title: Post diagnosis diet quality and colorectal cancer survival in women.
abstract: BACKGROUND
  Dietary factors are known to influence colorectal cancer (CRC) risk, however, their association with CRC survival is unclear. Therefore, we prospectively examined the association between diet quality scores, dietary patterns and colorectal cancer (CRC) survival.
  
  
  METHODS
  1201 women diagnosed with stage I-III CRC between 1986 and 2008, were followed through 2010. Diet was assessed via a food frequency questionnaire administered at least 6 months after diagnosis. We computed the Alternate Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet score (aMED) and Dietary Approaches to Stop Hypertension score (DASH) and derived two dietary patterns, Western (unhealthy) and prudent (healthy), by principal component analysis for each woman.
  
  
  RESULTS
  During follow-up, we documented 435 deaths, including 162 from CRC. After adjusting for potential confounders, only a higher AHEI-2010 score was significantly associated with lower overall mortality (HR comparing extreme quintiles = 0.71, 95% CI 0.52-0.98, p trend = 0.01) as well as borderline significantly with lower risk of CRC mortality by the trend test (HR Q5 vs Q1 = 0.72, 95% CI = 0.43-1.21, p trend = 0.07). When AHEI-2010 components were examined separately, inverse associations for overall mortality were primarily accounted for by moderate alcohol intake (HR comparing abstainers vs 5-15 g/d = 1.30, 95%CI = 1.05-1.61) and lower intake of sugar sweetened beverages and fruit juices combined (HR for each additional serving = 1.11, 95% CI = 1.01-1.23). No other diet quality score or dietary pattern was associated with overall or CRC-specific mortality.
  
  
  CONCLUSIONS
  Higher AHEI-2010 score may be associated with lower overall mortality, moderate alcohol consumption and lower consumption of sugar sweetened beverages and juices combined appeared to account for most of the observed associations.
authors.affiliation: Department of Nutrition, Simmons College, Boston, Massachusetts, United States of America; Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Teresa T
authors.initials: TT
authors.lastname: Fung
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Rutendo
authors.initials: R
authors.lastname: Kashambwa
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America.
authors.forename: Kaori
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Fuchs
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Kana
authors.initials: K
authors.lastname: Wu
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.affiliation: Channing Division of Network Medicine, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America.
authors.forename: Shuji
authors.initials: S
authors.lastname: Ogino
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, United States of America.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Meyerhardt
mesh_terms: D000328:Adult; D000368:Aged; D001628:Beverages; D015179:Colorectal Neoplasms / Q000401:mortality*; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D000067030:Fruit and Vegetable Juices; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate