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Diet Quality at the Initiation of Treatment for Metastatic Colorectal Cancer.

The Western diet, high in red meat and saturated fats and low in fiber, has long been implicated as an important risk factor in the development of colorectal cancer. The association between diet quality and outcomes after diagnosis of nonmetastatic colorectal cancer is less well studied, but there is hardly any data on diet quality on outcomes in metastatic colorectal cancer. Van Blarigan et al 1 have taken an important first step in addressing this critical gap in the field, using data from a study of patients with metastatic colorectal cancer. This is a prospective cohort study of participants with metastatic colorectal cancer enrolled in the Cancer and Leukemia Group B/Southwest Oncology Group 80405 trial, a multicenter randomized clinical trial of first-line therapy. 1 Of 2334 patients included in this study, 1284 (55.0%) had completed an optional validated food frequency questionnaire at initiation of first-line treatment. Using this questionnaire, which was based on food intake during the preceding 3 months, the authors calculated scores for 3 validated and widely used diet quality measures (ie, the Alternative Healthy Eating Index, the Alternative Mediterranean Diet, and the Dietary Approaches to Stop Hypertension) and 2 dietary patterns (Western vs prudent). The primary outcome was death from any cause. Higher scores corresponded to healthier diets in all but the Western diet pattern. Participants from both groups of the study were analyzed as 1 cohort. Multivariable Cox proportional hazards regression was used to estimate hazard ratios. The first model adjusted for age, sex, and daily kilocalorie consumption. The second model adjusted for additional factors, including Eastern Cooperative Oncology Group score, chemotherapy type, KRAS status, whether the tumor was unresected, recent weight change, body mass index, and physical activity level. The authors found that while none of the diet scores or patterns were associated with survival in this cohort, there was a statistically significant trend for an association between a lower risk of death and higher scores on the Alternative Mediterranean Diet measure, although the individual point estimates of each quintile did not reach statistical significance. The hazard ratio for those scoringinthehighestquintileforthisdiet,comparedwiththosescoringinthelowest,was0.83(95%