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Healthy eating index and ovarian cancer risk


The evidence for a role of diet on ovarian cancer prevention remains inconclusive. While many studies have evaluated individual foods and food groups, the evaluation of a comprehensive dietary quality index for predicting cancer risk has received little attention. This study investigates the association between the Healthy Eating Index (HEI), which reflects adherence to the current USDA Dietary Guidelines for Americans and ovarian cancer risk in a population-based case–control study in New Jersey. A total of 205 cases and 390 controls completed the Block 98.2 food frequency questionnaire (FFQ) in addition to reporting on potential risk factors for ovarian cancer. FFQ data were then utilized to calculate the HEI score, and cup, ounce, gram, or caloric equivalents for the 12 different food groups comprising the index. In multivariate models, the OR for the highest tertile of the HEI score compared with the lowest (reflecting a better diet compared with a worse diet) was 0.90 (95% CI: 0.55–1.47). There was limited evidence for a statistically significant association between any of the 12 individual food components and ovarian cancer risk. Based on this study’s results, neither individual food groups nor dietary quality showed potential for preventing ovarian cancer.

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Odds Ratio


Confidence Interval


Food frequency questionnaire


Body mass index


Waist to hip ratio


Hormone replacement therapy




Oral contraceptives


  1. 1.

    American Cancer Society (2010) Cancer facts and figures

  2. 2.

    National Cancer Institute (2010) Ovarian Cancer National Cancer Institute <> (cited 30 Aug 2010)

  3. 3.

    Holschneider CH, Berek JS (2000) Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol 19:3–10

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Permuth-Wey J, Sellers TA (2009) Epidemiology of ovarian cancer. In: Verma M (ed) Methods of molecular biology, cancer epidemiology. Humana Press, Totowa, pp 413–437

    Chapter  Google Scholar 

  5. 5.

    Bandera EV (2007) Nutritional factors in ovarian cancer prevention: what have we learned in the past 5 years? Nutr Cancer 59:142–151

    PubMed  Google Scholar 

  6. 6.

    Mommers M, Schouten LJ, Goldbohm RA et al (2005) Consumption of vegetables and fruits and risk of ovarian carcinoma. Cancer 104:1512–1519

    PubMed  Article  Google Scholar 

  7. 7.

    Kolahdooz F, Ibiebele TI, van der Pols JC et al (2009) Dietary patterns and ovarian cancer risk. Am J Clin Nutr 89:297–304

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Koushik A, Hunter DJ, Spiegelman D et al (2005) Fruits and vegetables and ovarian cancer risk in a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev 14:2160–2167

    PubMed  Article  Google Scholar 

  9. 9.

    Schulz M, Lahmann PH, Riboli E et al (2004) Dietary determinants of epithelial ovarian cancer: a review of the epidemiologic literature. Nutr Cancer 50:120–140

    PubMed  Article  Google Scholar 

  10. 10.

    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington

    Google Scholar 

  11. 11.

    Olsen CM, Green AC, Whiteman DC et al (2007) Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis. Eur J Cancer 43:690–709

    PubMed  Article  Google Scholar 

  12. 12.

    Biesma RG, Schouten LJ, Dirx MJ et al (2006) Physical activity and risk of ovarian cancer: results from the Netherlands cohort study (The Netherlands). Cancer Causes Cont 17:109–115

    Article  Google Scholar 

  13. 13.

    Lahmann PH, Friedenreich C, Schulz M et al (2009) Physical activity and ovarian cancer risk: the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 18:351–354

    PubMed  Article  Google Scholar 

  14. 14.

    Leitzmann MF, Koebnick C, Moore SC et al (2009) Prospective study of physical activity and the risk of ovarian cancer. Cancer Causes Control 20:765–773

    PubMed  Article  Google Scholar 

  15. 15.

    Rossing MA, Cushing-Haugen KL, Wicklund KG et al (2010) Recreational physical activity and risk of epithelial ovarian cancer. Cancer Causes Cont 21(4):485–491

    Article  Google Scholar 

  16. 16.

    Ray G, Henson DE, Schwartz AM (2010) Cigarette smoking as a cause of cancers other than lung cancer: an exploratory study using the SEER program. Chest 138(3):491–499

    PubMed  Article  Google Scholar 

  17. 17.

    Chandran U, Bandera EV, Williams-King MG et al (2010) Adherence to the dietary guidelines for Americans and endometrial cancer risk. Cancer Causes Cont 21:1895–1904

    Article  Google Scholar 

  18. 18.

    Fung TT, Hu FB, McCullough ML et al (2006) Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr 136:466–472

    PubMed  CAS  Google Scholar 

  19. 19.

    Reedy J, Mitrou PN, Krebs-Smith SM et al (2008) Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP diet and health study. Am J Epidemiol 168:38–48

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Miller PE, Lazarus P, Lesko SM et al (2010) Diet index-based and empirically derived dietary patterns are associated with colorectal cancer risk. J Nutr 140(7):1267–1273

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    McCullough ML, Feskanich D, Rimm EB et al (2000) Adherence to the dietary guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 72:1223–1231

    PubMed  CAS  Google Scholar 

  22. 22.

