Inflammatory and insulinemic dietary and lifestyle patterns and incidence of endometrial cancer: the multiethnic cohort
The incidence of endometrial cancer (EC) is increasing, particularly among racial and ethnic minority groups. Obesity is an established EC risk factor, and obesity-related inflammation and hyperinsulinemia may play an important role in EC etiology. We examined the association of 5 empirical hypothesis-oriented dietary and lifestyle indices, which assess the inflammatory and insulinemic potentials of diet and lifestyle, with risk of EC in ethnically diverse females. We included 60,441 female participants from the multiethnic cohort study, a cohort-based in the United States, who were African American, Japanese American, Latino, Native Hawaiian, or White, aged 45-75 y at baseline in 1993-1996. Using a quantitative food frequency questionnaire at baseline, we computed the empirical dietary inflammatory pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), empirical lifestyle index for hyperinsulinemia (ELIH), empirical dietary index for insulin resistance (EDIR), and empirical lifestyle index for insulin resistance (ELIR). Multivariable Cox models adjusting for known risk factors for EC were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between each index (using quintiles) and EC risk. We identified 1328 incident EC cases with a median follow-up of 25.2 y (IQR = 7.4 y). Females with higher ELIH had an increased risk of EC (HR In this ethnically diverse cohort, lifestyle patterns with higher insulinemic potential were associated with an increased risk of EC. Lifestyle changes that include more physical activity and achieving a healthy body weight, in addition to reducing insulinemic and diets, may lower EC risk.