Article Figures & Data
Figures
- Figure 1.
Multivariate adjusted RRs and 95% CI for ovarian cancer according to lactose intake (>30 compared with <10 g/d) by study. Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23 to <25, 25 to <30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies. Black squares and horizontal lines, study-specific RRs and 95% CIs for ≥30 g/d lactose intake compared with <10 g/d. The area of the black squares is proportional to the inverse of the sum of the between-study variance and the study-specific variance, which is related to the sample size, the total number of cases, and the range of variation in intake. Diamond, pooled multivariate RR and the 95% CI. Vertical dashed line, pooled multivariate RR.
Tables
- Table 1.
Daily mean intakes of dairy nutrients and foods by cohort study in the ovarian cancer analyses in the Pooling Project of Prospective Studies of Diet and Cancer
Cohort Follow-up years Baseline cohort size* No. cases Mean (SD) intake Dietary calcium (mg/d) Total calcium† (mg/d) Lactose (g/d) Dietary vitamin D (IU/d) Total vitamin D† (IU/d) Total milk (g/d)‡ Hard cheese (g/d)‡ Cottage cheese (g/d)‡ Yogurt (g/d)‡ Ice cream (g/d)‡ AHS 1976-1988 18,402 53 833 (124) 880 (139) 18 (14) — — 419 (349) 8 (8) 35 (36) — — BCDDP 1987-1999 32,885 142 862 (369) 1,186 (2,979) 19 (14) 206 (122) 341 (279) 260 (269) 13 (20) 11 (22) — 19 (36) CNBSS§ 1980-2000 49,613 223 673 (253) — 8 (7) — — 200 (199) 22 (23) 14 (27) 29 (61) 10 (17) CPS II 1992-2001 61,202 278 884 (379) 1,136 (584) 19 (13) 197 (119) 342 (258) 277 (265) 11 (14) — 44 (71) 7 (19) IWHS 1986-2001 28,486 208 748 (285) 1,029 (483) 15 (11) 223 (111) 382 (292) 275 (265) 11 (13) 19 (31) 12 (39) 11 (19) NLCS§ 1986-1995 62,412 208 869 (259) — 14 (7) — — 187 (153) 23 (18) 10 (26) 53 (57) — NYSC 1980-1987 22,550 77 828 (209) 873 (220) 15 (9) 203 (68) 371 (227) 137 (87) — — — — NYU 1985-1998 12,401 65 810 (307) 888 (327) 14 (11) — — 202 (243) 17 (22) 15 (26) 38 (61) 19 (32) NHSa 1980-1986 80,195 120 722 (298) 731 (310) 14 (11) 167 (107) 279 (262) 215 (241) 14 (15) 21 (34) 21 (54) 13 (20) NHSb 1986-2002 59,538 315 718 (254) 1,056 (492) 13 (10) 182 (100) 319 (243) 221 (230) 13 (13) 17 (25) 28 (55) 13 (18) NHS II 1991-2002 91,502 52 787 (271) 910 (381) 16 (11) 223 (109) 351 (231) 268 (255) 12 (12) 9 (16) 31 (55) 8 (12) SMC 1987-2003 61,103 287 913 (255) — 16 (10) 162 (51) — 156 (130) 27 (19) — 104 (108) 7 (10) WHS 1993-2004 32,466 104 729 (258) 940 (442) 14 (10) 217 (104) 324 (216) 215 (222) 9 (11) 10 (17) 36 (64) 7 (13) NOTE: Studies that have a “—” did not estimate that nutrient or did not ask on their questionnaire about the consumption of that food item.
Abbreviations: AHS, Adventist Health Study; BCDDP, Breast Cancer Detection Demonstration Project Follow-up Study; CNBSS, Canadian National Breast Screening Study; CPS II, Cancer Prevention Study II Nutrition Cohort; IWHS, Iowa Women's Health Study; NLCS, the Netherlands Cohort Study; NYSC, New York State Cohort; NYU, New York University Women's Health Study; NHSa, Nurses' Health Study (part a); NHSb, Nurses' Health Study (part b); NHS II, Nurses' Health Study II; SMC, Swedish Mammography Cohort; WHS, Women's Health Study.
