Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium

Christina M Nagle; Torukiri I Ibiebele; Renhua Na; Elisa V Bandera; Daniel Cramer; Jennifer A Doherty; Graham G Giles; Marc T Goodman; Gillian E Hanley; Holly R Harris; Allan Jensen; Susanne K Kjaer; Alice Lee; Valerie McGuire; Roger L Milne; Bo Qin; Jean Richardson; Naoko Sasamoto; Joellen M Schildkraut; Weiva Sieh; Kathryn L Terry; Linda Titus; Britton Trabert; Nicolas Wentzensen; Anna H Wu; Andrew Berchuck; Malcolm C Pike; Celeste Leigh Pearce; Penelope M Webb; Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium

doi:10.1016/j.ajcnut.2025.02.004

Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium

Christina M Nagle, Torukiri I Ibiebele, Renhua Na, Elisa V Bandera, Daniel Cramer, Jennifer A Doherty, Graham G Giles, Marc T Goodman, Gillian E Hanley, Holly R Harris, Allan Jensen, Susanne K Kjaer, Alice Lee, Valerie McGuire, Roger L Milne, Bo Qin, Jean Richardson, Naoko Sasamoto, Joellen M Schildkraut, Weiva SiehKathryn L Terry, Linda Titus, Britton Trabert, Nicolas Wentzensen, Anna H Wu, Andrew Berchuck, Malcolm C Pike, Celeste Leigh Pearce, Penelope M Webb^*, Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium

^*Corresponding author for this work

Department of Gynaecology, Fertility and Births

3 Citations (Scopus)

Abstract

BACKGROUND: Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent.

OBJECTIVES: This study aims to pool data from studies conducted around the world to evaluate the relationships among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer.

METHODS: This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models.

RESULTS: Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival; however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75; 95% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76; 95% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71; 95% CI: 0.56, 0.91), tomatoes (aHR: 0.72; 95% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71; 95% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids.

CONCLUSIONS: Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.

Original language	English
Journal	The American journal of clinical nutrition
Volume	121
Issue number	4
Pages (from-to)	758-768
Number of pages	11
ISSN	0002-9165
DOIs	https://doi.org/10.1016/j.ajcnut.2025.02.004
Publication status	Published - Apr 2025

Keywords

diet
diet quality
foods
nutrients
ovarian cancer
survival
Humans
Middle Aged
Proportional Hazards Models
Ovarian Neoplasms/mortality
Diet, Healthy
Diet
Female
Aged

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Nagle, C. M., Ibiebele, T. I., Na, R., Bandera, E. V., Cramer, D., Doherty, J. A., Giles, G. G., Goodman, M. T., Hanley, G. E., Harris, H. R., Jensen, A., Kjaer, S. K., Lee, A., McGuire, V., Milne, R. L., Qin, B., Richardson, J., Sasamoto, N., Schildkraut, J. M., ... Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium (2025). Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium. The American journal of clinical nutrition, 121(4), 758-768. https://doi.org/10.1016/j.ajcnut.2025.02.004

Nagle, CM, Ibiebele, TI, Na, R, Bandera, EV, Cramer, D, Doherty, JA, Giles, GG, Goodman, MT, Hanley, GE, Harris, HR, Jensen, A, Kjaer, SK, Lee, A, McGuire, V, Milne, RL, Qin, B, Richardson, J, Sasamoto, N, Schildkraut, JM, Sieh, W, Terry, KL, Titus, L, Trabert, B, Wentzensen, N, Wu, AH, Berchuck, A, Pike, MC, Pearce, CL, Webb, PM & Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium 2025, 'Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium', The American journal of clinical nutrition, vol. 121, no. 4, pp. 758-768. https://doi.org/10.1016/j.ajcnut.2025.02.004

