title: Daily intake of antioxidants in relation to survival among adult patients diagnosed with malignant glioma.
abstract: BACKGROUND
  Malignant glioma is a rare cancer with poor survival. The influence of diet and antioxidant intake on glioma survival is not well understood. The current study examines the association between antioxidant intake and survival after glioma diagnosis.
  
  
  METHODS
  Adult patients diagnosed with malignant glioma during 1991-1994 and 1997-2001 were enrolled in a population-based study. Diagnosis was confirmed by review of pathology specimens. A modified food-frequency questionnaire interview was completed by each glioma patient or a designated proxy. Intake of each food item was converted to grams consumed/day. From this nutrient database, 16 antioxidants, calcium, a total antioxidant index and 3 macronutrients were available for survival analysis. Cox regression estimated mortality hazard ratios associated with each nutrient and the antioxidant index adjusting for potential confounders. Nutrient values were categorized into tertiles. Models were stratified by histology (Grades II, III, and IV) and conducted for all (including proxy) subjects and for a subset of self-reported subjects.
  
  
  RESULTS
  Geometric mean values for 11 fat-soluble and 6 water-soluble individual antioxidants, antioxidant index and 3 macronutrients were virtually the same when comparing all cases (n=748) to self-reported cases only (n=450). For patients diagnosed with Grade II and Grade III histology, moderate (915.8-2118.3 mcg) intake of fat-soluble lycopene was associated with poorer survival when compared to low intake (0.0-914.8 mcg), for self-reported cases only. High intake of vitamin E and moderate/high intake of secoisolariciresinol among Grade III patients indicated greater survival for all cases. In Grade IV patients, moderate/high intake of cryptoxanthin and high intake of secoisolariciresinol were associated with poorer survival among all cases. Among Grade II patients, moderate intake of water-soluble folate was associated with greater survival for all cases; high intake of vitamin C and genistein and the highest level of the antioxidant index were associated with poorer survival for all cases.
  
  
  CONCLUSIONS
  The associations observed in our study suggest that the influence of some antioxidants on survival following a diagnosis of malignant glioma are inconsistent and vary by histology group. Further research in a large sample of glioma patients is needed to confirm/refute our results.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA. gerald.n.delorenze@kp.org
authors.forename: Gerald N
authors.initials: GN
authors.lastname: DeLorenze
authors.forename: Lucie
authors.initials: L
authors.lastname: McCoy
authors.forename: Ai-Lin
authors.initials: AL
authors.lastname: Tsai
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Terri
authors.initials: T
authors.lastname: Rice
authors.forename: Dora
authors.initials: D
authors.lastname: Il'yasova
authors.forename: Margaret
authors.initials: M
authors.lastname: Wrensch
mesh_terms: D000975:Antioxidants / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002140:California / Q000453:epidemiology; D019992:Databases as Topic; D004032:Diet; D015930:Diet Records; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants