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J Nutr. 2017 Apr;147(4):636-644. doi: 10.3945/jn.116.244129. Epub 2017 Feb 22.

Postdiagnostic Mediterranean and Healthy Nordic Dietary Patterns Are Inversely Associated with All-Cause Mortality in Long-Term Colorectal Cancer Survivors.

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Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany.
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Nutritional Epidemiology, Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
Medical Department 1, University Hospital Dresden, Technical University Dresden, Dresden, Germany; and.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany;


Background: Dietary factors are known to affect the risk of new-onset colorectal cancer (CRC), but information on the extent to which postdiagnostic diet affects mortality in long-term CRC survivors is scarce.Objective: We investigated the association of 2 a priori-defined postdiagnostic dietary patterns [Modified Mediterranean Diet Score (MMDS) and healthy Nordic Food Index (HNFI)] with all-cause mortality in long-term CRC survivors.Methods: Diet was assessed at a median time of 6 y after cancer diagnosis in 1404 CRC survivors (median age: 69 y; 56% men) in a prospective cohort study in Northern Germany by using a semiquantitative food-frequency questionnaire. Cox proportional hazard models, adjusting for clinical and sociodemographic characteristics, were used to assess associations of the MMDS and the HNFI with all-cause mortality.Results: A total of 204 patients died during a median follow-up time of 7 y after diet assessment. In multivariable-adjusted models, higher adherence to the modified Mediterranean diet was significantly associated with lower all-cause mortality (HR: 0.48; 95% CI: 0.32, 0.74 for highest compared with lowest score quartile and HR: 0.88; 95% CI: 0.81, 0.96 per 1-point increment in pattern score). Similarly, the HNFI was inversely associated with all-cause mortality when the highest was compared with the lowest index quartile (HR: 0.63; 95% CI: 0.39, 1.04) and when modeled as a continuous trait (HR: 0.90; 95% CI: 0.82, 0.99 per 1-point increment in the score).Conclusions: Our results suggest that higher adherences to the Mediterranean diet and to the healthy Nordic diet after CRC diagnosis are associated with better overall survival in long-term CRC survivors.


Modified Mediterranean Diet Score; colorectal cancer; dietary patterns; healthy Nordic Food Index; mortality; survivors

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