Ultraprocessed food intake and risk of ovarian and endometrial cancer in the NIH-AARP cohort: a prospective cohort analysis.

BACKGROUND

Ultraprocessed food (UPF) accounts for more than half of caloric intake by the United States population. UPF intake has been linked to weight gain and obesity, a known risk factor for cancer, including endometrial cancer.

OBJECTIVES

The objectives of this study were to evaluate the prospective association of UPF intake with ovarian and endometrial cancer risk.

METHODS

Participants in the NIH-AARP Diet and Health Study reported baseline diet using a food frequency questionnaire (FFQ). We disaggregated FFQ items to assign Nova classification and created quintiles of energy-adjusted UPF intake (grams/day). We used Cox proportional hazards models, adjusted for potential confounding factors, to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for epithelial ovarian and endometrial cancer incidence, overall and by histotype.

RESULTS

Among 129,870 female participants, without a history of oophorectomy or cancer, 1234 epithelial ovarian cancer cases were diagnosed during >20 y of follow-up. UPF intake was not associated with ovarian cancer risk (quintile 5 compared with quintile 1: HR: 0.92; 95% CI: 0.77, 1.11), overall or by histotype. Among 107,592 female participants, without a history of hysterectomy or cancer, 2249 endometrial cancer cases were diagnosed. Participants in the highest quintile of UPF intake tended to have higher BMI (in kg/m) [median (IQR) BMI, 27.4 (23.9-31.7)] than those in the lowest quintile [24.4 (22.0-28.0)]. Higher UPF intake was associated with increased endometrial cancer risk (HR: 1.25; 1.09, 1.43). The association was no longer observed after adjusting for BMI (HR: 0.96; 0.83, 1.10). HR estimates were similar for type I endometrial cancer, the subtype most strongly associated with BMI.

CONCLUSIONS

In this cohort of United States females who were at risk of developing endometrial or ovarian cancer, we found evidence of a positive association between UPF intake and endometrial, but not ovarian cancer. The positive association with endometrial cancer was not independent of BMI.