High Alternate Mediterranean Diet Scores Tied to Better Survival in Patients With Ovarian Cancer

High pre- and postdiagnosis alternate Mediterranean diet (AMED) scores were associated with improved overall survival (OS) in patients with ovarian cancer (OC), according to a study published in the Journal of Translational Medicine.¹

The researchers explained that OC is the second leading cause of mortality among gynecologic malignancies worldwide as most patients are diagnosed in advanced stages and have a short survival time.² Therefore, they noted the “pressing need” for modifiable factors, like diet, that can help improve survival following an OC diagnosis.¹

The Mediterranean Diet (MED) is widely recognized as a healthy eating pattern and helps prevent chronic diseases and cancers. However, the AMED is being explored as an alternative model to better adapt to the dietary characteristics of different populations; AMED keeps the core MED elements, but it also incorporates local ingredients and eating habits to make it more culturally adaptable.³

AMED has also received attention due to its health benefits, including cancer prevention and mortality reduction. The researchers hypothesized that it may enhance cancer prognosis, including OC, although studies on this topic are limited.¹ Consequently, they conducted a study examining the association between adherence to the AMED diet before and after diagnosis and OS in patients with OC; they also analyzed any OS changes linked to dietary shifts from pre- to post diagnosis.

Higher pre- and postdiagnosis Alternate Mediterranean Diet (AMED) scores are associated with improved overall survival in patients with ovarian cancer. | Image Credit: fascinadora - stock.adobe.com

To do so, they analyzed patients from the Ovarian Cancer Follow-Up Study (OOPS), which recruited 1082 patients with OC aged between 18 and 79 from the Shengjing Hospital of China Medical University by August 2022.⁴ It aims to collect clinical, demographic, and lifestyle data from patients with OC to assess their associations with cancer-related outcomes.

They obtained information on patient demographics and lifestyle factors, like dietary intake and physical activity, through self-administered questionnaires at diagnosis and 12 months post diagnosis.¹ Also, clinical characteristics, like age at diagnosis, histological type, and comorbidities, were abstracted from electronic medical records.

In particular, diet information was collected using a 111-item food frequency questionnaire (FFQ). This asked patients to estimate how often they consumed each food item listed. Patients were categorized into 7 groups based on intake frequency, ranging from “almost never” to “2 or more times per day.”

Each patient’s daily food intake (grams/day) was calculated using consumption frequencies and standard portion sizes. Then, daily nutrient intake was determined by multiplying the frequency of each food item by its nutrient content and summing the total across all consumed items.

The AMED score was adapted from the MED scale and included various food components, like vegetables, fruits, fish, alcohol, and red/processed meats. Scores ranged from 0 to 9, with higher scores indicating greater adherence to the MED. Patients received 1 point for intake above the median. Conversely, for red/processed meats and alcohol, lower intake earned patients 1 point.

The study’s main outcome was OS. Consequently, during follow-up, the researchers determined the vital status of patients through a combination of active and passive methods. Active follow-up involved face-to-face patient interviews to gather updated information. Conversely, passive follow-up involved acquiring health outcomes and medical records for all deceased patients.

The final study population consisted of 560 patients with OC, 211 (37.68%) of whom died during a median follow-up period of 44.40 months (IQR, 26.97-61.37). Among those who died, the mean (SD) pre- and postdiagnosis AMED scores were 27.63 (5.08) and 28.90 (5.04), respectively. Conversely, among patients who survived, the mean (SD) pre- and postdiagnosis AMED scores were 28.06 (4.97) and 29.46 (5.00), respectively.

The researchers determined that the highest tertile of AMED scores during prediagnosis (HR, 0.59; 95% CI, 0.38-0.90; P = .02) and post diagnosis (HR, 0.61; 95% CI, 0.41-0.91; P = .01) were associated with better OS than the lowest tertile.

Additionally, compared with patients who maintained a relatively stable AMED score from pre- to post diagnosis (change within 5%), they found that those with a decreased AMED score (change of more than 5%) had a 66% higher risk of all-cause mortality (95% CI, 1.11-2.50). However, those whose AMED scores increased by more than 15% from pre- to post diagnosis had a lower risk of all-cause mortality (HR, 0.59; 95% CI, 0.38-0.90).

Therefore, patients with OC who adhered to a high AMED score had a lower risk of all-cause mortality than those with consistently low AMED scores (HR, 0.47; 95% CI, 0.31-0.70).

The researchers acknowledged their limitations, one being that their findings had limited generalizability since they exclusively recruited participants from a single tertiary hospital in China. Also, they did not explore the impact of AMED score changes on progression-free survival. Therefore, they suggested next steps.

“To validate these findings, further research involving extended follow-up periods and larger cohorts was recommended,” the authors concluded.

References

1. Chen YH, Bao RH, Liu JC, et al. Association between pre-diagnosis and post-diagnosis Alternate Mediterranean Diet and ovarian cancer survival: evidence from a prospective cohort study. J Transl Med. 2024;22(1):860. doi:10.1186/s12967-024-05653-2
2. Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018;68(4):284-296. doi:10.3322/caac.21456
3. Shan Z, Wang F, Li Y, et al. Healthy eating patterns and risk of total and cause-specific mortality. JAMA Intern Med. 2023;183(2):142-153. doi:10.1001/jamainternmed.2022.6117
4. Gong TT, Liu FH, Liu YS, et al. A follow-up study of ovarian cancer (OOPS): a study protocol. Front Nutr. 2022;9:872773. doi:10.3389/fnut.2022.872773