Title: Dietary Patterns and Endometrial Cancer Risk in the California Teachers Study Cohort

Authors: Alison J. Canchola, James V. Lacey, Jr., Leslie Bernstein, Pamela L. Horn-Ross

Journal: Cancer Causes and Control

Corresponding author: Alison Canchola, Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538; USA; Phone: 510-608-5029; FAX: 510-608-5085; E-mail:

Online Resource Table 1. Factor loadings from principal components factor analysis for foods and beverages defining dietary patterns in the California Teachers Study, N=118,465.a, b

Food item / Plant-based / High-protein, high-fat / High- carbohydrate / Ethnic / Salad and wine
Peaches, apricots (fresh) / 0.57
Strawberries, other berries / 0.55
Carrots, mixed vegetables with carrots / 0.52
Apples, apple sauce / 0.51
Other fruit (e.g., grapes, raisins, kiwi, fruit cocktail) / 0.50
Oranges / 0.46
Broccoli / 0.46
Bananas / 0.45
Watermelon / 0.44
Cantaloupe / 0.41
Other vegetables / 0.39
String beans, green beans / 0.38
Peas / 0.36
Cauliflower, Brussels sprouts / 0.36
Peaches, apricots (dried) / 0.35
Butter, margarine, or fat added to vegetables / 0.55
Beef roasts, steaks, sandwiches / 0.52
Sausage, bacon / 0.49
Pork / 0.46
Hamburgers, cheeseburgers / 0.45
Fried chicken / 0.44
Beef stew or pot pie with vegetables / 0.43
Eggs / 0.40
Fried potatoes / 0.39 / 0.36
Butter on bread or rolls / 0.39
Salad dressing or mayonnaise (regular) / 0.38
Burritos or tacos with meat or beans / 0.54
Pizza / 0.50
Salsa, ketchup, taco sauce / 0.49
Tortillas / 0.43
Spaghetti, lasagna, other pasta with tomato sauce / 0.42
Bagels, English muffins, hamburger buns / 0.40
Lentil, pea and bean soups / 0.50
Beans such as baked beans, pintos, kidney (not including in soup) / 0.49
Tofu, bean curd / 0.44
Vegetable soups / 0.39
Rice / 0.38
Meat substitutes made from soy / 0.38
Mustard, turnip greens, collards / 0.37
Sweet potatoes, yams / 0.35
Green Salad / 0.50
Fish (broiled or baked) / 0.43
Wine, champagne / 0.42
Salad dressing or mayonnaise (low fat) / 0.42
Coffee, tea / 0.37
Tomatoes, tomato juice / 0.37

a Foods and beverages with factors loadings of ≥0.35 are shown.

b Previously published in Link L, Canchola A, Bernstein L, et al. (2013) Dietary patterns and breast cancer risk in the California Teachers Study cohort. Am J Clin Nutr. 98: 1524-32.

Online Resource Table 2. Endometrial cancer risk by participant characteristics, for those included in the present analysis, California Teachers Study Cohort, 1995-2011, N=75,093

Characteristic / Casesa / Person-years / RRb / 95% CI
Race
White (non-Hispanic) / 850 / 901,777 / 1.0
Non-white / 87 / 131,365 / 0.98 / 0.78, 1.23
Age at menarche
Per year increase / 937 / 1,033,141 / 0.94 / 0.90, 0.99
Age at last pregnancy
Nulligravid / 228 / 225,217 / 1.0
Age <25 yrs / 83 / 73,454 / 1.08 / 0.84, 1.40
Age 25-29 yrs / 222 / 223,369 / 0.85 / 0.70, 1.03
Age 30-34 yrs / 250 / 307,270 / 0.74 / 0.61, 0.89
Age ≥35 yrs / 154 / 203,831 / 0.61 / 0.50, 0.76
Oral contraceptive use
Never / 461 / 275,906 / 1.0
<3 yrs / 161 / 206,382 / 0.76 / 0.62, 0.93
≥3 yrs / 315 / 550,853 / 0.58 / 0.49, 0.69
Physical activityc
<5.5 hrs/wk / 732 / 714,987 / 1.0
≥5.5 hrs/wk / 205 / 318,154 / 0.81 / 0.69, 0.94
Smoking status
Never / 584 / 704,684 / 1.0
Ever / 353 / 328,457 / 0.95 / 0.83, 1.09
Caloric intake
Per 1,000 kcal increase / 937 / 1,033,141 / 1.08 / 0.96, 1.22
Height
Per inch increase / 937 / 1,033,141 / 1.05 / 1.02, 1.08
Body mass index, time-dependent
Per kg/m2 increase / 937 / 1,033,141 / 1.06 / 1.05, 1.07
Menopausal status and hormone therapy use, time-dependent
Premenopausal / 39 / 267,510 / 1.30 / 0.82, 2.07
Peri/postmenopausal not using HT / 394 / 317,320 / 1.0
Peri/postmenopausal using HT / 261 / 183,079 / 1.37 / 1.16, 1.62
Missing / 243 / 265,491 / 1.22 / 1.03, 1.44