@article{b2cbefefd908447498bba65602ad4557,

title = "Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium",

abstract = "BACKGROUND: Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent.OBJECTIVES: This study aims to pool data from studies conducted around the world to evaluate the relationships among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer.METHODS: This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHRs) and 95\% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models.RESULTS: Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival; however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95\% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75; 95\% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76; 95\% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71; 95\% CI: 0.56, 0.91), tomatoes (aHR: 0.72; 95\% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71; 95\% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids.CONCLUSIONS: Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.",

keywords = "diet, diet quality, foods, nutrients, ovarian cancer, survival, Humans, Middle Aged, Proportional Hazards Models, Ovarian Neoplasms/mortality, Diet, Healthy, Diet, Female, Aged",

author = "Nagle, \{Christina M\} and Ibiebele, \{Torukiri I\} and Renhua Na and Bandera, \{Elisa V\} and Daniel Cramer and Doherty, \{Jennifer A\} and Giles, \{Graham G\} and Goodman, \{Marc T\} and Hanley, \{Gillian E\} and Harris, \{Holly R\} and Allan Jensen and Kjaer, \{Susanne K\} and Alice Lee and Valerie McGuire and Milne, \{Roger L\} and Bo Qin and Jean Richardson and Naoko Sasamoto and Schildkraut, \{Joellen M\} and Weiva Sieh and Terry, \{Kathryn L\} and Linda Titus and Britton Trabert and Nicolas Wentzensen and Wu, \{Anna H\} and Andrew Berchuck and Pike, \{Malcolm C\} and Pearce, \{Celeste Leigh\} and Webb, \{Penelope M\} and \{Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium\}",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2025",

month = apr,

doi = "10.1016/j.ajcnut.2025.02.004",

language = "English",

volume = "121",

pages = "758--768",

journal = "The American journal of clinical nutrition",

issn = "0002-9165",

publisher = "Elsevier BV",

number = "4",

}

TY - JOUR

T1 - Diet and survival after a diagnosis of ovarian cancer

T2 - a pooled analysis from the Ovarian Cancer Association Consortium

AU - Nagle, Christina M

AU - Ibiebele, Torukiri I

AU - Na, Renhua

AU - Bandera, Elisa V

AU - Cramer, Daniel

AU - Doherty, Jennifer A

AU - Giles, Graham G

AU - Goodman, Marc T

AU - Hanley, Gillian E

AU - Harris, Holly R

AU - Jensen, Allan

AU - Kjaer, Susanne K

AU - Lee, Alice

AU - McGuire, Valerie

AU - Milne, Roger L

AU - Qin, Bo

AU - Richardson, Jean

AU - Sasamoto, Naoko

AU - Schildkraut, Joellen M

AU - Sieh, Weiva

AU - Terry, Kathryn L

AU - Titus, Linda

AU - Trabert, Britton

AU - Wentzensen, Nicolas

AU - Wu, Anna H

AU - Berchuck, Andrew

AU - Pike, Malcolm C

AU - Pearce, Celeste Leigh

AU - Webb, Penelope M

AU - Multidisciplinary Ovarian Cancer Outcomes Group and Ovarian Cancer Association Consortium

PY - 2025/4

Y1 - 2025/4

N2 - BACKGROUND: Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent.OBJECTIVES: This study aims to pool data from studies conducted around the world to evaluate the relationships among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer.METHODS: This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models.RESULTS: Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival; however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75; 95% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76; 95% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71; 95% CI: 0.56, 0.91), tomatoes (aHR: 0.72; 95% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71; 95% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids.CONCLUSIONS: Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.

AB - BACKGROUND: Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent.OBJECTIVES: This study aims to pool data from studies conducted around the world to evaluate the relationships among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer.METHODS: This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models.RESULTS: Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival; however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75; 95% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76; 95% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71; 95% CI: 0.56, 0.91), tomatoes (aHR: 0.72; 95% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71; 95% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids.CONCLUSIONS: Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.

KW - diet

KW - diet quality

KW - foods

KW - nutrients

KW - ovarian cancer

KW - survival

KW - Humans

KW - Middle Aged

KW - Proportional Hazards Models

KW - Ovarian Neoplasms/mortality

KW - Diet, Healthy

KW - Diet

KW - Female

KW - Aged

UR - https://www.scopus.com/pages/publications/85218859063

U2 - 10.1016/j.ajcnut.2025.02.004

DO - 10.1016/j.ajcnut.2025.02.004

M3 - Journal article

C2 - 39921094

SN - 0002-9165

VL - 121

SP - 758

EP - 768

JO - The American journal of clinical nutrition

JF - The American journal of clinical nutrition

IS - 4

ER -

Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium

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Keywords

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