    McCullough ML, Feskanich D, Stampfer MJ et al (2000) Adherence to the dietary guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr 72:1214–1222

    PubMed  CAS  Google Scholar 

  23. 23.

    Guenther PMRJ, Krebs-Smith SM, Reeve BB, Basiotis PP (2007) Development and evaluation of the Healthy Eating Index-2005 (cited 2 Sept 2010)

  24. 24.

    Bowman S, Lino M, Gerrior SA, Basiotis PP (1998) The healthy eating index:1994–1996. (cited 2 Sept 2010)

  25. 25.

    Olson SH, Orlow I, Bayuga S et al (2008) Variants in hormone biosynthesis genes and risk of endometrial cancer. Cancer Causes Cont 19:955–963

    Google Scholar 

  26. 26.

    Fortuny J, Sima C, Bayuga S et al (2009) Risk of endometrial cancer in relation to medical conditions and medication use. Cancer Epidemiol Biomarkers Prev 18:1448–1456

    PubMed  Article  Google Scholar 

  27. 27.

    Bandera EV, Williams MG, Sima C et al (2009) Phytoestrogen consumption and endometrial cancer risk: a population-based case-control study in New Jersey. Cancer Causes Cont 20:1117–1127

    Article  Google Scholar 

  28. 28.

    United States Department of Agriculture (2007) Healthy Eating Index (cited 1 Sept 2010)

  29. 29.

    United States Department of Agriculture (2010) Nutrient database for standard reference. Nutrient data laboratory. (cited 2 Sept 2010)

  30. 30.

    United States Department of Agriculture (2010) What’s in the foods you eat, Search Tool, 3.0 (cited 2 Sept 2010)

  31. 31.

    United States Department of Agriculture MyFood-a-Pedia. Center for Nutrition Policy and Promotion (cited 15 Sept 2010)

  32. 32.

    Savoca MR, Arcury TA, Leng X et al (2009) The diet quality of rural older adults in the South as measured by healthy eating index-2005 varies by ethnicity. J Am Diet Assoc 109:2063–2067

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Savoca MR, Arcury TA, Leng X et al (2010) Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems. J Am Geriatr Soc 58:1225–1232

    PubMed  Article  Google Scholar 

  34. 34.

    United States Department of Agriculture (2009) Inside the pyramid (cited 2 Sept 2010)

  35. 35.

    Gebhardt SE, Thomas RG (2002) Nutritive value of foods. U.S. Department of Agriculture. Agricultural Research Service. Home and Garden Bulletin No.72 (cited 2 Sept 2010)

  36. 36.

    National Blood, Heart, and Lung Institute (2010) Food Exchange Lists (cited 2 Sept 2010)

  37. 37.

    United States Department of Agriculture (2006) USDA database for the added sugar content of selected foods. (cited 2 Sept 2010)

  38. 38.

    United States Department of Agriculture (2009) Healthy Eating Index-2005 development and evaluation technical report support files (cited 2 Sept 2010)

  39. 39.

    Kushi LH, Byers T, Doyle C et al. (2006) American cancer society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 56:254–281, quiz 313–4

    Google Scholar 

  40. 40.

    Harnack L, Nicodemus K, Jacobs DR Jr et al (2002) An evaluation of the dietary guidelines for Americans in relation to cancer occurrence. Am J Clin Nutr 76:889–896

    PubMed  CAS  Google Scholar 

  41. 41.

    Hartge P (2006) Participation in population studies. Epidemiology 17:252–254

    PubMed  Article  Google Scholar 

  42. 42.

    New Jersey State Cancer Registry (2008) Cancer Epidemiology Services. New Jersey Department of Health and Senior Services. Primary Epithelial Ovarian Cancer in 6 NJ Counties, age-specific incidence rates by race and age, 2003–2006. November 2008 file

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We thank Thanusha Puvananayagam, the interviewers and students who were involved in this study, the New Jersey Department of Health and Senior Services personnel, as well as all the participants who generously donated their time to the study. This work was funded by NIH-K07 CA095666, R01CA83918, K22CA138563, and The Cancer Institute of New Jersey.

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Correspondence to Elisa V. Bandera.



See Table 4.

Table 4 Healthy Eating Index 2005—components and standards for scoring [23]

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Chandran, U., Bandera, E.V., Williams-King, M.G. et al. Healthy eating index and ovarian cancer risk. Cancer Causes Control 22, 563–571 (2011).

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  • Diet
  • Ovarian cancer
  • Food
  • Healthy Eating Index
  • Fruit
  • Vegetables
  • Grain
  • Whole grain
  • Dairy
  • Meat
  • Beans
  • Oils
  • Saturated fat
  • Diet
  • Nutrition