Institute of Epidemiology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
Department of General, Visceral, Vascular, and Transplantation Surgery, University Hospital Rostock, Rostock, Germany.
Am J Clin Nutr. 2021 Aug 2;114(2):441-449. doi: 10.1093/ajcn/nqab061.
Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear.
We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors.
Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence.
Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57-0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67-1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96-1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (<95 metabolic equivalent of task hours/week).
An overall plant-based diet was inversely associated with all-cause mortality in long-term CRC survivors. However, more research is needed to further disentangle the impacts of different qualities of plant-based diets on cancer survivors' health.
富含植物的饮食与一般人群较低的心血管代谢风险和更长的生存时间相关，但它们与癌症幸存者的死亡率的关系尚不清楚。
我们旨在研究三种基于植物的饮食指数与杂食性长期结直肠癌（CRC）幸存者全因死亡率之间的关系。
在一项德国北部前瞻性队列研究中，对 1404 名 CRC 幸存者（56%为男性；中位年龄为 69 岁）进行了中位数为 6 年的基于 FFQ 的饮食评估。通过对动物食品进行反向评分，以及对健康的（全谷物、蔬菜、水果、豆类、坚果、油、茶/咖啡）和不健康的植物性食物（精制谷物、果汁、含糖饮料、土豆、糖果/甜点）进行正向或反向评分，得出了一个整体的、健康的基于植物的饮食指数和一个不健康的基于植物的饮食指数。通过人口登记册对生存状况进行随访。应用 Cox 比例风险回归模型根据植物性饮食依从性估计全因死亡率的 HR。
在饮食评估后 7 年内（中位数），有 204 人死亡。整体基于植物的饮食指数与全因死亡率呈显著负相关（饮食指数每增加 10 分，HR 为 0.72；95%CI，0.57-0.91）。尽管没有统计学意义，但较高的健康的基于植物的饮食评分显示出较低的死亡率趋势（HR，0.82；95%CI，0.67-1.01）。不健康的基于植物的饮食指数与较高的死亡率相关，但在多变量调整后失去了统计学意义（HR，1.19；95%CI，0.96-1.48）。亚组分析显示，不健康的基于植物的饮食与死亡率呈正相关的趋势仅限于体力活动较少的个体（<95 代谢当量任务小时/周）。
整体基于植物的饮食与长期 CRC 幸存者的全因死亡率呈负相关。然而，需要进一步的研究来进一步厘清不同质量的基于植物的饮食对癌症幸存者健康的影响。
