Nutritional factors and non-Hodgkin lymphoma survival in an ethnically diverse population: the Multiethnic Cohort.
OBJECTIVE
To understand the possible effect of modifiable health behaviors on the prognosis of the increasing number of non-Hodgkin lymphoma (NHL) survivors, we examined the pre-diagnostic intake of major food groups with all-cause and NHL-specific survival in the Multiethnic Cohort (MEC).


METHODS
This analysis included 2339 participants free of NHL at cohort entry and diagnosed with NHL as identified by cancer registries during follow-up. Deaths were ascertained through routine linkages to state and national death registries. Cox proportional hazards regression was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and NHL-specific mortality according to pre-diagnostic intake of vegetables, fruits, red meat, processed meat, fish, legumes, dietary fiber, dairy products and soy foods assessed by food frequency questionnaire.


RESULTS
The mean age at diagnosis was 71.8±8.5 years. During 4.5±4.1 years of follow-up, 1348 deaths, including 903 NHL-specific deaths, occurred. In multivariable models, dairy intake was associated with higher all-cause mortality (highest vs lowest tertile: HR=1.14, 95% CI 1.00-1.31, Ptrend=0.03) and NHL-specific (HR=1.16, 95% CI 0.98-1.37) mortality. Legume intake above the lowest tertile was related to significant 13-16% lower all-cause and NHL-specific mortality, whereas red meat and fish intake in the intermediate tertiles was associated with lower NHL-specific mortality. No association with survival was detected for the other food groups.


CONCLUSIONS
These data suggest that pre-diagnostic dietary intake may not appreciably contribute to NHL survival, although the higher mortality for dairy products and the better prognosis associated with legumes agree with known biologic effects of these foods.
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
Q J N
QJ
Leo
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
N J
NJ
Ollberding
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
L R
LR
Wilkens
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
L N
LN
Kolonel
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
B E
BE
Henderson
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
L
L
Le Marchand
Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
G
G
Maskarinec
D000368:Aged; D004032:Diet; D005006:Ethnicity; D005247:Feeding Behavior; D005260:Female; D005502:Food; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D017741:Survivors