↵* Baseline cohort size was determined after specific exclusions (i.e., had a prior cancer diagnosis other than nonmelanoma skin cancer at baseline, had a bilateral oophorectomy before baseline, or had loge-transformed energy intakes beyond 3 SDs from the study-specific loge-transformed mean energy intake of the population).
↵† Total calcium and vitamin D intake includes dietary and supplemental sources.
↵‡ Milk: 1 8 oz serving is equivalent to 245 g; hard cheese: 1 oz serving is equivalent to 28 g; cottage cheese: 1 0.5 cups serving is equivalent to 105 g; yogurt: 1 cup serving is equivalent to 227 g; ice cream: 1 0.5 cups serving is equivalent to 66g.
↵§ The Canadian National Breast Screening Study and the Netherlands Cohort Study are analyzed as case-cohort studies so the baseline cohort size does not reflect the above exclusions.
- Table 2.
Median Pearson correlations for dairy products and nutrients across all studies included in the ovarian cancer analyses in the Pooling Project of Prospective Studies of Diet and Cancer
Lactose Total milk Whole milk Low-fat milk Hard cheese Cottage cheese Yogurt Ice cream Dietary calcium Total calcium Dietary vitamin D Total vitamin D Lactose 1.00 0.83 0.21 0.67 −0.08 0.08 0.18 0.02 0.90 0.63 0.83 0.40 Total milk 1.00 0.36 0.84 0.03 0.08 0.07 0.03 0.77 0.54 0.71 0.34 Whole milk 1.00 −0.19 0.03 0.00 −0.02 0.06 0.14 0.03 0.13 0.04 Low-fat milk 1.00 0.01 0.09 0.07 0.01 0.69 0.47 0.68 0.33 Hard cheese 1.00 0.09 0.04 0.09 0.17 0.08 −0.10 −0.04 Cottage cheese 1.00 0.15 0.03 0.14 0.10 0.04 0.04 Yogurt 1.00 0.00 0.28 0.23 0.17 0.13 Ice cream 1.00 −0.01 −0.01 −0.02 −0.02 Dietary calcium 1.00 0.70 0.79 0.39 Total calcium 1.00 0.50 0.47 Dietary vitamin D 1.00 0.47 Total vitamin D 1.00 NOTE: Median correlation value was calculated over all studies that measured that dairy food or nutrient. Studies that did not measure that particular food or nutrient were excluded from that specific analysis. For whole milk, New York State Cohort was excluded; for low-fat milk, New York State Cohort was excluded; for hard cheese, New York State Cohort was excluded; for cottage cheese, Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort were excluded; for yogurt, Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, and New York State Cohort were excluded; for ice cream, Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort were excluded; for total calcium (dietary + supplemental), Canadian National Breast Screening Study, the Netherlands Cohort Study, and Swedish Mammography Cohort were excluded; for dietary vitamin D, Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, and New York University Women's Health Study were excluded; and for total vitamin D, Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study, and Swedish Mammography Cohort were excluded. All studies measured lactose, total milk, and dietary calcium.
- Table 3.
Pooled age and multivariate adjusted RRs and 95% CIs for ovarian cancer according to intake of dairy foods and nutrients
