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Background: Pancreatic cancer is one of the deadliest cancers, and its incidence has been increasing steadily in the past decade. While some dietary components have been implicated as risk factors for pancreatic cancer, epidemiological data on the role of overall diet quality in pancreatic cancer etiology are limited, especially from population-based prospective studies. This study examined the relationship between diet quality and pancreatic cancer incidence in the Multiethnic Cohort Study (MEC). Methods: Data were analyzed from 177,313 African American, Native Hawaiian, Japanese American, Latino, and White men and women aged 45-75 years who completed a quantitative food frequency questionnaire at cohort entry. Diet quality was assessed by a priori diet quality indices (DQIs), the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII®). These five DQIs were investigated because of their potential to capture differences in various nutritional patterns across different racial/ethnic groups. Multivariate Cox models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the DQIs and pancreatic cancer incidence adjusted for age, sex, race/ethnicity, education, diabetes status, family history of pancreatic cancer, vigorous physical activity, smoking status with pack years, total energy intake, body mass index (BMI), and alcohol consumption. Stratified analyses were done by sex, race/ethnicity, smoking status and BMI. Results: During an average follow up of 19.3 years, 1,782 incident pancreatic cancer cases were identified. Overall, we did not observe statistically significant associations between the DQIs and pancreatic cancer risk. In subgroup analyses comparing the highest vs. lowest quintiles of the scores, a protective association was observed with the DASH for ever smokers (HR = 0.75, 95% CI: 0.60-0.92) and individuals with BMI ≥ 25 kg/m2 (HR = 0.77, 95% CI: 0.63-0.94), but not for never smokers (HR = 1.04, 95% CI: 0.82-1.31, P for heterogeneity = 0.004) or those with BMI < 25 kg/m2 (HR = 1.21, 95% CI: 0.94-1.56, P for heterogeneity = 0.097). There were no differences in associations by sex or race/ethnicity (P for heterogeneity ≥ 0.43). Conclusion: In this large prospective study, we did not find reduction in pancreatic cancer risk associated with healthier diet as assessed by the 5 DQIs. There is some indication that adherence to the DASH diet may potentially be protective against pancreatic cancer among ever smokers or individuals classified as overweight or obese. Further investigations are needed to confirm these findings. Citation Format: Heather Steel, Song-Yi Park, Tiffany Lim, Daniel Stram, Loic Le Marchand, Anna H. Wu, V. Wendy Setiawan. Diet quality and pancreatic cancer incidence in the Multiethnic Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5870.

Background: Data on diet quality and pancreatic cancer are limited. We examined the relationship between diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII®), and pancreatic cancer incidence in the Multiethnic Cohort Study. Methods: Diet quality scores were calculated from a validated food frequency questionnaire administered at baseline. Cox models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age, sex, race/ethnicity, education, diabetes, family history of pancreatic cancer, physical activity, smoking variables, total energy intake, body mass index (BMI) and alcohol consumption. Stratified analyses by sex, race/ethnicity, smoking status and BMI were conducted. Results: Over an average follow-up of 19.3 years, 1,779 incident pancreatic cancer cases were identified among 177,313 participants (average age of 60.2 years at baseline, 1993-1996). Overall, we did not observe associations between the dietary pattern scores and pancreatic cancer (aMED: 0.98, 0.83-1.16; HEI-2015: 1.03, 0.88-1.21; AHEI-2010: 1.03, 0.88-1.20; DASH: 0.92, 0.79-1.08; E-DII: 1.05, 0.89-1.23). An inverse association was observed with DASH for ever smokers (HR: 0.75, 0.61-0.93), but not for non-smokers (HR: 1.05, 0.83-1.32). Conclusion: The DASH diet showed an inverse association with pancreatic cancer among ever smokers, but does not show a protective association overall. Impact: Modifiable measures are needed to reduce pancreatic cancer burden in these high-risk populations; our study adds to the discussion of the benefit of dietary changes.

Summary Background and Aims Lifestyle factors are well associated with risk of hepatocellular carcinoma (HCC). However, the impact of reducing adverse lifestyle behaviours on population‐level burden of HCC is uncertain. Methods We conducted prospective analysis of the population‐based multi‐ethnic cohort (MEC) with linkage to cancer registries. The association of lifestyle factors (smoking, alcohol, diet quality assessed by alternate Mediterranean diet score, coffee drinking, physical activity and body mass index) with HCC incidence was examined using Cox regression. Population‐attributable risk (PAR, %) for the overall, lean and overweight/obese populations was determined. Results A total of 753 incident cases of HCC were identified in 181,346 participants over median follow‐up of 23.1 years. Lifestyle factors associated with elevated HCC risk included former/current smoking, heavy alcohol use, poor diet quality, lower coffee intake and obesity, but not physical activity. The lifestyle factor with highest PAR was lower coffee intake (21.3%; 95% CI: 8.9%–33.0%), followed by current smoking (15.1%; 11.1%–19.0%), obesity (14.5%; 9.2%–19.8%), heavy alcohol use (7.1%; 3.5%–10.6%) and lower diet quality (4.1%; 0.1%–8.1%). The combined PAR of all high‐risk lifestyle factors was 51.9% (95% CI: 30.1%–68.6%). A higher combined PAR was observed among lean (65.2%, 26.8%–85.7%) compared to overweight/obese (37.4%, 11.7%–58.3%) participants. Adjusting for viral hepatitis status in a linked MEC‐Medicare dataset resulted in similar PAR results. Conclusions Modifying lifestyle factors, particularly coffee intake, may have a substantial impact on HCC burden in diverse populations, with greater impact among lean adults. Diet and lifestyle counselling should be incorporated into HCC prevention strategies.