Abstract
Background
Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake
to food weight (grams) and is a measure of diet quality. Consumption of foods high
in DED has been associated with weight gain in adults.
Objective
To investigate the association between baseline DED and incident obesity-associated
cancers in the Women’s Health Initiative.
Design
Prospective cohort study of clinical trial and observational study participants.
Participants/setting
Postmenopausal women aged 50 to 79 years (N=92,295) enrolled in the observational
study or the calcium and vitamin D trial and hormone replacement therapy trials of
the Women’s Health Initiative.
Main outcome measures
Incident, medical record-adjudicated, obesity-related cancers during follow-up. Exposure
variable was DED (kilocalories per gram for the total diet) from self-reported dietary
intake at baseline using a food frequency questionnaire.
Statistical analyses
The associations between DED and each incident cancer, or any obesity-related cancer,
were examined using competing-risks regression models, with death as a competing risk.
Body mass index-stratified models were generated to investigate body mass index as
a potential modifying factor.
Results
DED was associated with higher body mass index (28.9±6.0 vs 26.3±4.9) and waist circumference
(89.3±14.2 vs 82.4±12.4 cm) for DED quintiles 5 vs 1, respectively. DED was associated
with a 10% increased risk of any obesity-related cancer (subhazard ratioQ5 vs Q1: 1.1, 95% CI 1.03 to 1.2; P=0.004). This increased risk appeared limited to women who were normal weight at enrollment.
Conclusions
Higher DED may be a contributing factor for obesity-related cancers, especially among
normal-weight postmenopausal women and, as such, could serve as a modifiable behavior
for dietary interventions to reduce obesity-associated cancer risk.
Keywords
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Biography
C. A. Thomson is a professor, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson.
Biography
T. E. Crane is an assistant professor, College of Nursing, The University of Arizona, Tucson.
Biography
D. O. Garcia is an assistant professor, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson.
Biography
B. C. Wertheim is a data analyst/statistician, University of Arizona Cancer Center, The University of Arizona, Tucson.
Biography
M. Hingle is an assistant professor, Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, Tucson.
Biography
L. Snetselaar is a professor and associate provost, College of Public Health, The University of Iowa, Iowa City.
Biography
M. Datta is an assistant professor and director, Coordinated Program in Dietetics, Department of Nutrition Science, Purdue University, West Lafayette, IN.
Biography
T. Rohan is a professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
Biography
E. LeBlanc is an endocrinologist, Kaiser Permanente Center for Health Research, Portland, OR.
Biography
R. T. Chlebowski is chief and professor in residence, Medical Oncology/Hematology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
Biography
L. Qi is an associate professor, Department of Public Health Sciences, The University of California, Davis.
Article info
Publication history
Published online: August 17, 2017
Accepted:
June 11,
2017
Received:
January 9,
2017
Footnotes
Supplementary materials: Podcast available at www.jandonline.org/content/podcast
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The WHI program is funded by the National Heart, Lung, and Blood Institute; National Institutes of Health; and US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number P30 CA023074 and The University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment.
Identification
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© 2018 by the Academy of Nutrition and Dietetics.
