Post-diagnostic Inflammatory, Hyperinsulinemic, and Insulin Resistant Diets and Lifestyles and the Risk of Prostate Cancer Progression and Mortality.

Inflammatory and insulin pathways have been linked to prostate cancer (PC); post-diagnostic behaviors activating these pathways may lead to poor outcomes. The empirical dietary inflammation pattern (EDIP), indices for hyperinsulinemia (EDIH) and insulin resistance (EDIR), and associated lifestyle indices (ELIH, ELIR) predict biomarkers of inflammation (EDIP: IL-6, TNFaR2, CRP) and insulin secretion (EDIH/ELIH: c-peptide; EDIR/ELIR: TAG:HDL) from whole foods and behaviors.

Associations of these indices with time to PC progression (primary, n=2,056) and PC-specific mortality (PCSM; secondary, n=2,447) were estimated among men diagnosed with non-metastatic PC in the CaPSURE cohort diet and lifestyle sub-study. Because the true (versus clinically-documented) date of progression is unobserved, we used parametric (Weibull) survival models to accommodate interval-censoring and estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for PC progression per 1-standard deviation increase in index. Cox proportional hazards models were used to estimate PCSM associations.

During a median (IQR) 6.4 years (IQR:1.3, 12.7), 192 progression and 73 PCSM events were observed. Inflammatory (EDIP: HR=1.27, CI: 1.17-1.37), hyperinsulinemic (EDIH: HR=1.24, CI: 1.05-1.46. ELIH: HR=1.34, CI:1.17-1.54), and insulin resistant (EDIR: HR=1.22, CI: 1.00-1.48. ELIR: HR=1.36, CI:1.12-1.64) indices were positively associated with risk of PC progression. There was no evidence of associations between the indices and PCSM.

Both inflammatory and insulinemic dietary and lifestyle patterns are associated with risk of PC progression.

For men with PC, consuming dietary patterns that limit chronic systemic inflammation and insulin hypersecretion may improve survivorship, especially when coupled with active lifestyle and healthy body weight.

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2022 Jun 29 [Epub ahead of print]

Crystal S Langlais, Rebecca E Graff, Erin L Van Blarigan, Stacey A Kenfield, John Neuhaus, Fred K Tabung, Janet E Cowan, Jeanette M Broering, Peter Carroll, June M Chan

University of California, San Francisco, San Francisco, CA, United States., The Ohio State University College of Medicine, Columbus, Ohio, United States.

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