Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial

Ikuko Kato, Dorothy Lane, Catherine Womack, Cathryn H. Bock, Lifang Hou, Jennifer H. Lin, Chunyuan Wu, Jennifer Beebe Dimmer, Michael S. Simon

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. Results: A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95% confidence interval [CI], 0.60–1.11 for users; HR = 1.12, 95% CI, 0.97–1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. Conclusion: Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.

Original languageEnglish (US)
Pages (from-to)462-469
Number of pages8
JournalJournal of the American College of Nutrition
Volume36
Issue number6
DOIs
StatePublished - Aug 18 2017

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Diet Therapy
Dietary Fats
Women's Health
Colorectal Neoplasms
Anti-Inflammatory Agents
Incidence
Aspirin
Pharmaceutical Preparations
Confidence Intervals
Fat-Restricted Diet
Ambulatory Care
Drug Users
Proportional Hazards Models
Vegetables
Fruit
Fats

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial. / Kato, Ikuko; Lane, Dorothy; Womack, Catherine; Bock, Cathryn H.; Hou, Lifang; Lin, Jennifer H.; Wu, Chunyuan; Beebe Dimmer, Jennifer; Simon, Michael S.

In: Journal of the American College of Nutrition, Vol. 36, No. 6, 18.08.2017, p. 462-469.

Research output: Contribution to journalArticle

Kato, Ikuko ; Lane, Dorothy ; Womack, Catherine ; Bock, Cathryn H. ; Hou, Lifang ; Lin, Jennifer H. ; Wu, Chunyuan ; Beebe Dimmer, Jennifer ; Simon, Michael S. / Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial. In: Journal of the American College of Nutrition. 2017 ; Vol. 36, No. 6. pp. 462-469.
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abstract = "Background: The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. Results: A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95{\%} confidence interval [CI], 0.60–1.11 for users; HR = 1.12, 95{\%} CI, 0.97–1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. Conclusion: Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.",
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T1 - Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial

AU - Kato, Ikuko

AU - Lane, Dorothy

AU - Womack, Catherine

AU - Bock, Cathryn H.

AU - Hou, Lifang

AU - Lin, Jennifer H.

AU - Wu, Chunyuan

AU - Beebe Dimmer, Jennifer

AU - Simon, Michael S.

PY - 2017/8/18

Y1 - 2017/8/18

N2 - Background: The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. Results: A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95% confidence interval [CI], 0.60–1.11 for users; HR = 1.12, 95% CI, 0.97–1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. Conclusion: Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.

AB - Background: The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. Results: A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95% confidence interval [CI], 0.60–1.11 for users; HR = 1.12, 95% CI, 0.97–1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. Conclusion: Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.

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