Categories of intake Pheterogeneity* Ptrend† Foods Milk‡ (g/d) Range 0 1-69.9 70-124.9 125-249.9 250-499.9 ≥500 Cases 214 305 320 673 321 273 Age RR 1.00 (Reference) 0.98 (0.81-1.17) 1.07 (0.85-1.34) 1.09 (0.87-1.36) 0.90 (0.73-1.10) 1.10 (0.89-1.36) 0.48 0.20 MV RR 1.00 (Reference) 0.98 (0.81-1.17) 1.07 (0.84-1.35) 1.09 (0.87-1.36) 0.90 (0.73-1.11) 1.11 (0.87-1.41) 0.30 0.43 Whole§,∥ (g/d) Range 0 1-124.9 125-249.9 ≥250 Cases 1,120 428 226 145 Age RR 1.00 (Reference) 0.92 (0.82-1.04) 1.01 (0.87-1.18) 0.93 (0.75-1.16) 0.28 0.83 MV RR 1.00 (Reference) 0.94 (0.83-1.05) 1.04 (0.88-1.21) 0.95 (0.73-1.24) 0.10 0.99 Low-fat§ (g/d) Range 0 1-124.9 125-249.9 ≥250 Cases 818 343 449 373 Age RR 1.00 (Reference) 1.00 (0.87-1.15) 1.08 (0.93-1.25) 1.07 (0.94-1.23) 0.44 0.38 MV RR 1.00 (Reference) 0.99 (0.86-1.14) 1.08 (0.93-1.25) 1.07 (0.93-1.23) 0.51 0.38 Hard cheese¶,** (g/d) Range 0 1-24.9 25-49.9 ≥50 Cases 191 1,444 253 139 Age RR 1.00 (Reference) 1.05 (0.87-1.27) 1.05 (0.74-1.49) 1.24 (0.92-1.68) 0.66 0.51 MV RR 1.00 (Reference) 1.09 (0.90-1.33) 1.09 (0.77-1.53) 1.30 (0.96-1.78) 0.74 0.38 Cottage cheese††,‡‡ (g/d) Range 0 1-25.9 26-52.9 ≥53 Cases 542 668 179 75 Age RR 1.00 (Reference) 0.96 (0.85-1.09) 0.91 (0.75-1.12) 0.88 (0.63-1.23) 0.14 0.31 MV RR 1.00 (Reference) 0.97 (0.85-1.10) 0.92 (0.75-1.13) 0.88 (0.63-1.23) 0.14 0.33 Yogurt¶,§§ (g/d) Range 0 1-27.9 28-56.9 57-113.9 ≥114 Cases 800 407 177 197 228 Age RR 1.00 (Reference) 0.98 (0.87-1.12) 0.89 (0.75-1.05) 0.90 (0.76-1.07) 1.04 (0.87-1.24) 0.80 0.86 MV RR 1.00 (Reference) 0.97 (0.85-1.10) 0.87 (0.73-1.04) 0.89 (0.75-1.06) 1.04 (0.86-1.24) 0.75 0.89 Ice cream∥∥ (g/d) Range 0 1-16.9 17-32.9 33-65.9 ≥66 Cases 561 862 230 67 33 Age RR 1.00 (Reference) 0.98 (0.88-1.10) 1.07 (0.87-1.32) 1.13 (0.83-1.52) 0.85 (0.59-1.23) 0.67 0.82 MV RR 1.00 (Reference) 1.02 (0.90-1.14) 1.12 (0.90-1.38) 1.18 (0.85-1.63) 0.91 (0.63-1.32) 0.66 0.55 Nutrients Dietary calcium¶¶ (mg/d) Range <500 500-699.9 700-899.9 900-1,099.9 1,100-1,299.9 ≥1,300 Cases 287 554 562 354 182 140 Age RR 1.00 (Reference) 1.02 (0.88-1.18) 1.06 (0.87-1.28) 1.00 (0.78-1.29) 0.98 (0.79-1.21) 1.17 (0.93-1.47) 0.43 0.33 MV RR 1.00 (Reference) 1.02 (0.88-1.18) 1.05 (0.89-1.24) 1.00 (0.79-1.27) 0.98 (0.79-1.21) 1.17 (0.93-1.47) 0.53 0.38 Total calcium¶¶,*** (mg/d) Range <500 500-699.9 700-899.9 900-1,099.9 1,100-1,299.9 ≥1,300 Cases 119 251 274 213 169 335 Age RR 1.00 (Reference) 1.01 (0.85-1.33) 1.10 (0.87-1.40) 1.08 (0.85-1.36) 1.22 (0.95-1.56) 1.18 (0.90-1.53) 0.27 0.11 MV RR 1.00 (Reference) 1.05 (0.84-1.30) 1.06 (0.85-1.34) 1.04 (0.82-1.32) 1.16 (0.90-1.48) 1.08 (0.84-1.38) 0.37 0.49 Lactose (g/d) Range <10 10-19.9 20-29.9 ≥ 30 Cases 785 793 344 210 Age RR 1.00 (Reference) 1.09 (0.97-1.22) 1.06 (0.91-1.24) 1.21 (1.03-1.42) 0.55 0.17 MV RR 1.00 (Reference) 1.09 (0.97-1.22) 1.07 (0.91-1.25) 1.19 (1.01-1.40) 0.58 0.19 Dietary vitamin D†††,‡‡‡ (IU/d) Range <100 100-199.9 200-299.9 300-399.9 400-499.9 ≥ 500 Cases 226 699 427 136 71 24 Age RR 1.00 (Reference) 1.05 (0.90-1.22) 1.11 (0.94-1.31) 1.07 (0.84-1.36) 1.60 (1.20-2.13) 1.46 (0.80-2.65) 0.15 0.02 MV RR 1.00 (Reference) 1.05 (0.90-1.23) 1.10 (0.93-1.30) 1.05 (0.83-1.33) 1.56 (1.17-2.08) 1.37 (0.78-2.40) 0.21 0.04 Total vitamin D†††,‡‡‡ (IU/d) Range <100 100-199.9 200-299.9 300-399.9 400-499.9 ≥500 Cases 125 346 252 113 121 339 Age RR 1.00 (Reference) 1.20 (0.97-1.48) 1.28 (1.02-1.59) 1.11 (0.80-1.54) 1.33 (1.02-1.72) 1.16 (0.94-1.44) 0.49 0.29 MV RR 1.00 (Reference) 1.20 (0.97-1.48) 1.26 (1.00-1.57) 1.09 (0.79-1.51) 1.27 (0.98-1.64) 1.12 (0.90-1.38) 0.55 0.60 NOTE: Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23-<25, 25-<30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies.
