Prediagnosis dietary pattern and survival in patients with multiple myeloma

Dong Hoon Lee, Teresa T. Fung, Fred K. Tabung, Catherine R. Marinac, Elizabeth E. Devore, Bernard A. Rosner, Irene M. Ghobrial, Graham A. Colditz, Edward L. Giovannucci, Brenda M. Birmann

Research output: Contribution to journalArticlepeer-review


Inflammation and endogenous growth factors are important in multiple myeloma (MM) pathogenesis. Although diets that modulate these biologic pathways may influence MM patient survival, studies have not examined the association of dietary patterns with MM survival. We conducted pooled prospective survival analyses of 423 MM patients from the Nurses' Health Study (1986–2016) and the Health Professionals Follow-up Study (1988–2016) using Cox regression models. We used data from repeated food frequency questionnaires (FFQ) to compute dietary patterns as of the last prediagnosis FFQ, including the Alternate Healthy Eating Index (AHEI)-2010, alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension, Prudent, Western and empirical dietary inflammatory patterns and empirical dietary indices for insulin resistance and hyperinsulinemia. During follow-up, we documented 295 MM-related deaths among 345 total deaths. MM-specific mortality was 15–24% lower per one standard deviation (SD) increase (e.g., toward healthier habits) in favorable dietary pattern scores. For example, the multivariable-adjusted hazard ratio [HR] and 95% confidence interval [CI] per 1-SD increase in AHEI-2010 score were 0.76, 0.67–0.87 (p < 0.001). In contrast, MM-specific mortality was 16–24% higher per 1-SD increase (e.g., toward less healthy habits) in “unhealthy” diet scores; for example, the multivariable-adjusted HR, 95% CI per 1-SD increase in Western pattern score were 1.24, 1.07–1.44 (p = 0.005). Associations were similar for all-cause mortality. In conclusion, our consistent findings for multiple dietary patterns provide the first evidence that MM patients with healthier prediagnosis dietary habits may have longer survival than those with less healthy diets.

Original languageEnglish
Pages (from-to)1823-1830
Number of pages8
JournalInternational Journal of Cancer
Issue number7
Publication statusPublished - 2020 Oct 1

Bibliographical note

Funding Information:
We thank the participants and staff of the NHS and HPFS for their valuable contributions, as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. This work was supported by the National Institutes of Health (UM1 CA167552, R01 HL35464, UM1 CA186107, P01 CA87969, K99 CA207736, R00 CA207736, F32 CA220859 and R21 CA198239). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 UICC

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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