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November 21, 2007

Cancer Recurrence and Survival Associated With Dietary Patterns in Stage III Colon Cancer—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(19):2263. doi:10.1001/jama.298.19.2263-b

In Reply: We agree with Dr Chu that other measures of energy expenditure have been shown to be associated with disease-free survival in colon cancer survivors. However, we believe that BMI alone is not a surrogate marker for the potential biological impact of diet and physical activity. In Dignam et al1 (cited by Chu), only patients with class III obesity (BMI ≥35) experienced an inferior disease-free survival compared with normal weight patients. The hazard ratio for very obese patients was 1.28 (95% confidence interval, 1.04-1.57),1 weaker than the association we found for patients with the highest level of a Western pattern diet (hazard ratio, 3.25; 95% confidence interval, 2.04-5.19). In our study, we adjusted for BMI in all multivariate analyses, and this did not attenuate the relationship. Furthermore, as shown in Table 6 of our article, stratification by BMI (≤25 vs >25) showed a similar association for underweight/normal weight individuals and overweight/obese individuals. We are currently in the process of analyzing BMI by cancer state and node status, and intend to publish that information when it is completed.

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