Diabetes-Related Dietary Patterns and Endometrial Cancer Risk and Survival in the European Prospective Investigation into Cancer and Nutrition Study

Abstract

Background/Objectives: Endometrial cancer (EC)'s major risk factors include obesity and diabetes, both strongly related with lifestyle choices and dietary factors. Our study aimed to evaluate the relationship between diabetes-related dietary patterns, EC risk, and survival in a population of middle-aged European women. Methods: A total of 285,418 female participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included in the analysis. After a mean time of 10.6 years of follow-up, 1955 incident EC cases were registered; of those, 133 women died from EC. The Empirical Dietary Index for Insulin Resistance (EDIR), the Empirical Dietary Index for Hyperinsulinemia (EDIH), and the Diabetes Risk Reduction Diet (DRRD), were estimated from dietary information collected at baseline from EPIC participants. Cox proportional hazards regression models were used to evaluate the association between the dietary patterns and EC risk, using hazard ratios (HR), 95% confidence intervals (CI), and adjusting for relevant confounders. Cox and Fine-Gray models were used to assess the association with overall and EC-specific mortality, respectively. Results: Higher adherence to EDIR was associated with an increased risk of EC, multivariable HR for T3vsT1 were 1.17 (95% CI = 1.04 to1.31). However, when BMI was included in the models, these associations became weaker and no longer statistically significant. No associations were observed in relation to adherence to EDIH, DRRD, and EC risk. No associations were found in relation to diabetes-related dietary patterns and mortality. Conclusions: This study highlights the potential role of diabetes related dietary patterns and EC etiology and prevention. Further studies are warranted to better understand the role of etiology-derived dietary patterns and disease prevention and prognosis.