Sex differences in the association of planetary health diet, genetic risk, with overall cancer incidence: a prospective study from UK Biobank

Yue Han; Jia-Cheng Liu; Ying-Ying Zhang; Yu Li; Xi Chen; Bang-Quan Liu; Dong-Run Li; He-Li Xu; Wen-Rui Zheng; Fang-Hua Liu; Yi-Zi Li; Yi-Fan Wei; Fan Cao; Qi-Jun Wu; Fu-Lan Hu; Ting-Ting Gong

doi:10.1097/JS9.0000000000002711

Sex differences in the association of planetary health diet, genetic risk, with overall cancer incidence: a prospective study from UK Biobank

Int J Surg. 2025 Jun 24. doi: 10.1097/JS9.0000000000002711. Online ahead of print.

Authors

Yue Han¹, Jia-Cheng Liu¹, Ying-Ying Zhang^{2

3}, Yu Li^{1

4}, Xi Chen⁵, Bang-Quan Liu⁶, Dong-Run Li^{2

3}, He-Li Xu^{2

3}, Wen-Rui Zheng^{2

3}, Fang-Hua Liu^{2

3}, Yi-Zi Li^{2

3}, Yi-Fan Wei^{2

3}, Fan Cao^{2

3}, Qi-Jun Wu^{1

2

3

4

7}, Fu-Lan Hu⁵, Ting-Ting Gong¹

Affiliations

¹ Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
² Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
³ Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China.
⁴ Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
⁵ Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, China.
⁶ Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.
⁷ NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), National Health Commission, Shenyang, China.

PMID: 40552888
DOI: 10.1097/JS9.0000000000002711

Abstract

Background: The effect of Planetary Health Diet (PHD) may differ by sexes, and the associations with cancer risk remain unclear. This study aimed to investigate sex differences in the associations between PHD and overall cancer risk, as well as the joint effects of PHD and genetic risk.

Methods: This study included 177,441 participants from the UK Biobank. The PHD score was calculated by summing the scores of 14 dietary components, each assessed on an adjustable 0-10 scoring system. To evaluate genetic risk, an overall cancer polygenic risk score (CPRS) was constructed using 1,025 single-nucleotide polymorphisms. The outcome was overall cancer, defined by 20 site-specific cancers.

Results: During a median follow-up of 12.98 years, 15,476 cancer cases were identified, comprising 82,146 men and 95,295 women. In the multivariable-adjusted model, participants in the highest quintile of PHD adherence showed a borderline significant reduction in overall cancer risk (hazard ratio [HR]: 0.95, 95% confidence intervals [CI]: 0.90-1.00) relative to the lowest quintile. Additionally, each standard deviation increase in PHD score was associated with a 4% reduction in overall cancer risk (HR: 0.96, 95% CI: 0.95-0.98). When stratified by sex, individuals with the highest PHD score were associated with lower cancer risk in men (HR: 0.92, 95% CI: 0.86-0.99), but not in women (HR: 0.96, 95% CI: 0.89-1.03). In the joint analysis, individuals with high PHD scores and low CPRS had the relatively lowest risk of overall cancer compared to those with low PHD scores and high CPRS, in both men (HR: 0.39, 95% CI: 0.33-0.46) and women (HR: 0.55, 95% CI: 0.47-0.65).

Conclusion: The PHD was associated with a reduced overall cancer risk among men. Individuals with high PHD scores and low CPRS had the relatively lowest cancer risk. These findings highlight that the PHD may be particularly beneficial in men for cancer prevention.

Keywords: genetic risk; overall cancer; planetary health diet; prospective cohort study.