Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China; Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Ecotoxicol Environ Saf. 2024 Oct 1;284:116894. doi: 10.1016/j.ecoenv.2024.116894. Epub 2024 Aug 17.
Ambient air pollution might serve as a prognostic factor for ovarian cancer (OC) survival, yet the relationships between plant-based diet indices (PDIs) and OC survival remain unclear. We aimed to investigate the associations of comprehensive air pollution and PDIs with OC survival and explored the effects of air pollution-diet interactions.
The present study encompassed 658 patients diagnosed with OC. The overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) were evaluated by a self-reported validated food frequency questionnaire. In addition, an air pollution score (APS) was formulated by summing the concentrations of particulate matter with a diameter of 2.5 microns or less, ozone, and nitrogen dioxide. Cox proportional hazard models were applied to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). The potential interactions of APS with PDIs in relation to overall survival (OS) were assessed on both multiplicative and additive scales.
Throughout a median follow-up of 37.60 (interquartile: 24.77-50.70) months, 123 deaths were confirmed. Comparing to the lowest tertiles, highest uPDI was associated with lower OS of OC (HR = 2.06, 95 % CI = 1.30, 3.28; P-trend < 0.01), whereas no significant associations were found between either overall PDI or hPDI and OC survival. Higher APS (HR = 1.27, 95 % CI = 1.01, 1.60) was significantly associated with worse OC survival, and the association was exacerbated by adherence to uPDI. Notably, an additive interaction was identified between combined air pollution and uPDI (P < 0.005 for high APS and high uPDI). We also found that adherence to overall PDI aggravated associations of air pollution with OC survival (P-interaction = 0.006).
Joint exposure to various ambient air pollutants was significantly associated with lower survival among patients with OC, particularly for those who predominantly consumed unhealthy plant-based foods.
环境空气污染可能是卵巢癌（OC）生存的预后因素，但植物性饮食指数（PDI）与 OC 生存之间的关系尚不清楚。我们旨在研究综合空气污染和 PDI 与 OC 生存的关系，并探讨空气污染-饮食相互作用的影响。
本研究纳入了 658 名诊断为 OC 的患者。通过自我报告的验证食物频率问卷评估整体植物性饮食指数（PDI）、健康 PDI（hPDI）和不健康 PDI（uPDI）。此外，通过将直径 2.5 微米或更小的颗粒物、臭氧和二氧化氮的浓度相加来制定空气污染评分（APS）。应用 Cox 比例风险模型计算危险比（HR）和 95%置信区间（CI）。在乘法和加法尺度上评估 APS 与 PDI 之间与总生存（OS）相关的潜在相互作用。
在中位数为 37.60 个月（四分位距：24.77-50.70）的随访期间，确认了 123 例死亡。与最低三分位数相比，最高的 uPDI 与 OC 的较低 OS 相关（HR=2.06，95%CI=1.30，3.28；P-trend<0.01），而整体 PDI 或 hPDI 与 OC 生存之间无显著关联。较高的 APS（HR=1.27，95%CI=1.01，1.60）与 OC 生存不良显著相关，并且这种关联在 uPDI 依从性较高时会加剧。值得注意的是，在高 APS 和高 uPDI 之间，发现了空气污染物与 uPDI 之间的附加相互作用（高 APS 和高 uPDI 时 P<0.005）。我们还发现，整体 PDI 的依从性加剧了空气污染与 OC 生存之间的关联（P 交互作用=0.006）。
各种环境空气污染物的联合暴露与 OC 患者的生存降低显著相关，尤其是那些主要食用不健康植物性食物的患者。
