Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York (SUNY) at Buffalo, Buffalo, NY, USA.
Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York (SUNY) at Buffalo, Buffalo, NY, USA.
J Nutr. 2021 Jun 1;151(6):1618-1627. doi: 10.1093/jn/nxab033.
Prospective evidence on associations between diet quality indices and lung cancer risk is limited, particularly among older women.
We investigated associations between 4 diet quality indices [Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)] and lung cancer incidence and mortality in the Women's Health Initiative Observational Study.
Postmenopausal women aged 50-79 y at baseline (1993-1998) self reported their diet intake and information on relevant covariates. We used Cox proportional hazards regression models to estimate HRs and 95% CIs after controlling for age, smoking, and other relevant covariates.
During ∼17 y of follow-up among 86,090 participants, 1491 lung cancer cases and 1393 lung cancer deaths were documented. Dietary indices were not associated with overall lung cancer incidence but were protective against squamous cell carcinoma (12.8% of total lung cancer) cases (HEI-2015: HR: 0.85; 95% CI: 0.76, 0.96; AHEI-2010: HR: 0.87; 95% CI: 0.78, 0.98; aMED: HR: 0.90; 95% CI: 0.81, 0.99; DASH: HR: 0.87; 95% CI: 0.77, 0.98). Among the indices, only HEI-2015 showed an inverse trend (P-trend = 0.02) with overall lung cancer mortality. Smoking status or participant age at baseline did not modify the association between dietary indices and lung cancer incidence or mortality.
After comprehensive control of smoking exposure, we found that diet quality was not associated with overall lung cancer among postmenopausal women. However, a high-quality diet was inversely related to incident lung cancer of the squamous cell subtype. Future studies in populations with diverse age, smoking history, and dietary intake may further elucidate the relation between diet quality indices and lung cancer, especially by histological subtype.
关于饮食质量指数与肺癌风险之间关联的前瞻性证据有限，尤其是在老年女性中。
我们研究了 4 种饮食质量指数[健康饮食指数-2015（HEI-2015）、替代健康饮食指数 2010（AHEI-2010）、替代地中海饮食（aMED）和停止高血压的饮食方法（DASH）]与妇女健康倡议观察性研究中肺癌发病率和死亡率之间的关联。
基线时（1993-1998 年）年龄在 50-79 岁的绝经后妇女自我报告其饮食摄入量和相关协变量信息。我们使用 Cox 比例风险回归模型来估计 HRs 和 95%CI，在控制年龄、吸烟和其他相关协变量后进行分析。
在 86090 名参与者大约 17 年的随访期间，记录了 1491 例肺癌病例和 1393 例肺癌死亡病例。饮食指数与总体肺癌发病率无关，但对鳞状细胞癌（占总肺癌的 12.8%）病例具有保护作用（HEI-2015：HR：0.85；95%CI：0.76，0.96；AHEI-2010：HR：0.87；95%CI：0.78，0.98；aMED：HR：0.90；95%CI：0.81，0.99；DASH：HR：0.87；95%CI：0.77，0.98）。在这些指数中，只有 HEI-2015 显示出与总体肺癌死亡率呈负相关趋势（P 趋势=0.02）。吸烟状况或基线时参与者的年龄并未改变饮食指数与肺癌发病率或死亡率之间的关联。
在综合控制吸烟暴露后，我们发现绝经后妇女的饮食质量与总体肺癌无关。然而，高质量的饮食与鳞状细胞肺癌的发病呈负相关。在具有不同年龄、吸烟史和饮食摄入量的人群中进行的未来研究可能会进一步阐明饮食质量指数与肺癌之间的关系，特别是通过组织学亚型。
