Association Between Pre-diagnosis and Post-diagnosis Alternate Mediterranean Diet and Ovarian Cancer Survival: Evidence from a Prospective Cohort Study

Overview

Journal J Transl Med

Publisher Biomed Central

Specialties Biomedical Engineering
General Medicine

Date 2024 Sep 28

PMID 39334418

Authors

Yu-Han Chen

Rui-Han Bao

Jia-Cheng Liu

Jia-Xin Liu

Jia-Nan Sun

Lang Wu

Dong-Hui Huang

Xiao-Ying Li

Qian Xiao

Sha Ni

Meng Luan

Qi-Jun Wu

Ting-Ting Gong

Affiliations

Soon will be listed here.

Abstract

Background: There is currently a lack of comprehensive evidence regarding the correlation between Alternate Mediterranean Diet (AMED) and the survival of patients with ovarian cancer (OC). This prospective cohort study first assessed the association of AMED, not only pre-diagnosis and post-diagnosis but also the change from pre-diagnosis to post-diagnosis with OC survival.

Methods: A total of 560 OC patients were included in the study, and their dietary intake was assessed using a reliable 111-item food frequency questionnaire. The overall survival (OS) of the patients was monitored through active follow-up and review of medical records until February 16th, 2023. Cox proportional hazard regression models were utilized to compute the hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs).

Results: Out of the total 560 patients with OC, 211 (37.68%) succumbed during a median follow-up period of 44.40 months (interquartile range: 26.97-61.37). Comparative analysis indicated a significant association between the highest tertiles of pre-diagnosis (HR = 0.59; 95% CI 0.38-0.90; P < 0.05) and post-diagnosis (HR = 0.61; 95% CI 0.41-0.91; P < 0.05) AMED intake and improved OS as opposed to the lowest tertile. Additionally, a significant linear trend was observed for AMED and OC survival. Notably, decreased intake (more than 5% change) and significantly increased intake (more than 15% change) of AMED from pre-diagnosis to post-diagnosis were linked to worse and better OS, respectively, when compared to the stable intake group (change within 5%). Furthermore, patients displaying consistently higher AMED intake both before and after diagnosis experienced enhanced OS in comparison to those with consistently low AMED intake (HR = 0.47; 95% CI 0.31-0.70).

Conclusion: High pre-diagnosis and post-diagnosis AMED was associated with an improved OS in patients with OC, suggesting that maintaining a consistently high intake of AMED could potentially benefit the prognosis of OC.

Citing Articles

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Disease-free survival of 15 years after primary surgery in a patient with advanced high-grade serous ovarian cancer: a case report and literature review.

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References

Achon M, Alonso-Aperte E, Reyes L, Ubeda N, Varela-Moreiras G . High-dose folic acid supplementation in rats: effects on gestation and the methionine cycle. Br J Nutr. 2000; 83(2):177-83. View

Sasamoto N, Wang T, Townsend M, Eliassen A, Tabung F, Giovannucci E . Pre-diagnosis and post-diagnosis dietary patterns and survival in women with ovarian cancer. Br J Cancer. 2022; 127(6):1097-1105. PMC: 9470575. DOI: 10.1038/s41416-022-01901-8. View

Fung T, McCullough M, Newby P, Manson J, Meigs J, Rifai N . Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005; 82(1):163-73. DOI: 10.1093/ajcn.82.1.163. View

Amir E, Seruga B, Kwong R, Tannock I, Ocana A . Poor correlation between progression-free and overall survival in modern clinical trials: are composite endpoints the answer?. Eur J Cancer. 2011; 48(3):385-8. DOI: 10.1016/j.ejca.2011.10.028. View

Haneuse S, VanderWeele T, Arterburn D . Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies. JAMA. 2019; 321(6):602-603. DOI: 10.1001/jama.2018.21554. View

Xu Z, Steffen L, Selvin E, Rebholz C . Diet quality, change in diet quality and risk of incident CVD and diabetes. Public Health Nutr. 2019; 23(2):329-338. PMC: 6992481. DOI: 10.1017/S136898001900212X. View

