title: A prospective analysis of diet quality and endometrial cancer among 84,415 postmenopausal women in the Women's Health Initiative.
abstract: OBJECTIVE
  Endometrial cancer is the most commonly diagnosed gynecologic cancer, but no convincing dietary risk factors for this cancer have been identified. Among postmenopausal women, we examined how four key a priori diet quality indices--the Healthy Eating Index-2010, Alternative Healthy Eating Index-2010, alternate Mediterranean Diet, and Dietary Approaches to Stop Hypertension are related to the risk of endometrial cancer in the Women's Health Initiative Clinical Trials and Observational Study.
  
  
  METHODS
  Our prospective cohort study included 84,415 postmenopausal women with a uterus who completed a food frequency questionnaire at enrollment. Cox proportional hazards models were used to estimate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for endometrial cancer associated with increasing quintiles of diet quality index scores.
  
  
  RESULTS
  During 13.3 years of follow-up, 1392 endometrial cancer cases occurred. After adjustment for known risk factors, having better diet quality (Q5 vs. Q1) was not associated with the risk of endometrial cancer, as evidenced using Healthy Eating Index-2010 (HR: 1.11, 95% CI: 0.93-1.33), Alternative Healthy Eating Index-2010 (HR: 0.98, 95% CI: 0.82-1.17), alternate Mediterranean Diet (HR: 0.98, 95% CI: 0.82-1.17), or Dietary Approaches to Stop Hypertension (HR: 1.00, 95% CI: 0.84-1.19).
  
  
  CONCLUSIONS
  Diet quality was not associated with endometrial cancer risk in this large cohort of postmenopausal women.
authors.affiliation: Office of Disease Prevention, National Institutes of Health, Bethesda, MD. Electronic address: stephanie.george@nih.gov.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: George
authors.affiliation: Office of Disease Prevention, National Institutes of Health, Bethesda, MD.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.affiliation: Department of Nutritional Sciences, University of Arizona, Tucson; University of Arizona Cancer Center, University of Arizona, Tucson; Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Crane
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
mesh_terms: D000367:Age Factors; D000368:Aged; D004032:Diet; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016387:Women's Health
keywords: Diet quality; Endometrial cancer; Prospective cohort study