CI, confidence interval; RR, relative risk

a Number of cases of endometrial cancer.

b All factors listed were included in a single Cox regression model; age was the time metric and the model was stratified by age at baseline.

c Average lifetime (high school to age 54 or age at baseline if younger) strenuous plus moderate physical activity.

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Online Resource Table 3. Participant characteristics by quintiles of the “salad and wine” dietary pattern, for those included in the present analysis, California Teachers Study Cohort, 1995-2011, N=75,093

Quintile 1 (lowest) / Quintile 2 / Quintile 3 / Quintile 4 / Quintile 5 (highest)
Characteristic / Med / IQR / % / Med / IQR / % / Med / IQR / % / Med / IQR / % / Med / IQR / %
Age at baseline, yrs / 41 / 34-49 / 46 / 38-53 / 49 / 42-57 / 51 / 44-60 / 54 / 47-64
<40 / 44.0 / 28.7 / 19.2 / 13.4 / 8.0
40-49 / 32.9 / 35.7 / 34.9 / 31.6 / 25.0
50-59 / 14.5 / 21.1 / 25.8 / 29.6 / 30.9
60-69 / 4.9 / 8.4 / 12.0 / 15.6 / 23.2
70-79 / 3.0 / 4.8 / 6.8 / 8.0 / 11.2
≥80 / 0.7 / 1.3 / 1.3 / 1.8 / 1.7
Race/ethnicity
White / 78.7 / 85.1 / 88.6 / 91.6 / 93.9
Hispanic / 8.9 / 5.4 / 3.8 / 2.9 / 2.0
Asian/PI / 5.9 / 5.2 / 3.8 / 2.4 / 1.5
Black / 3.9 / 2.2 / 1.9 / 1.3 / 1.1
Other/mixed / 2.6 / 2.0 / 1.9 / 1.7 / 1.5
Age at menarche, yrs / 13 / 12-13 / 13 / 12-13 / 13 / 12-13 / 12 / 12-13 / 12 / 12-13
<11 / 6.8 / 6.6 / 6.6 / 7.1 / 7.3
11 / 14.9 / 15.0 / 15.5 / 15.6 / 15.5
12 / 27.5 / 27.2 / 27.8 / 27.4 / 27.9
13 / 29.0 / 30.8 / 30.2 / 30.4 / 30.1
≥14 / 21.8 / 20.3 / 19.9 / 19.6 / 19.2
Gravidity and age at last pregnancya, yrs / 31 / 28-34 / 31 / 28-35 / 31 / 28-35 / 31 / 28-35 / 31 / 28-34
Nulligravid / 24.8 / 22.4 / 21.2 / 20.1 / 20.1
Age <25 / 7.0 / 7.1 / 7.1 / 7.4 / 7.9
Age 25-29 / 21.0 / 20.3 / 21.8 / 22.4 / 23.7
Age 30-34 / 29.1 / 29.8 / 30.0 / 30.1 / 29.3
Age ≥35 / 18.2 / 20.5 / 20.0 / 20.1 / 19.0
Oral contraceptive use
Never / 24.6 / 24.6 / 26.8 / 28.7 / 33.6
<3 yrs / 22.2 / 20.8 / 19.4 / 18.9 / 17.8
≥3 yrs / 53.2 / 54.6 / 53.8 / 52.4 / 48.6
Physical activityb, hrs/wk / 3.5 / 1.7-6.3 / 3.5 / 1.7-6.2 / 3.5 / 1.7-6.1 / 3.5 / 1.8-6.3 / 3.7 / 1.8-6.6