Plotti F, Terranova C, Luvero D, Bartolone M, Messina G, Feole L . Diet and Chemotherapy: The Effects of Fasting and Ketogenic Diet on Cancer Treatment. Chemotherapy. 2020; 65(3-4):77-84. DOI: 10.1159/000510839. View

Rahman I, Biswas S, Kirkham P . Regulation of inflammation and redox signaling by dietary polyphenols. Biochem Pharmacol. 2006; 72(11):1439-52. DOI: 10.1016/j.bcp.2006.07.004. View

Yao Z, Jia X, Chen Z, Zhang T, Li X, Zhang L . Dietary patterns, metabolomics and frailty in a large cohort of 120 000 participants. Food Funct. 2024; 15(6):3174-3185. DOI: 10.1039/d3fo03575a. View

10.

Park S, Kang M, Shvetsov Y, Setiawan V, Boushey C, Haiman C . Diet quality and all-cause and cancer-specific mortality in cancer survivors and non-cancer individuals: the Multiethnic Cohort Study. Eur J Nutr. 2021; 61(2):925-933. PMC: 8857026. DOI: 10.1007/s00394-021-02700-2. View

11.

Willett W, Howe G, Kushi L . Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997; 65(4 Suppl):1220S-1228S; discussion 1229S-1231S. DOI: 10.1093/ajcn/65.4.1220S. View

12.

Pitsavos C, Panagiotakos D, Tzima N, Chrysohoou C, Economou M, Zampelas A . Adherence to the Mediterranean diet is associated with total antioxidant capacity in healthy adults: the ATTICA study. Am J Clin Nutr. 2005; 82(3):694-9. DOI: 10.1093/ajcn.82.3.694. View

13.

Trichopoulou A, Kouris-Blazos A, Wahlqvist M, Gnardellis C, Lagiou P, Polychronopoulos E . Diet and overall survival in elderly people. BMJ. 1995; 311(7018):1457-60. PMC: 2543726. DOI: 10.1136/bmj.311.7018.1457. View

14.

Yiannakou I, Singer M, Jacques P, Xanthakis V, Ellison R, Moore L . Adherence to a Mediterranean-Style Dietary Pattern and Cancer Risk in a Prospective Cohort Study. Nutrients. 2021; 13(11). PMC: 8622098. DOI: 10.3390/nu13114064. View

15.

Wang Y, Fan H, Ren Z, Liu X, Niu X . Sleep disorder, Mediterranean diet, and all-cause and cause-specific mortality: a prospective cohort study. BMC Public Health. 2023; 23(1):904. PMC: 10193722. DOI: 10.1186/s12889-023-15870-x. View

16.

Shan Z, Li Y, Y Baden M, Bhupathiraju S, Wang D, Sun Q . Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Intern Med. 2020; 180(8):1090-1100. PMC: 7296454. DOI: 10.1001/jamainternmed.2020.2176. View

17.

Trichopoulou A, Costacou T, Bamia C, Trichopoulos D . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003; 348(26):2599-608. DOI: 10.1056/NEJMoa025039. View

18.

Xu H, Gong T, Liu F, Wei Y, Chen H, Yan S . Pre-diagnosis Dietary One-Carbon Metabolism Micronutrients Consumption and Ovarian Cancer Survival: A Prospective Cohort Study. Front Nutr. 2022; 9:873249. PMC: 9053828. DOI: 10.3389/fnut.2022.873249. View

19.

Bray F, Laversanne M, Sung H, Ferlay J, Siegel R, Soerjomataram I . Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3):229-263. DOI: 10.3322/caac.21834. View

20.

Playdon M, Nagle C, Ibiebele T, Ferrucci L, Protani M, Carter J . Pre-diagnosis diet and survival after a diagnosis of ovarian cancer. Br J Cancer. 2017; 116(12):1627-1637. PMC: 5518850. DOI: 10.1038/bjc.2017.120. View