title: Diet quality and survival after ovarian cancer: results from the Women's Health Initiative.
abstract: BACKGROUND
  Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival.
  
  
  METHODS
  We identified 636 centrally adjudicated cases of ovarian cancer within the Women's Health Initiative Observational Study or Clinical Trials of 161808 postmenopausal women followed from 1995 to 2012. Dietary quality was assessed for the Healthy Eating Index (2005) using a food frequency questionnaire, covariables were obtained from standardized questionnaires, and adiposity was measured by clinic-based measurements of height, weight, and waist circumference. The association between diet quality and mortality was analyzed using Cox proportional hazards regression, adjusted for potential confounders, and stratified by waist circumference, physical activity level, and diabetes status. Tests of statistical significance were two-sided.
  
  
  RESULTS
  Overall, higher diet quality was associated with lower all-cause mortality after ovarian cancer (hazard ratio [HR] for highest vs lowest tertile = 0.73; 95% confidence interval [CI] = 0.55 to 0.97, P(trend) = .03). The effect was strongest among women with waist circumference of 88 cm or less and with no history of diabetes (HR = 0.73, 95% CI = 0.54 to 0.98). Physical activity level did not modify the association between diet quality and survival.
  
  
  CONCLUSIONS
  Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian cancer.
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI). cthomson@email.arizona.edu.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Tracy
authors.initials: T
authors.lastname: E Crane
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Wertheim
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Linda G
authors.initials: LG
authors.lastname: Snetselaar
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Karen M
authors.initials: KM
authors.lastname: Basen-Engquist
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Irwin
mesh_terms: D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D048909:Diabetes Complications / Q000401:mortality; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D009367:Neoplasm Staging; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D016387:Women's Health