<1.50 / 22.3 / 22.4 / 21.9 / 21.4 / 21.0
1.50-2.99 / 21.3 / 21.4 / 21.7 / 21.4 / 20.6
3.00-4.49 / 16.9 / 17.2 / 17.7 / 17.6 / 16.9
4.50-6.99 / 18.6 / 18.8 / 18.9 / 18.6 / 18.7
≥7.00 / 21.0 / 20.2 / 19.8 / 21.0 / 22.8
Smoking status
Never smoker / 81.8 / 75.5 / 68.7 / 60.9 / 51.5
Former smoker / 15.0 / 20.6 / 26.8 / 33.5 / 41.3
Current smoker / 3.2 / 3.9 / 4.6 / 5.6 / 7.2
Caloric intake, kcal / 1581 / 1223-2002 / 1442 / 1132-1819 / 1473 / 1171-1831 / 1527 / 1225-1880 / 1686 / 1378-2069
<1000 / 11.7 / 15.9 / 13.3 / 9.8 / 4.8
1000-1499 / 32.6 / 38.5 / 38.7 / 37.9 / 29.7
1500-1999 / 30.6 / 28.6 / 31.1 / 33.3 / 37.0
≥2000 / 25.1 / 17.0 / 16.9 / 19.1 / 28.5
Body mass index at baseline, kg/m2 / 23.3 / 20.9-27.4 / 23.3 / 21.0-26.7 / 23.3 / 21.3-26.7 / 23.5 / 21.3-26.7 / 23.8 / 21.5-26.9
<25.0 / 62.6 / 64.3 / 64.2 / 62.4 / 60.6
25.0-29.9 / 21.8 / 22.2 / 23.1 / 24.4 / 26.7
30.0-34.9 / 8.8 / 8.7 / 8.3 / 8.6 / 8.3
≥35.0 / 6.8 / 4.8 / 4.4 / 4.6 / 4.4
Menopausal status and HT use at baseline
Premenopausal / 75.4 / 63.4 / 53.1 / 44.6 / 33.4
Peri/
postmenopausal
Not using HT / 11.5 / 15.8 / 19.5 / 23.0 / 28.3
Using HT / 8.1 / 13.5 / 18.6 / 22.6 / 27.7
Unknown / 5.1 / 7.3 / 8.8 / 9.9 / 10.7
Socioeconomic statusc, statewide deciles / 7 / 5-9 / 8 / 6-9 / 8 / 6-9 / 8 / 6-9 / 8 / 6-9
1-5 (lowest) / 27.5 / 22.6 / 20.0 / 17.7 / 16.2
6-7 / 28.9 / 27.0 / 25.6 / 24.7 / 22.3
8 / 16.2 / 16.5 / 16.6 / 16.0 / 16.5
9 / 16.0 / 18.8 / 19.6 / 20.3 / 20.6
10 (highest) / 11.5 / 15.1 / 18.3 / 21.3 / 24.5
Alcohol consumption, g/d / 0.0 / 0.0-4.5 / 3.3 / 0.0-7.8 / 4.0 / 0.0-11.1 / 7.8 / 3.3-11.8 / 11.1 / 3.3-21.0
Non-drinker / 57.0 / 39.9 / 30.0 / 21.9 / 14.4
<10.00 / 34.0 / 42.4 / 42.6 / 39.3 / 27.9
10.00-19.99 / 8.3 / 16.2 / 23.4 / 29.7 / 32.7
≥20.00 / 0.7 / 1.5 / 4.0 / 9.0 / 25.1

Med median; IQR interquartile range; PI Pacific Islander; HT hormone therapy

a Median and IQR age at last pregnancy among those gravid.

b Average lifetime (high school to age 54 or age at baseline if younger) strenuous plus moderate physical activity.

c Neighborhood-level socioeconomic status.

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