
Study Population
The NIH–AARP Diet and Health Study has been described
previously (
15
). Men and women aged 50 to 71 years who were AARP
members were recruited by mailed questionnaire returned in the
period from 1995 to 1996. All participants were residents in one
of six US states (California, Florida, Louisiana, New Jersey, North
Carolina, or Pennsylvania) or two metropolitan areas (Atlanta,
Georgia, or Detroit, Michigan) at baseline. Of the 566 399
participants who satisfactorily completed the baseline questionnaire,
we excluded those whose questionnaires were completed by proxy
(n = 15 760), those with any prevalent registry-confirmed cancer
(except for nonmelanoma skin cancer) a (...truncated)
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Arem, Hannah, Reedy, Jill, Sampson, Josh, Jiao, Li, Hollenbeck, Albert R., Risch, Harvey, Mayne, Susan T., Stolzenberg-Solomon, Rachael Z..
Healthy Eating Index 2005 and Risk for Pancreatic Cancer in the NIH–AARP Study ,
JNCI: Journal of the National Cancer Institute,
2013, pp. 1298-1305, Volume 105, Issue 17, DOI: 10.1093/jnci/djt185