Diet and Lifestyle Quality in Australian Females with Endometrial Cancer at Diagnosis: Insights from the Fertility-sparing Management for Early Endometrial Cancer (FeMMe) Trial.

Background: Diet, lifestyle, and body composition may impact quality of life (QoL) and health outcomes in females with endometrial cancer (EC). Many seek guidance on improving prognosis, treatment outcomes, and QoL through nutrition and other modifiable lifestyle factors. Objectives: This study aims to investigate diet and lifestyle quality in FeMMe trial participants and associations with glycemic control, body composition, QoL, and mental health before treatment. Methods: Baseline data from the multicenter, 3-arm, phase II FeMMe trial (NCT01686126), which enrolled females with obesity and early-stage EC or complex endometrial hyperplasia with atypia undergoing conservative hormonal therapy. The Mediterranean diet score (MDS), World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), and Extended Healthy Lifestyle Index (EHLI) scores were derived from self-reported dietary and lifestyle data. QoL, depression, and anxiety were measured using validated tools. Anthropometry and body composition (height, weight, hip, and waist circumference) were measured by a study nurse. Glycemic control was assessed using blood samples, utilizing the Homeostatic Model Assessment for Insulin Resistance as the measurement metric. Bonferroni correction applied for multiple comparisons; nominal associations defined as P < 0.05 but ≥ 0.001. Results: Approximately 40.7%, 31.3%, and 34.7% of females had good diet and/or lifestyle quality according to the MDS, WCRF/AICR, and EHLI, respectively. We found that higher WCRF/AICR scores, expressed per standard deviation (SD) increase, were nominally associated with a better overall QoL score (β perSD = 4.45, 95% confidence interval (CI): 0.30, 8.61, P = 0.036), and with higher anxiety and depression scores (β perSD = 0.60, 95% CI: 0.09, 1.11, P = 0.02). For the EHLI, each SD increase was nominally associated with 8% reduction in insulin resistance (Exp(β perSD ) = 0.92, 95% CI: 0.85, 0.996, P = 0.039). Conclusions: Among females with EC and BMI ≥ 30 kg/m2, healthier lifestyle patterns were associated with better QoL and insulin sensitivity, but also higher anxiety and depression.