Introduction
Methods
Study design
DRRD score calculation
Covariates data collection
Renal cancer ascertainment
Statistical analysis
Results
Participant baseline features
Characteristics | Overall | Quartiles of overall Diabetes Risk Reduction Diet score | |||
---|---|---|---|---|---|
Quartile 1 (9–23) | Quartile 2 (24–27) | Quartile 3 (28–30) | Quartile 4 (31–45) | ||
Number of participants | 101,755 | 27,890 | 28,970 | 19,784 | 25,111 |
Diabetes risk reduction diet score | 26.8 ± 5.3 | 20.4 ± 2.4 | 25.5 ± 1.1 | 28.9 ± 0.8 | 33.8 ± 2.6 |
Age | 65.5 ± 5.7 | 64.7 ± 5.6 | 65.5 ± 5.7 | 65.9 ± 5.8 | 66.2 ± 5.7 |
Sex | |||||
Male | 49,496 (48.6%) | 16,282 (58.4%) | 14,856 (51.3%) | 8839 (44.7%) | 9519 (37.9%) |
Female | 52,259 (51.4%) | 11,608 (41.6%) | 14,114 (48.7%) | 10,945 (55.3%) | 15,592 (62.1%) |
Race | |||||
White | 94,066 (92.4%) | 26,077 (93.5%) | 26,890 (92.8%) | 18,295 (92.5%) | 22,804 (90.8%) |
Non-white | 7689 (7.6%) | 1813 (6.5%) | 2080 (7.2%) | 1489 (7.5%) | 2307 (9.2%) |
Marital status | |||||
Married or living as married | 79,826 (78.4%) | 22,143 (79.4%) | 23,066 (79.6%) | 15,509 (78.4%) | 19,108 (76.1%) |
No | 21,929 (21.6%) | 5747 (20.6%) | 5904 (20.4%) | 4275 (21.6%) | 6003 (23.9%) |
Education level | |||||
College below | 64,953 (63.8%) | 19,955 (71.5%) | 19,034 (65.7%) | 12,053 (60.9%) | 13,911 (55.4%) |
College graduate | 17,848 (17.5%) | 4210 (15.1%) | 4973 (17.2%) | 3687 (18.6%) | 4978 (19.8%) |
Postgraduate | 18,954 (18.6%) | 3725 (13.4%) | 4963 (17.1%) | 4044 (20.4%) | 6222 (24.8%) |
Body mass index (kg/m2) | 27.2 ± 4.8 | 28.2 ± 5.0 | 27.5 ± 4.7 | 26.9 ± 4.6 | 26.0 ± 4.4 |
Weight changea (pounds) | 33.0 ± 27.2 | 38.5 ± 28.8 | 34.6 ± 26.9 | 31.5 ± 26.4 | 26.4 ± 24.8 |
Arm | |||||
Intervention | 51,817 (50.9%) | 14,077 (50.5%) | 14,663 (50.6%) | 10,063 (50.9%) | 13,014 (51.8%) |
Control | 49,938 (49.1%) | 13,813 (49.5%) | 14,307 (49.4%) | 9721 (49.1%) | 12,097 (48.2%) |
Smoking status | |||||
Never | 48,580 (47.7%) | 12,409 (44.5%) | 13,572 (46.8%) | 9700 (49.0%) | 12,899 (51.4%) |
Current | 9401 (9.2%) | 3772 (13.5%) | 2841 (9.8%) | 1488 (7.5%) | 1300 (5.2%) |
Former | 43,774 (43.0%) | 11,709 (42.0%) | 12,557 (43.3%) | 8596 (43.4%) | 10,912 (43.5%) |
Smoking pack-years | 17.7 ± 26.6 | 21.7 ± 30.0 | 18.4 ± 27.0 | 16.1 ± 25.0 | 13.5 ± 22.2 |
Drinking status | |||||
No | 27,757 (27.3%) | 8654 (31.0%) | 7780 (26.9%) | 5006 (25.3%) | 6317 (25.2%) |