Abbreviation: MV RR, multivariate RR.
↵* P value, test for between-studies heterogeneity is based on the highest category of intake for that food or nutrient.
↵† P value, test for trend.
↵‡ New York State Cohort was not included in the categories 250 to 499.9 and ≥500 g/d of milk because this study had no cases in that category.
↵§ New York State Cohort was not included in the low-fat or whole-milk analyses because they did not measure consumption of these items separately.
↵∥ Nurses' Health Study II was not included in the category ≥250 g/d of whole milk because this study had no cases in that category.
↵¶ New York State Cohort is not included in the hard cheese or yogurt analyses because they did not measure consumption of these food items.
↵** Adventist Health Study, Nurses' Health Study (part a) and Nurses' Health Study II were not included in the category ≥50 g/d of hard cheese because this study had no cases in that category.
↵†† Nurses' Health Study II was not included in the category ≥53 g/d of cottage cheese because this study had no cases in that category.
↵‡‡ Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort were not included in this analysis because they did not measure consumption of this item.
↵§§ Adventist Health Study and Breast Cancer Detection Demonstration Project Follow-up Study are not included in the yogurt analysis because they did not measure consumption of this food item.
↵∥∥ Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort are excluded from the ice cream analyses because they did not measure consumption of this food item. Nurses' Health Study II and Women's Health Study were not included in the category ≥66 g/d of ice cream because this study had no cases in that category.
↵¶¶ Adventist Health Study was not included in the analysis of dietary or total calcium because this study had no cases in the reference group.
↵*** Canadian National Breast Screening Study, the Netherlands Cohort Study, Swedish Mammography Cohort are excluded from the total calcium and vitamin D analyses because they did not have supplement use data available for these nutrients.
↵††† New York State Cohort, Nurses' Health Study (part a) were not included in the category ≥500 g/d of dietary vitamin D because this study had no cases in that category.
↵‡‡‡ Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study are excluded from the dietary and total (dietary and supplemental) vitamin D analyses because they did not assess vitamin D intake; Swedish Mammography Cohort is excluded from the total (dietary and supplemental) vitamin D analyses because they did not have supplement use data available.
- Table 4.
