title: Association between selected dietary scores and the risk of urothelial cell carcinoma: A prospective cohort study.
abstract: Studies investigating the association of food and nutrient consumption with the risk of urothelial cell carcinoma (UCC) have produced mixed results. We used three common dietary scores, the Mediterranean Diet Score (MDS), the Alternate Healthy Eating Index 2010 (AHEI-2010) and the Dietary Inflammatory Index (DII) to assess the evidence of an association between diet and the risk of UCC. Over a median follow-up time of 21.3 years, 379 incident UCC cases were diagnosed. Dietary scores were calculated using data from a 121-item food frequency questionnaire administered at baseline. We used Cox models to compute hazard ratios (HR) for the association between dietary scores (per one standard deviation) and UCC risk. In order to reflect overall adherence to a healthy diet, a metascore was constructed by summing the quintiles of each of the three scores. None of the dietary scores was associated with the risk of UCC overall. A healthier diet was found to be inversely associated with the risk of invasive (MDS: HR = 0.86, 95% CI: 0.74-1.00, metascore: HR = 0.84, 95% CI: 0.71-0.98), but not superficial disease (heterogeneity between subtypes p = 0.04 and p = 0.03, respectively). Results were consistent but weaker for the DII and the AHEI-2010. We found some evidence of effect modification by smoking, in particular for the metascore (Current: HR = 0.77, 95% CI: 0.58-1.01, Former: HR = 0.77, 95% CI: 0.64-0.92, Never: HR = 1.01, 95% CI: 0.81-1.26, p for heterogeneity = 0.05). A healthy diet may be protective against the risk of invasive, but not superficial, UCC. Promoting healthy dietary habits may help lower the risk of invasive UCC, especially for current and former smokers.
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
authors.forename: Pierre-Antoine
authors.initials: PA
authors.lastname: Dugué
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Hodge
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.
authors.forename: Maree T
authors.initials: MT
authors.lastname: Brinkman
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Bassett
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.|Connecting Health Innovations LLC, Columbia, SC.
authors.forename: Nitin
authors.initials: N
authors.lastname: Shivappa
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.|Connecting Health Innovations LLC, Columbia, SC.
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
authors.forename: Dallas R
authors.initials: DR
authors.lastname: English
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Milne
authors.affiliation: Cancer Council Victoria, Cancer Epidemiology Centre, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002277:Carcinoma / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012306:Risk; D014523:Urethral Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology
keywords: Alternate Healthy Eating Index; Dietary Inflammatory Index; Mediterranean Diet Score; bladder cancer; dietary score; urothelial cell