Yes | 73,998 (72.7%) | 19,236 (69.0%) | 21,190 (73.1%) | 14,778 (74.7%) | 18,794 (74.8%) |
Alcohol consumption (g/day) | 9.5 ± 25.3 | 8.4 ± 23.5 | 9.7 ± 24.4 | 10.7 ± 28.1 | 9.7 ± 25.7 |
Ibuprofen use | |||||
No | 73,349 (72.1%) | 19,784 (70.9%) | 20,817 (71.9%) | 14,243 (72.0%) | 18,505 (73.7%) |
Yes | 28,406 (27.9%) | 8106 (29.1%) | 8153 (28.1%) | 5541 (28.0%) | 6606 (26.3%) |
Family history of renal cancer | |||||
No | 97,569 (95.9%) | 26,624 (95.5%) | 27,766 (95.8%) | 19,007 (96.1%) | 24,172 (96.3%) |
Yes | 1543 (1.5%) | 406 (1.5%) | 423 (1.5%) | 310 (1.6%) | 404 (1.6%) |
Possibly | 2643 (2.6%) | 860 (3.1%) | 781 (2.7%) | 467 (2.4%) | 535 (2.1%) |
History of diabetes | |||||
No | 94,949 (93.3%) | 25,675 (92.1%) | 26,957 (93.1%) | 18,531 (93.7%) | 23,786 (94.7%) |
Yes | 6806 (6.7%) | 2215 (7.9%) | 2013 (6.9%) | 1253 (6.3%) | 1325 (5.3%) |
History of hypertension | |||||
No | 68,707 (67.5%) | 18,002 (64.5%) | 19,251 (66.5%) | 13,558 (68.5%) | 17,896 (71.3%) |
Yes | 33,048 (32.5%) | 9888 (35.5%) | 9719 (33.5%) | 6226 (31.5%) | 7215 (28.7%) |
Energy intake from diet (kcal/day) | 1738.6 ± 736.4 | 1797.0 ± 740.6 | 1739.3 ± 782.4 | 1715.3 ± 763.7 | 1691.5 ± 645.2 |
Healthy Eating Index-2015 | 66.5 ± 9.7 | 57.5 ± 7.9 | 65.2 ± 7.0 | 69.9 ± 6.5 | 75.5 ± 6.2 |
DRRD and other nutrients intakes | |||||
Cereal fiber (g/day) | 11.9 ± 5.7 | 9.3 ± 4.2 | 11.1 ± 5.2 | 12.5 ± 5.6 | 15.1 ± 6.2 |
Nuts (g/day) | 6.7 ± 14.5 | 2.7 ± 5.7 | 4.9 ± 9.9 | 7.4 ± 14.8 | 12.7 ± 21.8 |
Coffee (g/day) | 846.4 ± 794.5 | 730.2 ± 788.9 | 869.6 ± 802.6 | 892.7 ± 790.5 | 912.2 ± 780.6 |
Polyunsaturated/saturated fatty acids | 0.8 ± 0.3 | 0.6 ± 0.2 | 0.7 ± 0.2 | 0.8 ± 0.2 | 0.9 ± 0.3 |
Whole fruit (Servings/day) | 2.7 ± 2.0 | 1.7 ± 1.3 | 2.4 ± 1.7 | 3.0 ± 2.0 | 4.0 ± 2.4 |
Glycemic index of diet | 53.6 ± 3.3 | 55.6 ± 3.0 | 53.9 ± 3.0 | 52.8 ± 2.9 | 51.4 ± 2.7 |
Trans fat acid (g/day) | 4.0 ± 2.4 | 4.9 ± 2.5 | 4.2 ± 2.5 | 3.7 ± 2.2 | 2.9 ± 1.6 |
Sugar-sweetened beverage (g/day) | 264.5 ± 433.3 | 449.6 ± 565.5 | 264.4 ± 407.3 | 191.5 ± 329.2 | 116.6 ± 254.4 |
Red and processed meat (g/day) | 12.4 ± 15.3 | 19.5 ± 19.3 | 13.4 ± 15.0 | 9.8 ± 11.8 | 5.5 ± 7.6 |
Association between DRRD score and the incidence of renal cancer
Quartiles of DRRD score | Number of cases | Person-years | Incidence rate per 1000 person-years (95% confidence interval) | Hazard ratio (95% confidence interval) | ||
---|---|---|---|---|---|---|
Unadjusted | Model 1a | Model 2b | ||||