Pooled multivariate adjusted RRs and 95% CIs for histologic subtypes of ovarian cancer according to dairy food and nutrient intake, continuous model
Increment* (/d) All ovarian cancer Endometrioid cancer† Mucinous cancer‡ Serous cancer§ P∥ Case, n RR (95% CI)¶ P** Case n RR (95% CI)¶ P** Case n RR (95% CI)¶ P** Case n RR (95% CI)¶ P** Foods Milk 250 g 2,106 1.02 (0.97-1.08) 0.34 255 1.10 (0.95-1.27) 0.50 120 0.97 (0.77-1.22) 0.40 1,015 1.06 (0.94-1.19) 0.01 0.60 Whole milk†† 250 g 1,919 0.98 (0.88-1.10) 0.09 240 0.91 (0.65-1.27) 0.29 113 1.19 (0.88-1.61) 0.88 930 0.91 (0.76-1.08) 0.19 0.37 Low-fat milk†† 250 g 1,983 1.04 (0.98-1.09) 0.64 249 1.16 (1.00-1.34) 0.81 116 0.93 (0.73-1.20) 0.42 968 1.08 (0.99-1.18) 0.26 0.21 Cheese Hard cheese‡‡ 25 g 2,027 1.02 (0.93-1.11) 0.17 259 1.11 (0.92-1.35) 0.77 122 1.00 (0.75-1.33) 0.56 982 1.07 (0.97-1.18) 0.69 0.75 Cottage cheese§§ 105 g 1,464 0.82 (0.63-1.08) 0.22 182 0.95 (0.50-1.81) 0.64 87 1.59 (0.92-2.57) 0.53 708 0.90 (0.62-1.32) 0.21 0.05 Yogurt∥∥ 227 g 1,809 0.91 (0.77-1.07) 0.80 239 0.98 (0.64-1.49) 0.83 119 0.83 (0.42-1.64) 0.71 931 0.93 (0.74-1.18) 0.93 0.95 Ice cream¶¶ 66 g 1,753 1.00 (0.84-1.20) 0.49 237 1.13 (0.68-1.87) 0.76 96 0.47 (0.12-1.83) 0.20 869 1.17 (0.94-1.44) 0.85 0.36 Nutrients Dietary calcium 350mg 2,132 1.03 (0.97-1.09) 0.32 261 1.08 (0.93-1.25) 0.39 122 0.88 (0.70-1.11) 0.70 1,025 1.08 (0.97-1.21) 0.03 0.50 Total calcium*** 350mg 1,414 1.01 (0.99-1.02) 0.41 148 1.08 (0.94-1.24) 0.03 59 1.08 (0.89-1.30) 0.48 682 1.00 (0.93-1.07) 0.29 0.53 Lactose 10 g 2,132 1.04 (0.99-1.08) 0.26 261 1.07 (0.95-1.20) 0.63 122 0.97 (0.81-1.16) 0.66 1,025 1.06 (0.97-1.16) 0.02 0.63 Dietary vitamin D††† 100 IU 1,583 1.06 (1.00-1.12) 0.28 198 1.17 (0.97-1.42) 0.04 81 0.95 (0.73-1.24) 0.22 782 1.04 (0.98-1.12) 0.83 0.84 Total vitamin D‡‡‡ 100 IU 1,296 1.02 (0.99-1.04) 0.31 148 1.08 (1.02-1.15) 0.21 59 0.99 (0.85-1.10) 0.25 647 1.02 (0.94-1.09) 0.85 0.17 ↵* Increment for foods is based on the standard serving size and for nutrients is based on the mean of the SD of the mean intake for each nutrient.
↵† Endometrioid analyses additionally exclude Adventist Health Study, New York State Cohort, and New York University Women's Health Study due to small case numbers.
↵‡ Mucinous analyses additionally exclude Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, New York State Cohort, New York University Women's Health Study, Nurses' Health Study II, and Women's Health Study due to small case numbers.
↵§ Serous analyses additionally exclude Adventist Health Study due to small case numbers.
↵∥ P value for the test for the common effect by histologic types of ovarian cancer (endometrioid, mucinous, and serous).
↵¶ Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23-<25, 25-<30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies.
↵** P value, test for between-studies heterogeneity.
↵†† New York State Cohort is not included in the low-fat or whole-milk analyses because they did not measure consumption of these items separately.
↵‡‡ New York State Cohort is not included in the hard cheese analyses because they did not measure consumption of this food item.
↵§§ Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort are excluded from the cottage cheese analyses because they did not measure consumption of this food item.
↵∥∥ Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, and New York State Cohort are excluded from the yogurt analyses because they did not measure consumption of this food item.
↵¶¶ Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort are excluded from the ice cream analyses because they did not measure consumption of this food item.
↵*** Canadian National Breast Screening Study, the Netherlands Cohort Study, and Swedish Mammography Cohort are excluded from the total calcium analyses because they did not have supplement use data available.
↵††† Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study are excluded from the dietary and total vitamin D analyses because they did not assess vitamin D intake.
↵‡‡‡ Swedish Mammography Cohort is excluded from the total vitamin D analyses because they did not have supplement use data available.
Volume 15, Issue 2