Quartile 1 (9–23) | 162 | 243,233.1 | 0.67 (0.57, 0.78) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Quartile 2 (24–27) | 133 | 256,240.4 | 0.52 (0.44, 0.62) | 0.78 (0.62, 0.98) | 0.81 (0.64, 1.02) | 0.85 (0.68, 1.08) |
Quartile 3 (28–30) | 73 | 175,613.0 | 0.42 (0.33, 0.52) | 0.62 (0.47, 0.82) | 0.68 (0.52, 0.90) | 0.75 (0.57, 1.00) |
Quartile 4 (31–45) | 78 | 224,251.0 | 0.35 (0.28, 0.43) | 0.52 (0.40, 0.68) | 0.61 (0.46, 0.80) | 0.71 (0.54, 0.94) |
Ptrend | < 0.001 | < 0.001 | 0.008 |
Additional analyses
Subgroup variable | Number of participates | Number of cases | HR Quartile 4 vs. Quartile 1 (95% CI) a | P-interaction |
---|---|---|---|---|
Age (years) | 0.135 | |||
≤ 65 | 28,171 | 114 | 0.75 (0.39, 1.42) | |
> 65 | 24,830 | 126 | 0.84 (0.48, 1.47) | |
Sex | 0.585 | |||
Male | 25,801 | 156 | 0.74 (0.44, 1.27) | |
Female | 27,200 | 84 | 0.94 (0.47, 1.87) | |
Body mass index (kg/m2) | 0.455 | |||
≤ 30 | 40,972 | 161 | 0.93 (0.56, 1.53) | |
> 30 | 12,029 | 79 | 0.55 (0.26, 1.18) | |
Smoking status | 0.289 | |||
Never | 25,308 | 80 | 0.48 (0.24, 0.99) | |
Current/former | 27,693 | 160 | 1.05 (0.63, 1.75) | |
Smoking pack-years | 0.214 | |||
≤ Medium | 26,872 | 85 | 0.45 (0.22, 0.91) | |
> Medium | 26,129 | 155 | 1.13 (0.67, 1.89) | |
Family history of renal cancer | 0.661 | |||
No | 50,796 | 228 | 0.79 (0.52, 1.22) | |
Yes/possibly | 2205 | 12 | 1.34 (0.2, 8.81) | |
History of hypertension | 0.792 | |||
No | 35,898 | 137 | 1.35 (0.77, 2.36) | |
Yes | 17,103 | 103 | 0.43 (0.23, 0.80) | |
History of diabetes | 0.394 | |||
No | 49,461 | 219 | 0.87 (0.56, 1.34) | |
Yes | 3540 | 21 | 0.42 (0.10, 1.77) | |
Healthy eating index-2015 | 0.015 | |||
≤ Medium | 27,000 | 154 | 0.29 (0.11, 0.80) | |
> Medium | 26,001 | 86 | 1.12 (0.57, 2.20) |
Categories | HR Quartile 4 vs. Quartile 1 (95% CI)a | P-trend |
---|---|---|
Excluded participants with a family history of renal cancerb | 0.69 (0.52, 0.92) | 0.006 |
Excluded participants with a history of diabetesc | 0.74 (0.55, 0.99) | 0.024 |
Exclude 32 cases with renal pelvis cancer | 0.72 (0.54, 0.97) | 0.020 |
Excluded cases observed within the first 2 years of follow-up | 0.69 (0.50, 0.93) | 0.005 |
Excluded cases observed within the first 3 years of follow-up | 0.68 (0.49, 0.94) | 0.008 |
Further adjusted for Healthy Eating Index-2015d | 0.69 (0.48, 0.99) | 0.035 |
Further adjusted for weight changee | 0.71 (0.53, 0.93) | 0.007 |